[1]燕玉清,赵红.脉络膜黑色素瘤的病理特点与预后[J].眼科新进展,2019,39(1):075-78.[doi:10.13389/j.cnki.rao.2019.0017]
　YAN Yu-Qing,ZHAO Hong.The pathological characteristics and prognosis of choroid melanoma[J].Recent Advances in Ophthalmology,2019,39(1):075-78.[doi:10.13389/j.cnki.rao.2019.0017]
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脉络膜黑色素瘤的病理特点与预后/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
39卷
期数:
2019年1期
页码:
075-78
栏目:
应用研究
出版日期:
2019-01-05

文章信息/Info

Title:
The pathological characteristics and prognosis of choroid melanoma
作者:
燕玉清; 赵红
300350　天津市，天津市海河医院眼科（燕玉清）；300300　天津市，天津市眼科医院（赵红）
Author(s):
YAN Yu-Qing; ZHAO Hong
Department of Ophthalmology，Tianjin Haihe Hospital（YAN Yu-Qing），Tianjin 300350，China；Tianjin Eye Hospital（ZHAO Hong），Tianjin 300300，China
关键词:
脉络膜黑色素瘤; 肿瘤分型; 肿瘤转移; 肿瘤预后
Keywords:
choroidal melanoma; melanoma; surgery; pathological
分类号:
R773.4
DOI:
10.13389/j.cnki.rao.2019.0017
文献标志码:
A
摘要:
目的　分析脉络膜黑色素瘤的病理特点及预后影响因素。方法　对天津市眼科医院2003年10月至2014年3月入院的31例（31眼）经病理证实的脉络膜黑色素瘤进行回顾性研究，总结病理特点及预后影响因素。结果　脉络膜黑色素瘤31例（31眼）中男18例（58.1%），女13例（41.9%）；均为单眼发病，右眼17例（54.8%），左眼14例（45.2%）；年龄30~71岁，平均52.5岁。肿瘤位于睫状体者7眼，位于赤道后者15眼，位于旁视神经者4眼，位于赤道前者5眼。瘤体呈蘑菇状者6眼，呈圆顶状者5眼，呈类圆形者3眼，呈半圆形者4眼，呈扁平形者12眼，呈弥漫状者1眼。31眼中，大肿瘤8眼，中等肿瘤23眼。肿瘤细胞类型：梭形细胞型7眼（眼内期4眼，青光眼期1眼，眼外蔓延期2眼），上皮细胞型4眼（眼内期3眼，眼外蔓延期1眼），混合细胞型20眼（眼内期15眼，青光眼期2眼，眼外蔓延期2眼，全身转移期1眼）。肿瘤细胞向巩膜外蔓延程度：Ⅰ级15眼，Ⅱ级6眼，Ⅲ级3眼，Ⅳ级7眼。在Ⅳ级中有4眼伴有大量坏死，大部分为大肿瘤。眶内蔓延途径：沿巩膜导管和巩膜涡静脉蔓延者6眼；直接侵犯巩膜、向眼球外蔓延者5眼；沿筛板直接蔓延者1眼；侵犯视网膜、睫状体、虹膜、结膜者4眼。随访22例患者中有2例死亡，均为混合细胞型并发肝转移，存活时间为术后17个月（全身转移期）和28个月（眼内期）。结论　脉络膜黑色素瘤的预后受多种因素的影响（位置、形状和体积、瘤细胞类型、扩散途径等），沿巩膜导管、巩膜涡静脉蔓延和侵犯巩膜、向眼球外蔓延是主要的蔓延途径。
Abstract:
Objective　To analyze the pathologic characteristics and the factors affecting prognosis of patients with choroidal melanoma.Methods　A retrospective study was carried out on clinic case series of 31 patients who were diagnosed to choroidal melanoma at the orbital department of Tianjin Eye Hospital，thereby analyzing the pathologic characteristics and the factors affecting prognosis of these patients.Results　Among the 31 patients （31 eyes），there were 18 male patients （58.1%） and 13 female patients （41.9%）.All patients were unlateral，including 14 patients of left eye and 17 patients of right eye.The age of the patients ranged from 30 to 70 years old，and the average age was 52.5 years old.The location of tumors：7 patients occurred in ciliary body，15 patients were in posterior equatorial part of the eyeball，4 patients were in the peripheral optic nerve tumor and 5 patients were in anterior equatorial part of the eyeball.The growth pattern of the tumor：6 patients were shaped of mushroom，5 patients of dome shaped，3 patients of quasi-circular，4 patients of semicircle，12 patients of flat shape and 1 patient of the diffuser.In the 31 patients，the large tumor was in 8 patients and medium tumor were 23 patients.The tumor cell pathologic types：the spindle cell type were observed in 7 patients （intraocular stage 4 patients，glaucoma stage 1 patient，extraocular stage 2 patients），epithelial cell type were in 4 patients（intraocular stage 3 patients，extrocular phase 1 patients） and mixed cell type in 20 patients（intraocular stage 15 patients，glaucoma stage 2 eyes，extraocular stage 2 patients，whole body metastasis stage 1 patient）.The degree of exteral scleral invasion：15 patients were clarified into the I level，6 patients belong to the Ⅱlevel，Ⅲ level were 3 patients and Ⅳ level were 7 patients.Moreover，a large number of necrotic tissues would be observed within the tumors that were in the Ⅳ level when the tumors were enough large.Among the 16 patients within the extraocular stage：the tumor cells were spreading along the Sclera catheter and Scleral vortex vein in 6 patients，5 patients invaded the sclera directly，1 patient spread through the sieve plate，the rest were invasion of retina，ciliary body，iris and conjunctival at the same time.In this study，among the 31 patiens，we followed up successfully for 22 patients，2 patients died to the liver metastases whose pathologic type was mixed cell type and the survival time of them were 17 months （whole body metastasis） and 28 months（intraocular phase） after surgery.Conclusion　The prognosis of choroid melanoma can be influenced by many factors，including pathologic cell type，location，growth pattern，tumor size and the invasion pathway of exteral sclera etc.Furthermore，spreading through the sclera catheter and sclera vortex vein is the main invasive pathway.

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更新日期/Last Update: 2019-01-04