虹膜睫状体肿瘤37例的临床分析  

Clinical analysis of tumors of the iris and ciliary body

作　　者：刘桂琴[1] 吴中耀[1] 冯官光[1] 杨华胜[1] 颜建华[1] 郑湖玲[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华眼科杂志》2003年第2期77-80,共4页Chinese Journal of Ophthalmology

摘　　要：目的　分析虹膜睫状体肿瘤患者的临床表现、鉴别诊断要点、病理组织学特征、处理及预后。方法　对 196 6年 1月至 2 0 0 0年 12月经病理检查证实的 37例虹膜睫状体肿瘤的临床和病理资料进行回顾性分析。结果　按病理组织学分类 ,第一位为虹膜睫状体黑色素瘤 15例 ( 40 5 % ) ,其他依次为虹膜睫状体转移癌 8例 ( 2 1 6 % )、睫状体髓上皮瘤 3例 ( 8 1% )、虹膜色素痣 2例 ( 5 4% )及其他 9例 ( 2 4 3% )。处理方法 :局部切除 14例 ( 37 8% ) ,眼球摘除 2 1例 ( 5 6 8% ) ,活检后观察 2例( 5 4% )。对其中的 34例随访 2个月至 15年 ,平均 31个月。虹膜睫状体黑色素瘤多呈半球形或球形的棕黑色实性肿物 ,肿瘤内有丰富的新生血管 ,部分睫状体黑色素瘤邻近的表层巩膜有“哨兵”样血管 ,巩膜透照试验瘤体不透光 ;超声生物显微镜检查示低至中等回声图像 ,邻近受累组织回声及形态异常 ,对黑色素瘤特异性抗原呈阳性反应 ,预后较好。虹膜睫状体转移癌可为单发或多发 ,肿瘤扁平隆起或近似球形 ,色泽污秽 ,有丰富的新生血管 ,生长迅速 ,可发现原发癌 ,预后极差。结论　虹膜睫状体黑色素瘤具有典型的临床特征 ,易与其他虹膜睫状体良、恶性肿瘤混淆。虹膜睫状体转移癌的临床表现复杂 ,需借助影像学检查及免疫组化?ObjectiveTo evaluate the clinical features, different diagnosis, pathological features, management, and prognosis of tumors of the iris and ciliary body. MethodsMedical records, photographs, pathological findings and the results of follow-up of 37 cases with tumors of the iris and ciliary body were reviewed as a retrospective study. ResultsOf the 37 cases with tumors of the iris and ciliary body, 26 were male and 11 were female. The mean age at diagnosis was 38 years, ranged from 5-64 years. According to the histopathological examination, melanoma was the most common tumor in the iris and ciliary body (15 cases, 40.5%),followed by metastatic tumors (8 cases, 21.6%),teratoid medulloepitheliomas (3 cases, 8.1%) and iris nevus (2 cases, 5.4%). Management: The tumors were excised in 14 cases. Enucleation was performed in 21 cases. Two cases were observed without any surgical treatment. Thirty-four cases were followed-up for 2 months to 15 years, averaged 31 months. Most melanomas of the iris and ciliary body are round or semi-spherical dark brown vascularized mass, with engorged episcleral sentinel vessels in some cases. The tumor showed a shadow during transillumination. Ultrasound biomicroscopy revealed a low to medium echoic solid lesion,with echoic changes in adjacent infiltrated tissues. Melanoma showed positive immunoreactivity for melanoma-specific antigen, and had a good prognosis. Metastatic tumors of the iris and ciliary body were flat or near round, dirty, single or multiple neoplasms, growth rapidly, with abundant neovascularization, and had a poor prognosis. Primary carcinomas could be found in other parts of the body. ConclusionsMelanoma of the iris and ciliary body has typical features that may help to distinguish them from other tumors. Metastatic tumor has characteristic features, but the diagnosis can be made only with supplementary examination and immunocytochemical studies. Medulloepitheliomas should be differentiated from retinoblastoma.

关 键 词：临床分析 虹膜肿瘤 睫状体 葡萄膜肿瘤 黑色素瘤 回顾性研究 诊断 

分 类 号：R739.7[医药卫生—肿瘤]