液基细胞学涂片和细胞蜡块技术在脉络膜黑色素瘤诊断中的应用  

Application of liquid based cytological smear and cell wax block technique in the diagnosis of melanoma of choroid

作　　者：席雷 戎荣 周晋星 吴妍 XI Lei;RONG Rong;ZHOU Jinxing;WU Yan(Department of Pathology,First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院/江苏省人民医院病理学部,南京210029

出　　处：《临床与病理杂志》2024年第4期517-523,共7页Journal of Clinical and Pathological Research

摘　　要：目的:脉络膜黑色素瘤(melanoma of choroid,CM)是成人常见的原发性眼内恶性肿瘤,特点为恶性程度高、易侵袭转移、预后极差,严重影响患者视力,甚至威胁患者生命。目前诊断CM主要依赖影像学检查,在眼球摘除手术后加做病理诊断,缺乏明确的术前病理诊断。本研究旨在探索液基细胞学涂片和细胞蜡块技术在CM术前诊断中的应用。方法:收集南京医科大学第一附属医院2023年3至6月收治的2例临床诊断为CM患者的脉络膜下液。采用液基细胞学涂片方法进行初步诊断,改良的细胞蜡块制作技术、苏木精-伊红(hematoxylin and eosin,HE)染色、脱黑色素和免疫组织化学(immunohistochemistry,IHC)染色进行进一步的病理诊断。结果:2例患者经过影像学检查均诊断为CM,通过液基细胞学涂片做出初步的细胞学病理诊断,1例诊断为“黑色素瘤”,另1例诊断为“见异型细胞,黑色素瘤不除外”。通过改良的细胞蜡块制作技术,HE、脱黑色素和IHC染色,病理诊断结果显示临床诊断相同的2例患者,1例明确诊断为CM,而另1例诊断为低分化神经内分泌癌,修正了原先的诊断。结论:本改良技术能够在手术前精准诊断CM,为临床眼科医生制定治疗方案提供重要依据,操作简便,值得推广。其有3个优点:1)能制作出10~20张连续切片,满足IHC染色的要求;2)在用本技术处理的切片中,可见各种异型细胞,且细胞核结构清晰;3)简单易行,成本不高,适用于各级医院,特别是中小医院。本文有2个原创点:1)将液基细胞学涂片、细胞蜡块切片及IHC染色用于诊断CM;2)对传统的细胞蜡块制作技术进行改良,使其适用于诊断CM。Objective:Melanoma of choroid(CM)is a common primary intraocular malignant tumor in adults,characterized by high malignancy,easy invasion and metastasis,poor prognosis,which seriously impacts patients’vision,and threatens patients’life.However,the current diagnostic method mainly relies on imaging,and pathological diagnosis is added after enucleation surgery,lacking a clear preoperative pathological diagnosis.This article aims to explore the application of liquid based cytology smear and cell wax block techniques to provide clear preoperative pathological diagnosis for CM.Methods:The choroidal fluid of two patients diagnosed with CM who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2023 to June 2023 were firstly collected,then,preliminary diagnosis was made using liquid based cytology smear method,and further pathological diagnosis was made using improved cell wax block making technique,hematoxylin and eosin(HE)staining,depigmentation staining,and immunohistochemistry(IHC)staining.Results:Both patients were diagnosed with CM through imaging examination.A preliminary cytological and pathological diagnosis was made through liquid based cytology smear:one case was diagnosed with melanoma,and the other case was diagnosed with heterotypic cells,melanoma is not excluded.Through improved cell wax block making technique,HE staining,depigmentation staining,and IHC staining,the pathological diagnosis results showed that two patients with the same clinical diagnosis,one patient was clearly diagnosed with CM,while the other patient was diagnosed with poorly differentiated neuroendocrine carcinoma(NEC),this study corrected the original diagnosis.Conclusion:This improved technique can accurately diagnose CM before surgery,providing important basis for clinical ophthalmologists to develop treatment plans.The operation is simple and worthy of promotion,which has three advantages:1)It can produce 10−20 continuous slices,meeting the requirements of IHC staining;2)In the slices proces

关 键 词：细胞蜡块 液基细胞学 脉络膜黑色素瘤 诊断 

分 类 号：R739.7[医药卫生—肿瘤]