结膜原发性获得性黑变病75例临床病理学分析  

A Clinicopathologic Analysis of 75 Cases of Conjunctival Primary Acquired Melanosis

作　　者：闫文卿 陈耕中 王友沛 秦晓怡 Wenqing Yan;Gengzhong Chen;Youpei Wang;Xiaoyi Qin(National Clinical Research Center for Ocular Diseases,Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院国家眼耳鼻喉疾病(眼部疾病)临床医学研究中心,温州325027

出　　处：《中华眼视光学与视觉科学杂志》2025年第1期15-22,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:探讨结膜原发性获得性黑变病(PAM)的临床病理学特征、病理分期以及鉴别诊断。方法:回顾性系列病例研究。收集2017年1月至2024年9月间温州医科大学附属眼视光医院75例PAM患者的临床及病理资料,分析患者的临床信息、大体表现及组织学形态,并复习相关文献。结果:75例患者年龄17~87(38.6±16.0)岁,男24例,女51例,男女比1∶2,69例发生于球结膜,1例发生于睑结膜,1例发生于泪阜,4例同时累及球结膜、睑结膜、穹窿结膜。病灶最大径1.5~16.0(6.0±2.6)mm,其中59例病变最大径5~10 mm。就诊前发病时间0.5~20年,其中52例患者发病时间为5年及以上。59例患者病变不伴有异型,12例伴有轻度异型,4例伴有中-重度异型。病理分期为ⅠA期的患者59例,ⅠB期患者14例,Ⅱ期患者2例。结论:PAM多发于球结膜,多为良性慢性病变,少部分伴有异型,少数可发生恶变,异型性及病变范围与PAM恶变风险呈正相关。Objective:To investigate the clinicopathological features,pathological staging and differential diagnosis of conjunctival primary acquired melanosis(PAM).Methods:The clinical and pathological data of 75 patients with PAM were collected from January 2017 to September 2024 at Eye Hospital,Wenzhou Medical University.A comprehensive review of relevant literature was also conducted.Results:The 75 patients(mean age,38.6±16.0 years;range,17-87 years)included 24 males and 51 females,with a male-to-female ratio of 1:2.PAM predominantly occurred in the bulbar conjunctiva(69 cases),with rare involvement of the palpebral conjunctiva(1 case),the lacrimal caruncle(1 case),or multiple sites including the bulbar,palpebral and fornix conjunctiva(4 cases).The maximum lesion diameter ranged from 1.5 to 16.0 mm(mean,6.0±2.6 mm),with 59 cases measuring 5 to 10 mm.The duration of symptoms prior to diagnosis ranged from 0.5 to 20 years,with 52 cases having a disease course of 5 years or longer.Among the patients,59 had lesions without atypia,12 with mild atypia,and 4 with moderate to severe atypia.Pathological staging revealed 59 cases in stage IA,14 in stage IB,and 2 in stage II.Conclusions:PAM primarily affects the bulbar conjunctiva and is predominantly a benign chronic condition.However,some cases exhibit atypia,and a small proportion may undergo malignant transformation.The degree of atypia and the extent of lesion are positively correlated with the risk of malignant progression in PAM.

关 键 词：黑色素瘤 原发性获得性黑变病 结膜黑色素细胞增生性病变 临床病理特征 

分 类 号：R73[医药卫生—肿瘤]