眼内占位1例  

A case of intraocular mass

作　　者：岳晗 薛康 钱江 YUE Han;XUE Kang;QIAN Jiang(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期1-4,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：53岁女性,因“右眼视力下降1年”于复旦大学附属眼耳鼻喉科医院眼科就诊。右眼视力为指数/30 cm,眼压18 mmHg(1 mmHg=0.133 kPa),右眼鼻侧晶状体后巨大黄白色肿物,表面伴出血。B超及彩超提示右眼后极偏上方探及17.9 mm×17.3 mm中高回声实质性隆起,内回声不均,隆起内探及少量点状、条状血流信号。眼眶增强磁共振成像提示右眼内结节影,T1为中等稍高信号,T2为中等信号,局部稍低信号,可显著增强。因肿物性质不明,拟入院行右眼内占位活检术。3周后患者入院时,主诉“右眼疼痛2天”,右眼视力为无光感,眼压30 mmHg,眼睑和球结膜高度水肿充血,球结膜部分脱出于睑裂,角膜水肿,前房大量出血及渗出,眼内结构不清。复查B超提示右眼玻璃体中-大量点状回声,后极部隆起基本同前。眼眶增强磁共振成像显示右眼内结节性病变较前片大致相仿,玻璃体内信号混杂,眼表及眼睑弥漫软组织影,伴泪腺稍肿大。考虑患者眼内占位为恶性可能,给予患者右眼眼球摘除术。术后病理提示右眼坏死性葡萄膜黑色素瘤。讨论体会:葡萄膜黑色素瘤可以表现为无色素或少色素型,也可以出现类似眶蜂窝织炎等表现,具有隐蔽性,应仔细鉴别;同时,当临床上遇到不明原因的急性眼内出血、结膜水肿、眼眶炎症时,必须始终考虑眼内占位的可能。A 53-year-old female patient visited the Department of Ophthalmology,Eye&ENT Hospital of Fudan University due to vision loss in the right eye for one year.The visual acuity of the right eye(OD)was counting fingers/30cm,and the intraocular pressure was 18mmHg(1 mmHg=0.133 kPa)(OD).A large yellowish-white mass with surface bleeding behind the lens was observed on the nasal side.B-mode ultrasound and color Doppler ultrasound showed a 17.9 mm×17.3 mm solid elevation with medium to high echogenic mass above the posterior pole of the right eye,with uneven internal echo and a small amount of punctate and striplike blood flow signals detected in the mass.Orbital contrast-enhanced magnetic resonance imaging(MRI)showed a nodular shadow in the right eye,with moderate to slightly high signal intensity on T1 and moderate signal intensity on T2 with a slightly low local signal,which could be significantly enhanced.Due to the unknown features of the mass,the patient was advised to undergo a tumor biopsy.Three weeks later,the patient was admitted to the hospital with a complaint of“pain in the right eye for 2 days”.Visual acuity of the right eye was no light perception then,and the intraocular pressure was 30 mmHg.Eyelids and bulbar conjunctiva were highly edematous and congested with partial conjunctiva prolapsing in the palpebral fissure.Corneal was edematous,and massive hemorrhage and exudation were seen in the anterior chamber with unclear intraocular structures.B-ultrasound showed large amount of punctate echoes in the vitreous body of the right eye,and the mass was the same as before.Orbital MRI showed a similar nodular lesion in the right eye with mixed signals in the vitreous,diffuse soft tissue shadows on the ocular surface and eyelids,and a slightly enlarged lacrimal gland.Due to the possibility of a malignant intraocular mass,the right eye of the patient was enucleated.Postoperative pathology revealed a necrotic uveal melanoma.In conclusion,uveal melanoma can present as an amelanotic or hypopigmented mass,and may

关 键 词：葡萄膜黑色素瘤 坏死 眼眶蜂窝织炎 

分 类 号：R73[医药卫生—肿瘤]