伪装综合征14例临床诊治分析  

Diagnosis and treatment of masquerade syndrome, an analysis of 14 cases

作　　者：杨敏[1] 颜建华[1] 

机构地区：[1]中山大学中山眼科中心,国家眼科学重点实验室,广州510060

出　　处：《中国实用眼科杂志》2012年第8期994-997,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨伪装综合征的临床表现特征及诊断线索，减少临床误诊误治。方法回顾分析中山大学中山眼科中心在2004年1月至2010年4月期间收治的表现为伪装综合征的14例患者，包括视网膜母细胞瘤12例，眼内转移癌1例，眼内淋巴瘤1例，对这些病例资料进行整理分析。结果12例视网膜母细胞瘤患者年龄均大于5岁，其中9例误诊为葡萄膜炎，3例初诊时表现类似葡萄膜炎，临床上多呈现为“羊脂状KP”，“前房积脓”，虹膜表面有大小不一，灰白球状或雪花状沉着物，玻璃体灰白雪球状或小片状混浊物漂动等，却很少以白瞳症就诊。1例眼内转移癌误诊为青光眼、葡萄膜炎，1例眼内非霍奇金淋巴瘤误诊为睫状体炎，两例患者中前者前房内的灰白颗粒状、球状或片状沉着物不伴有明显的眼内炎症反应，后者有明显的虹膜局限性肿瘤浸润增厚，不同于真正的葡萄膜炎。结论部分视网膜母细胞瘤、眼内转移癌和眼内非霍奇金淋巴瘤等眼内恶性肿瘤患者可表现为类似葡萄膜炎症，容易误诊，应引起重视。Objective To discuss the clinical manifestations and the clue of diagnosis of masquerade syndrome and to decrease its misdiagnosis. Methods Fourteen patients with masquerade syndrome seen in Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-Sen University from January 2004 to April 2010 were retrospectively reviewed. These patients include 12 cases of retinoblastoma, 1 case of intraocular lymphoma, and 1 case of intraocular metastases. Results The age of all 12 cases of retinoblastoma was more than 5 years old. Nine cases of them were misdiagnosed as uveitis at the first visit. Three cases of them were correctively diagnosed as retinoblastoma, but had their clinical features similar to uveitis. Instead of leukocoria, these patients had their clinical findings such as ＂mutton fat KP＂, ＂hypopyon＂, gray-white balls or snowflake cells with different sizes and shapes in the surface of iris, gray-white balls and snowflake or strip-shaped ceils in vitreous body, which often led to misdiagnoses of uveitis. One patient with intraocular metastases was misdiagnosed as uveitis and secondary glaucoma because of the gray-white ball or flake-shaped cells within the anterior chamber, but actually no inflammation sign existed. One patient with intraocular lymphoton was misdiagnosed as iridocyclitis, however, the prominent thickening of the involved iris meant infiltration of tumor rather than uveitis. Conclusions Some patients with retinoblastoma, intraocular metastases and intraocular lymphoma demonstrated clinical features similar to uveitis, which is easy to be misdiagnosed.

关 键 词：伪装综合征 视网膜母细胞瘤 葡萄膜炎 眼内转移癌 眼内淋巴瘤 

分 类 号：R155.3[医药卫生—营养与食品卫生学]