脉络膜恶性黑色素瘤误诊误治分析  

Analysis of Misdiagnosis and Mistreatment of Malignant Choroidal Melanoma

作　　者：魏美慧 张志强 左晶 施炜 WEI Meihui;ZHANG Zhiqiang;ZUO Jing;SHI Wei(Department of Ophthalmology,the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院眼科,南京210029

出　　处：《临床误诊误治》2024年第12期14-16,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨以玻璃体积血为首发症状的脉络膜恶性黑色素瘤(CM)临床特征、误诊原因及防范措施。方法回顾性分析2023年12月收治的脉络膜黑色素瘤1例的临床资料。结果该例因双眼视物模糊,于外院诊断为玻璃体积血行玻璃体切割联合白内障超声乳化人工晶体植入术后7个月,术后视物不见,伴眼胀痛,加重7 d入院,考虑为继发性青光眼,完善术前检查后行“左眼球摘除术”,术中发现色素块,标本送病理检查确诊恶性黑色素瘤,行PETCT全身断层显像排除其他部位原发肿瘤或转移病灶。行“左眼眼眶内容物清除术”,术后予对症处理。随访半年未见明显异常。结论以玻璃体积血为首发症状的CM易误诊,医生在接诊此类病例时,应采取综合性的诊断策略,必要时活检,以降低误诊风险。Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of malignant choroidal melanoma(CM)with vitreous hemorrhage as the initial symptom.Methods The clinical data of 1 patient with CM misdiagnosed and mistreated in December 2023 were retrospectively analyzed.Results Due to blurred vision in both eyes for several days,the patient was diagnosed as vitreous hemorrhage and underwent vitrectomy combined with phacoemulsification and intraocular lens implantation for cataracts 7 months afterwards.After surgery,the patient was admitted to the hospital with no vision after surgery,accompanied by eye distension and aggravation for 7 d.The patient was considered to have second-ary glaucoma.After completing preoperative examination,a left eye enucleation was performed.Pigment clumping was found during the surgery,and the specimen was sent for pathological examination to confirm malignant melanoma.Whole body PET-CT tomography was performed to exclude primary tumors or metastases at other sites.Removal of orbital contents of the left eye was performed and symptomatic treatment was given after surgery.No significant abnormality was found at 6-month follow-up.Conclusion CM with vitreous hemorrhage as the initial symptom is more likely to be misdiagnosed.For those patients,attending physicians should adopt comprehensive diagnostic strategy and perform biopsy if necessary to reduce the risk of misdiagnosis.

关 键 词：脉络膜肿瘤 黑色素瘤 误诊 玻璃体积血 青光眼 正电子发射断层扫描及电脑断层扫描 

分 类 号：R739.7[医药卫生—肿瘤]