弥漫型脉络膜黑色素瘤的临床病理特点  

Clinical and histopathological features of diffuse choroidal melanoma

作　　者：李文博[1] 林锦镛[1] 陈松[1] 李恩江[1] 

机构地区：[1]天津医科大学眼科临床学院、天津市眼科医院,300020

出　　处：《中华眼底病杂志》2009年第2期108-111,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察弥漫型脉络膜黑色素瘤临床病理特点。方法回顾分析119例病理学检查确诊的脉络膜黑色素瘤患者中11例弥漫型脉络膜黑色素瘤患者的临床病理资料。患者中10例因视力丧失或眼痛就诊，1例外地医院诊断Coats病，继发性青光眼和眼球萎缩要求眼球摘除。临床诊断脉络膜肿物或黑色素瘤8例，绝对期青光眼2例，Coats病、眼球萎缩1例。眼球摘除9例，眼球摘除和眶内肿物切除2例。应用Ki-67免疫组织化学染色，检测细胞增生情况。结果11例弥漫型脉络膜黑色素瘤均为基底广泛的扁平状肿物。肿瘤基底直径12～20mm，厚度2～4mm。混合细胞型9例，上皮样细胞型1例，坏死型1例。瘤细胞侵犯巩膜7例、侵犯眶内3例，继发性青光眼7例。Ki-67阳性细胞7％～13％，平均阳性细胞9％，多分布于肿瘤基底部，上皮样瘤细胞的表达高于梭形瘤细胞。结论弥漫型脉络膜黑色素瘤具有特殊生长方式，早期临床诊断困难，有些病例容易诊断为其它脉络膜肿物或青光眼。由于肿瘤基底广泛，容易侵犯眶内和发生转移，预后较差。Objective To evaluate the clinical and histopathological features of diffuse choroidal melanoma. Methods The clinical and histopathological data of 11 patients with diffuse choroidal melanoma were reviewed retrospectively. Those patients were referred to Tianjin Eye Hospital because of visual loss or ophthalmalgia （10 cases）, or Coats disease with secondary glaucoma and atrophy bulbi （1 case）. The clinical disgnosis included choroidal tumor or melanoma （8 cases）, absolute-stage glaucoma （2 cases） and atrophy bulbi with Coats disease （1 case）. Nine patients received enucleation, and 2 patients received enueleation combined with orbital exenteration. The cellular proliferation was assessed by Ki-67staining. Results All 11 tumors had grown flatly with a wide base ranged from 12 to 20 ram, and tumor thickness ranged from 2 to 4 mm. There were 9 cases of mixed cell type, 1 case of epithelioid cell type and 1 case of necrotic cell type. The tumors invaded into the sclera in 7 cases and orbital cavity in 3 cases. Secondary glaucoma was found in 7 cases. On average, 9% （7%-13%） of tumor cells were Ki-67 positive and most of them located at the tumor base. There were more Ki67 positive epithelioid tumor cells than Ki67 positive spindle-shaped cells. Conclusions Diffuse choroidal melanoma had a special growth pattern and is difficult to be recognized, sometimes could be misdiagnosed as glaucoma or other choroidal tumors. With its wide base, this tumor could easily invade the orbit and metastate, and its prognosis is very poor.

关 键 词：脉络膜肿瘤/诊断 脉络膜肿瘤/病理学 黑色素瘤/病理学 KI-67抗原 

分 类 号：R739.7[医药卫生—肿瘤]