角膜缘肿瘤激光扫描共焦显微镜与组织病理学检查结果的比较

Comparison of in vivo confocal microscopic and histopathological findings in limbal tumors

目的应用激光扫描共焦显微镜对角膜缘肿瘤浸润深度进行观察并与组织病理学检查结果相比较。方法回顾性系列病例研究。对5例临床诊断为鳞状细胞癌并接受肿物切除及部分板层角巩膜移植术的角膜缘肿瘤患者进行病历回顾，所有患者术前都进行了激光扫描共焦显微镜活体扫描，以判断肿瘤浸润深度和范围，术中所取病变组织进行了病理检查，将共焦显微镜扫描图像与组织切片的病理检查进行比较。结果组织病理学检查确定了其中1例为浸润性鳞状细胞癌，3例为上皮内瘤变，1例为乳头状瘤。激光扫描共焦显微镜扫描可以观察到主要的组织病理学特征，包括细胞乳头状增生结构、细胞核异型性、树突状细胞的活跃程度等。适当调整扫描平面可以检查到肿瘤基底部与正常组织的交界区。结论激光扫描共焦显微镜扫描在适当平面可以对角膜缘肿瘤细胞形态和浸润深度提供参考，对手术治疗方案进行指导。肿瘤性质的最终确定目前仍然依赖于活检组织病理学检查。（中华聪群杂志，2012，48：915-919）

Objective To explore the depth of invasion of limbal tumors using in vivo confocal microscope and to compare the result to that in histopathological findings. Methods Five eases of limbal tumors with clinical diagnosis of squamous eell carcinoma were evaluated with in vivo confocal microscope. Tumor excision and lamella corneal transplantation were perfo1~ned for each patient. The results of confocal microscopy were compared to that in histopathologic sections. Results One case of invasive squamous carcinoma, three cases of intraepithelial dysphasia and one case of squamous papilloma were identified by histopathological examination. The main pathological features could be recognized by confoeal microscope images, ine]uding papillomatous hyperplasia, eytonuclear atypias, and activation of dendritic cells. Intersection of neoplasm and normal tissue could be displayed by oblique scanning. Conclusions With appropriated oblique scanning, in vivo confocal microscopy can provide information of cellular structure and the depth of invasion, this is useful in the diagnosis and management of limbal neoplasm. However, the identification of tumor cell phenotypes still needs ex vivo histopathological examination. （Chin J Ophthalmol, 2012,48：915-919）