脉络膜转移癌临床特征的分析  

Clinical characteristics of choroidal metastasis

作　　者：张惠蓉[1] 马志中[1] 冯云[1] 郭彤[1] 

机构地区：[1]北京大学第三医院北京大学眼科中心,100191

出　　处：《中华眼科杂志》2009年第4期301-308,共8页Chinese Journal of Ophthalmology

摘　　要：目的研究脉络膜转移癌的临床特征，以便早期诊断及与其他脉络膜肿瘤进行鉴别诊断。方法本研究为回顾性系列病例研究。通过病历，收集患者视力检查、裂隙灯显微镜眼前节检查、间接检眼镜眼底检查、荧光素眼底血管造影（FFA）、吲哚氰绿血管造影（ICGA）、相干光断层扫描（OCT）及A超和B超扫描、磁共振（MRI）以及胸部CT检查等资料。结果共5例（9只眼）脉络膜转移癌，单眼1例，双眼4例。男性1例，女性4例；年龄31～56岁，中位数年龄45岁。症状：视力减退4例，视物变形1例。眼部检查：视力≤0．05且〈0．3者4只眼；≤0．3且〈0．7者2只眼；≥0．7者3只眼。原发癌来自肺癌者3例，乳腺癌1例，胃癌1例。肿瘤转移至眼的时间：2例为眼科首诊发现，3例分别为1年半、4年及5年。眼底特征：脉络膜转移癌表现为黄白色扁平形隆起者比球形隆起更多见，或伴斑驳样色素沉着及视网膜下液体或视网膜脱离。转移癌位于黄斑部和近视乳头者共6只眼，黄斑和赤道部之间3只眼。孤立转移灶5只眼，多个转移灶4只眼。FFA表现为瘤体呈现斑驳样强荧光，晚期有荧光素渗漏。ICGA表现为遮蔽荧光和弱荧光。A超扫描显示转移灶呈现中等不规则内反射。B超扫描显示扁平实质性隆起。眼部MRI显示肿瘤处表现为中等短T1W和短T2W信号。血清肿瘤标志物增高：3例癌抗原分别为16．28μg／L、4．95μg/L、癌抗原125增高为160．50kU／L。结论脉络膜是最常发生转移癌的部位。脉络膜转移癌可发生在原发癌诊断之前，当患者眼底有黄白色扁平形隆起病灶时，尤其是双眼有病灶者，眼A、B超扫描、胸部CT及癌抗原检查以排除来自肺和乳腺的原发癌是很重要的。Objective To study the clinical characteristics of choroidal metastasis （CM）to promote the early diagnosis and differentiate from other choroidal tumors. Methods Retrospective clinical observational cases. All patients with choroidal metastasis underwent ophthalmologic examination including best corrected visual acuity （VA）, slit-lamp examination, binocular indirect funduscopy, color photography, fundus fluorescein angiography （ FFA ）, indocyanine-green angiography （ ICGA ）, optical coherence tomography （OCT）, A and B scan ultrasound examination, magnetic resonance image （MRI） as well as CT of the thorax, etc. Results Nine eyes of 5 patients with CM were examined. Unilateral choroidal involvement was present in 1 patient,bilateral in 4 cases. There were 1 case male and 4 case females. The age of these patients ranged from 31 to 56 years, median 45 years. Ocular symptoms included reduced vision in 4 patients and visual distortion in 1 patient. Visual acuity was 20/400- 〈 20/63 in four eyes ;20/63- 〈 20/ 30 in two eyes and ≥ 20/30 in three eyes. The primary cancer site was in the lung in 3 patients, in the breast in 1 patient and in the stomach in 1 patient. Fundus characteristics： Typical CM was more often in the plateau-shaped than in the dome-shaped ; yellow-white or mottled in color and associated with subretinal fluid and retinal detachment. The tumor was found in the macular area and juxtapapillary area in 6 eyes, in the area between the macula and the equator in 3 eyes. CM was solitary in 5 eyes and showed muhiple lesions in 4 eyes. By FA the lesions showed mottled hyperfluorescence in early stage and leakage in late stage. By ICGA the lesion showed blocked fluorescence and hypofluorescence. Choroidal mass showed moderate irregular internal reflectivity in A-scan ultrasound. B-scan showed a plateau-shaped solid mass. MRI examination of the lesion revealed moderate short T1W and T2W signals. The cancer antigen increased to 16. 28 and 4. 95 μg/L in two cases. CA125 increased to

关 键 词：脉络膜肿瘤 肿瘤转移 早期诊断 

分 类 号：R686[医药卫生—骨科学]