脉络膜转移癌的眼底表现

Fundus manifestation of choroidal metastasis

目的探讨脉络膜转移癌眼底表现的特点及原发癌的病理分型和预后。方法应用回顾性系列病例研究方法。分析16例20眼脉络膜转移癌患者的临床资料。眼部检查包括视力、眼前节、散瞳眼底、B型超声、彩色眼底照相和荧光素眼底血管造影(FFA)检查。全身检查包括肿瘤标记物筛查,支气管活检,头部、胸部和腹部影像学检查及全身骨扫描等。结果 16例患者中男6例,女10例;年龄31～72岁,平均年龄50.9岁;随诊1～60个月,平均12.6个月。双眼患者4例;单眼患者12例,其中右眼8例,左眼4例。首诊于眼科者9例,其中8例原发癌为肺癌,1例乳腺癌为原发癌。初诊视力:光感者2眼,手动/眼前～0.1者4眼,0.2～0.5者6眼,0.6～1.0者5眼,>1.0者3眼。裂隙灯显微镜检查:15眼眼前节正常,5眼有继发性青光眼。散瞳眼底检查:19眼可见视网膜下黄白色、扁平隆起的实性肿物,12眼伴有不同程度的渗出性视网膜脱离。B型超声检查结果显示,20眼均为脉络膜实性占位性病变。FFA可见早期脉络膜肿物遮挡背景荧光,晚期可见融合成斑驳样的高荧光。原发癌为肺癌者10例,乳腺癌者4例,直肠腺癌者1例,子宫颈鳞癌者1例。结论脉络膜转移癌眼底表现的特点是视网膜下实性肿物,常伴有渗出性视网膜脱离,可继发青光眼。原发癌病理分型以肺腺癌为主,乳腺癌次之。

Background Choroidal metastasis （CM） is a common intraocular malignancy in adults with a poor prognosis.Some patients present without primary cancer history.It is important for ophthalmologists to correctly diagnose CM and find the primary malignant neoplasm.Objective Present study was to assess the fundus and pathological characteristics and prognosis of CM.Methods Retrospective case series was carried out to investigate the clinical data of 20 eyes from 16 patients with CM at Peking Union Medical College Hospital.Examinations of eye and system were performed,including the best corrected visual acuity （BCVA）,slit-lamp examination,fundus,B-sonograph scan,fundus fluorescein angiography （FFA）,and general examinations.Results Sixteen cases aged 31-72 years （mean 50.9 years） were examined,including 6 male and 10 female patients.Bilateral eyes got involved in 4 patients and unilateral in 8 right eyes and 4 left eyes.CM was firstly determined in 9 patients prior to the diagnosis of lung cancer and breast cancer.The BCVA were from light perception to 0.1 in 6 eyes,0.2-0.5 in 6 eyes,0.6-1.0 in 5 eyes and 1.0-1.5 in 3 eyes.In the 20 eyes received slit-lamp examination,secondary glaucoma was found in 5 eyes.The fundus examination revealed the solid mass with plateau shape and yellow-white color in 19 eyes,exudative retinal detachment in 12 eyes,and only 1 eye was dome-shaped.B-type sonography exhibited the solid mass in 20 eyes and funnel-shaped retinal detachment in 3 eyes.Blocked fluorescence around lesion was displayed in the early phase and hyperfluorescence in the late phase by FFA.The primary cancer located at lung in 10 patients,including 8 adencarcinoma and 1 adeno-squamous carcinoma and 1 squamous cell carcinoma.Breast cancer was found in 4 patients,and the rectum carcinoma in 1 patient and cervical cancer in other 1 patient.Conclusion Majority of CM is characterized by plateau-shape solid mass of fundus mainly in posterior pole.Exudative retinal detachment and secondary glaucoma are frequently visible in the late stage of CM.The primary lesion is often found in lung and breast.Further ocular and systemic examinations should be performed in the CM patients visited the ophthalmologist firstly.