眼部原发性恶性黑色素瘤的影像诊断及病理分析  

Imaging diagnosis and pathological analysis of primary malignant melanoma of orbital

作　　者：邵举薇[1] 苏伟[1] 何茜[1] 向述天[1] 周虹[2] 李建波[1] 尹建华[3] SHAO Juwei;SU Wei;HE Qian;XIANG Shutian;ZHOU Hong;LI Jianbo;YIN J ianhua(Department of Radiology,the Fourth Affiliated Hospital of Kunming Medical University,Kunming 650021,China;Department of Pathology,the Fourth Affiliated Hospital of Kunming Medical University,Kunming 650021,China;Department of Radiology,the First People's Hospital of Kunming,Kunming 650224,China)

机构地区：[1]昆明医科大学第四附属医院放射科,云南昆明650021 [2]昆明医科大学第四附属医院病理科,云南昆明650021 [3]昆明市第一人民医院放射科,云南昆明650224

出　　处：《实用放射学杂志》2020年第9期1378-1382,共5页Journal of Practical Radiology

摘　　要：目的分析眼部原发性恶性黑色素瘤(PMMO)影像学表现,提高对该病的认识.方法回顾性分析42例经病理确诊PMMO,据黑色素顺磁性效应致黑色素瘤典型信号特点,同时病理含色素多寡不同,将42例PMMO分为典型信号型(色素型),非典型信号型(非色素型)及非典型信号(色素型)3型.总结眼各部位各型的MRI及CT影像表现,并结合病理结果对照分析.结果脉络膜PMMO均为扁平、圆形或蘑菇形,虹膜睫状体PMMO为结节状增厚,结膜PMMO呈弧形局限性肿块影,泪囊PMMO为鼻泪管铸型肿块影.42例病例中CT均呈等稍高密度.MRI显示29例为典型信号(色素型)(占69%),其中脉络膜28例(占66.7%),虹膜累及睫状体1例(占2.4%),脉络膜病变以典型信号(色素型)为主(P<0.001).42例中非典型信号型(非色素型)13例(占31%),结膜病变以非典型信号(非色素型)为主(P<0.001),该类型中大量出血5例,坏死1例.非典型信号型(色素型)2例,均为结膜病变(占4.8%),其中1例有较多坏死,1例有大量出血.MRI增强后30例呈明显强化者(71.4%),TIC流出型8例(53.3%).结论眼部PMMO不同部位有不同形态,CT平扫为等高密度,色素型通常呈典型信号,脉络膜病变以典型信号型(色素型)为主,结膜病变以非典型信号型(非色素型)为主,色素含量少或无、合并出血、坏死是导致信号复杂多变的原因.病变中度以上强化,强化程度与信号特点及色素多少无关,眼部PMMO多为流出型曲线.Objective Tb analyze the imaging findings of primary malignant melanoma of orbital(PMMO),to improve the understanding of the disease.Methods Forty-two cases of PMMO diagnosed by postoperative pathological examination were analyzed retrospectively.According to the typical MR signal characteristics of melanoma caused by the paramagnetic content and different levels of pigment in pathology,42 cases were divided into three types:typical MR signal type(pigmented type),untypical MR signal type(non-pigmented type)and atypical MR signal(pigmented type).The MRI and CT findings of three types in different orbital parts were summarized and analyzed combined with the pathologic results.Results The choroidal PMMO appeared as flat,round or semicircular soft tissue mass.The iris ciliary body PMMO presented as soft tissue nodules.The conjunctival PMMO showed arc-shaped localized lump.The lacrimal sac PMMO demonstrated irregular shaped mass,expanding into nasolacrimal duct.All the lesions showed mild hyper-dense by CT scan.Twenty-nine cases demonstrated typical MR signal type(pigmented type)(69%),including 28 cases in choroid(66.7%),1 in iris ciliary body(2.4%).Most cases of choroid were typical MR signal type(pigmented type)(P<0.001).Thirteen cases were untypical MR signal(non-pigmented type)(31%),most cases located in conjunctiva(P<0.001),including 5 of hemorrhage,1 of necrosis.Two cases from conjunctiva were atypical MR signal(pigmented type)(4.8%).including 1 of massive hemorrhage and 1 of more necrosis.Thirty cases showed intense enhancement by MRI contrast enhanced(71.4%)and 8 cases revealed a washout-type by the TIC of MR contrast enhanced(53.3%).Conclusion PMMO have different shapes in different orbital regions.All cases showed isodensity or slightly higher density in CT images.The pigmented type mostly demonstrated typical MR signal.Most choroidal melanoma is typical MR signal(pigmented type)and most conjunctival melanoma is untypical MR signal(non-pig men ted type).Complex MR signals are caused by the content of pigment

关 键 词：恶性黑色素瘤 眼部肿瘤 计算机体层成像 磁共振成像 

分 类 号：R739.5[医药卫生—肿瘤] R739.7[医药卫生—临床医学]