297例视网膜母细胞瘤的临床病理研究

A clinicopathological study of 297 cases of retinoblastoma

目的探讨视网膜母细胞瘤（ｒｅｔｉｎｏｂｌａｓｔｏｍａ，Ｒｂ）脉络膜浸润的形态学分期标准，为在统一的标准下进一步对该肿瘤进行临床病理研究。方法对摘除的２９７例原发性Ｒｂ患者的眼球组织标本，进行光镜观察。结果肿瘤侵犯球壁组织在形态学上可分为４期（色素上皮脉络膜分期）：Ⅰ期，仅为视网膜色素上皮层受侵犯，玻璃体膜结构完整。Ⅱ期，玻璃体膜结构被破坏，脉络膜毛细血管层尚未被侵犯。Ⅲ期，肿瘤浸润深达脉络膜，靠近毛细血管层的中血管层内的小范围区域。Ⅳ期，大范围脉络膜浸润，巩膜可同时受累。Ⅳ期病死率为１１５％，Ⅰ～Ⅲ期的病死率为０４％。结论色素上皮脉络膜分期可作为研究不同个体肿瘤细胞浸润程度进行比较的统一标准。

Objective To find a morphological criterion of classification for choroidal invasion of retinoblastoma in order to further study clinical pathology of retinoblastoma (Rb) under an integrate rule. Methods The changes of retinal pigment epithelium, Bruchs membrane and choroid on histopathological sections of primarily enucleated eyes with Rb in 297 cases were observed under a light microscope. Results The globe wall invasion could be morphologically divided into four stages (briefly pigment epitheliumchoroid classification).Stage I: Only retinal pigment epithelium was infiltrated, the Bruchs membrane was intact. Stage 2.: The Bruchs membrane was destructed, but the choriocapillaries were not invaded. Stage 3: The invasion reached middle choroidal blood vessels close to the choriocapillaris in a limited scope. Stage 4: Massive choroidal infiltration of all choroidal layers existed and the sclera could be simultaneously involved. The mortality for stage 4 was 115% and for stage 1 to 3 was 04%. Conclusion The pigment epitheliumchoroid stage (PECstage) classification in our study can be used as an integrate rule to compare the invasion degree of retinoblastoma in different individuals and studies.