青少年炎性结膜色素痣19例的临床及组织病理学特征观察  

Inflammatory juvenile conjunctival nevus:a clinicopathological analysis of 19 cases

作　　者：李静 刘颖 王靖瑞 王玉川[1] 林锦镛[1] Li Jing;Liu Ying;Wang Jingrui;Wang Yuchuan;Lin Jinyong(Tianjin Eye Hospital,Nankai University Affiliated Eye Hospital,Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China;Department of Ophthalmology,Tianjin People′s Hospital,Tianjin 300121,China)

机构地区：[1]天津市眼科医院、南开大学附属眼科医院、天津医科大学眼科临床学院、天津市眼科研究所、天津市眼科学与视觉科学重点实验室,天津300020 [2]天津市人民医院眼科,天津300121

出　　处：《中华眼科杂志》2025年第2期112-117,共6页Chinese Journal of Ophthalmology

摘　　要：目的总结分析青少年炎性结膜色素痣(IJCN)的临床及组织病理学特点。方法回顾性病例系列研究。收集2015年1月至2023年12月在天津市眼科医院诊断为IJCN并行结膜色素痣切除手术且年龄≤18岁患者的临床资料。观察临床表现(年龄、发病部位和外观等)以及光学显微镜下苏木精-伊红染色和免疫组织化学染色表现。结果共收集符合标准的IJCN患者19例,男性10例,女性9例;年龄为10(6,13)岁,范围为5~18岁;均为单眼发病。IJCN位于球结膜颞侧13例,鼻侧5例,下方1例;其中近角膜缘9例。颜色为不同程度黄白色或灰褐色,伴色素沉着15例,无色素沉着4例;边界清楚13例,边界不清6例。15例患者术后随访时间为51(17,54)个月,范围为6~68个月,未见复发。交界痣患者1例,复合痣患者18例,痣细胞巢周围可见大量淋巴细胞和浆细胞浸润。在痣细胞中,Melan-A和S100蛋白呈强阳性表达;黑色素瘤相关抗原45主要表达于上皮与基质交界处痣细胞,随着痣细胞向基质内生长,表达逐渐减弱;黑色素瘤特异性抗原呈阴性表达;ki-67指数为1%~5%;角蛋白在结膜上皮细胞及基质内下陷的囊肿上皮或上皮实性巢团细胞中呈阳性表达。分化群(CD)20、CD3和CD138呈阳性表达,其中13例以B细胞为主,4例以浆细胞为主,2例以T细胞为主。结论IJCN可发生于幼儿及青少年,临床主要表现为球结膜黄白色至灰褐色扁平状肿物,多数为复合痣,痣细胞间伴有大量淋巴细胞浸润和结膜上皮内生。Objective The aim of this study was to analyze the clinical and histopathological characters of inflammatory juvenile conjunctival nevus(IJCN).MethodsRetrospective case series study.A total of 19 patients aged 18 years or younger with IJCN underwent conjunctival nevus excision surgery in Tianjin Eye Hospital from January 2015 to December 2023.The clinical signs(patient age,lesion location,and appearance,etc)as well as the hematoxylin-eosin staining and immunohistochemical staining appearances under an optical microscope were observed.ResultsThere were 10 males and 9 females.The age at surgery ranged from 5 to 18 years old,and the median age was 10(6,13)years old.All patients had a unilateral onset.The nevus was located at the temporal side of the bulbar conjunctiva in 13 eyes,at the nasal side in 5 eyes and at the inferior side in 1 eye.Nine lesions were adjacent to the limbus.The color of the lesions varied from yellowish-white to grayish-brown,with pigmentation in 15 eyes.The border was well circumscribed in 13 eyes.Follow-up data were available for 15 cases,with a median follow-up time of 51(17,54)months,ranging from 6 to 68 months,and no recurrence was found.Eighteen lesions were of the compound type,while one lesion was a junctional nevus.Lymphocytic and plasma cell infiltration was observed around the nevus cells.All nevus cells exhibited immunopositivity for S-100 and Melan-A proteins.HMB-45 was only positive within the superficial junctional zone,and the expression gradually decreased with the growth of nevus cells into the stroma.No nuclear PRAME expression was detected in any nevus cells.The ki-67 index ranged from 1%to 5%.The CK was positive in the conjunctival epithelium and epithelial inclusions(either solid or cystic).Cluster of differentiation(CD)20,CD3 and CD138 were expressed positively in inflammatory cells,which were mainly B cells in 13 eyes,plasma cells in 4 eyes,and T cells in 2 eyes.ConclusionThe IJCN primarily occurs in children and adolescents.It presents with a yellowish-white to grayish

关 键 词：结膜肿瘤 痣 色素 黑色素瘤 炎症 MART-1抗原 青少年 

分 类 号：R73[医药卫生—肿瘤]