110例眼部恶性黑色素瘤的临床病理分析

Clinicopathological analysis of 110 ocular malignant melanoma

背景眼部黑色素瘤是一种恶性肿瘤，预后较差。了解眼部黑色素瘤的发生发展规律对于其早期诊断和治疗有重要意义。目的了解眼部恶性黑色索瘤的发生部位、病理分型及其与预后的关系。方法收集自1980年1月至2007年12月在华西医院眼科就诊，并经常规组织病理学检查、免疫组织化学检测和组织超微结构观察证实为眼部恶性黑色素瘤的110例标本及其患者的临床资料进行回顾性分析，对眼部黑色素瘤的组织发生、病理组织成分进行分类，并分析不同类型黑色素瘤与扩散率及预后的关系。结果眼部黑色素瘤的发病部位依次为：葡萄膜66例（60．00％）、眼表组织27例（24．55％）、眼眶继发性肿瘤8例（7．27％）、眼睑皮肤7例（6．36％）、泪囊2例（1．82％）。按照肿瘤的组织病理学结果可分为梭A细胞型31例（28．18％）、梭B细胞型31例（28．18％）、混合细胞型25例（22．73％）、上皮细胞型17例（15．46％）和其他型6例（5．45％）。上述5种病理分型的110例肿瘤患者的扩散或复发率从高到低依次为其他型、上皮细胞型、混合细胞型、梭B细胞型、梭A细胞型，各型总体扩散或复发率比较差异有统计学意义（x2=14．463，P：0．006）。眼部黑色素瘤的临床表现与其发生的部位有关，但多无特异性。结论眼部恶性黑色素瘤的好发部位绝大多数为葡萄膜和眼表组织，组织病理学分类中以梭形细胞型最常见，分类为其他型的黑色素瘤扩散率较高。恶性黑色素瘤的临床表现无特异性，应引起临床医师的重视。

Background Ocular melanoma is a malignant tumor with a poor prognosis. To study its mode of pathogenesis and development is helpful for early diagnosis and treatment and improving prognosis. Objective This study was to analyze the location and pathological types of ocular melanoma, and explore the relationship of pathological types with prognosis of ocular malignant melanoma. Methods 110 clinical data and specimens of ocular melanoma were colleeted at West China Hospital,China. The speeimens were examined by hematoxylin ＆ eosin staining,immunochemistry and studying their ultrastructure. The growth location, histological classification, and their relationship with prognosis were analyzed and discussed. The elinicopathological records of the 110 cases with ocular region malignant melanoma treated from January 1980 to December 2007 were analyzed. Results The primary locations of the tumors with respect to the tissue type were：66 cases in the uvea （60.00%） ,27 cases in the ocular surface tissue （24.55%）, 8 cases in the secondary lesion of orbit cavity （7.27%）, 7 cases on the eyelid skin （6.36%） ,and 2 cases in the lacrimal sac （ 1.82% ）. The neoplasm was classified according to pathological types： spindle-cell A type in 31 cases （28. 18% ） ,spindle-cell B type in 31 cases （28. 18% ） ,mixed-cell type in 25 cases （22. 73% ）,epithelioid-cel] type in 17 cases （15.46%） and other type in 6 cases （5.45%）. The notability of diffusion or recurrence rate of the 5 pathological types showed statistical significance （X2 = 14. 463, P = 0. 006） , and the rank in decending order was：other type, epithelioid-cell type,mixed-cell type, spindle-cell B type and spindle-cell A type. The clinical manifestations of ocular melanoma were dependent upon the lesion position without specificity. Conclusions The majority of the ocular malignant melanoma appears in the uvea and ocular surface tissue,and its common pathological types were spindle-cell type followed by mixed-cell type,epithelioid-cell type and other type. Thehighest recurrence rate is in other type of ocular malignant melanoma. Ophthalmologist should be aware of the clinical manifestation of ocular malignant melanoma.