CAJ | 학술논문

目的分析睫状体无色素上皮腺瘤患者的临床表现、诊断、病理学特征、手术治疗及预后.方法对中山大学中山眼科中心在2004年10月至2010年10月经病理检查证实的5例睫状体无色素上皮腺瘤患者的临床和病理资料进行回顾性分析.全部病例采用局部板层巩膜睫状体或板层巩膜睫状体前脉络膜切除法治疗,2例肿瘤较大者联合玻璃体切割术.结果 5例患者中,男性1例,女性4例;右眼4例,左眼1例,年龄28～46岁,平均38岁,均以视力下降为主诉入院.眼部检查见虹膜根部后方占位、局部虹膜向前隆起,肿瘤由虹膜后方进入瞳孔区,呈灰白色,有时呈半透明状,血管较丰富;均伴晶状体混浊、3例伴晶状体移位.UBM检查显示肿瘤位于睫状体,呈中高回声不均质实性圆形或类圆形肿物,游离缘边界清楚;2例肿瘤较大者合并虹膜囊肿.眼部B超检查示球内前段中高回声边界清楚的类圆形肿物.组织病理学检查:肿物无包膜,瘤细胞为多边形或梭形,呈条状或腺管样排列,胞浆淡染,其内无色素,核呈圆形或梭形,无异型性.免疫组化:Vimentin(+),S100(+)、CK(+),HMB45(-).经平均随访5.5年,4例视力0.6或以上,1例无光感.全部病例保存眼球,肿物无复发.结论睫状体无色素上皮腺瘤属少见病,可借助UBM等早期发现和诊断,采用手术切除肿物保存眼球的治疗方法效果理想.
목적 분석첩상체무색소상피선류환자적림상표현、진단、병이학특정、수술치료급예후.방법 대중산대학중산안과중심재2004년10월지2010년10월경병리검사증실적5례첩상체무색소상피선류환자적림상화병리자료진행회고성분석.전부병례채용국부판층공막첩상체혹판층공막첩상체전맥락막절제법치료,2례종류교대자연합파리체절할술.결과 5례환자중,남성1례,녀성4례;우안4례,좌안1례,년령28～46세,평균38세,균이시력하강위주소입원.안부검사견홍막근부후방점위、국부홍막향전륭기,종류유홍막후방진입동공구,정회백색,유시정반투명상,혈관교봉부;균반정상체혼탁、3례반정상체이위.UBM검사현시종류위우첩상체,정중고회성불균질실성원형혹류원형종물,유리연변계청초;2례종류교대자합병홍막낭종.안부B초검사시구내전단중고회성변계청초적류원형종물.조직병이학검사:종물무포막,류세포위다변형혹사형,정조상혹선관양배렬,포장담염,기내무색소,핵정원형혹사형,무이형성.면역조화:Vimentin(+),S100(+)、CK(+),HMB45(-).경평균수방5.5년,4례시력0.6혹이상,1례무광감.전부병례보존안구,종물무복발.결론 첩상체무색소상피선류속소견병,가차조UBM등조기발현화진단,채용수술절제종물보존안구적치료방법효과이상.
Objective To analyze the clinical manifestations,diagnosis,pathological characteristics,surgical treatment and prognosis in patients with adenoma of the non-pigmented ciliary epithelium.Methods The clinical and pathological data in 5 patients,who were seen and diagnosed as adenoma of the non-pigmented ciliary epithelium in Zhongshan Ophthalmic Center,Sun Yat-sen University from October 2004 to October 2010,were retrospectively reviewed.Results Among all 5 cases,1 was male and 4 were female.The mean age was 38.0 years old (range 28.0 to 46.0 years).The right eye was affected in 4 cases and the left in 1 case.All 5 patients were admitted to our hospital with chief complaint of decreased vision.Ophthalmic examination showed that a gray-white,sometimes translucent,mass lay behind the iris root and extend to the area of the pupil,the local iris was pushed forward.The mass was relatively rich in vessels.All complicated with lens opacity and 3 cases with lens dislocation.UBM examination demonstrated that the tumor was located in the ciliary body,it was a round or oval,heterogeneous,moderate-or hyperechoic solid mass,the free edge of the tumor was well-defined.Two cases with larger ciliary tumors also had iris cysts in the same eye.B-mode ultrasound examination also revealed a well-demarcated moderate-or hyper-echoic round mass at the anterior segment of eye balls.Histopathological examination showed that the surgical mass had no capsule,microscopically,it consisted of polygonal or spindle-shaped tumor cells,arranged in strip or duct-like,the cytoplasm was lightly stained with no pigment,the nuclear was cylindrical or spindle-shaped and no atypia cells existed in them.Immunohistochemistry staining showed positive for Vimentin,S100,CK,and negative for HMB45.All patients were treated with partial lamellar sclera and ciliary body mass excision.Among them,the two cases with larger tumors were treated with tumor removal combined with vitrectomy.After an average follow-up of 5.5 years,visual acuity in 4 cases were equal to or better than 0.6,1 case had no light perception.All cases had their eyes saved,with no tumor recurrence.Conclusions The adenoma of the non-pigmented ciliary epithelium is a rare clinical entity,UBM can be used for early detection,surgical resection of the local tumor had very good outcome of saving both the eyeball and eye vision.