脉络膜黑色素瘤微循环模式与其组织病理学关系的分析

Relationship of microcirculation pattern and histopathologic factors in choroidal melanoma

背景脉络膜黑色素瘤生物学行为与肿瘤内血管生成的因素密切相关，肿瘤细胞参与血管重塑的微循环模式不同于新生血管。目的观察脉络膜黑色素瘤不同微循环模式的形态特点，分析其与脉络膜黑色素瘤的临床组织病理学因素及肿瘤细胞增生程度之间的关系。方法收集北京同仁医院1997年11月至2006年3月保存的脉络膜黑色素瘤标本48例进行回顾分析，应用过碘酸希夫染色法确定48例脉络膜黑色素瘤组织的微循环模式，并在以544nm波长激发的荧光显微镜下观察其形态特征及其在肿瘤中的分布特点，分析瘤组织中不同微循环模式与脉络膜黑色素瘤临床组织病理学因素及核增生抗原Ki-67表达之间的关系。结果过碘酸希夫染色发现脉络膜黑色素瘤组织中共有9种微循环模式，其中网状结构微循环模式在含有上皮细胞的肿瘤组织中的出现率为66．7％，明显多于梭形细胞者中的30．6％，差异有统计学意义（P=0．027）。有环状结构、网状结构微循环模式的肿瘤组织中Ki-67表达率分别为18．961±10．995和19．481±12．167，明显高于无环状结构、无网状结构微循环模式的肿瘤组织的10．261±5．669和12．021±6．802，差异均有统计学意义（P=0．000、0．010）。多元逐步回归分析表明，环状结构微循环模式进入回归模型，即环状结构的存在与否对Ki-67表达阳性率影响最为显著（P=0．002）。结论脉络膜黑色素细胞瘤的9种微循环模式结构中，网状结构微循环模式在含上皮样细胞型肿瘤中出现明显增多，而在有环状结构和有网状结构微循环模式的肿瘤中Ki-67表达明显增高，这种微循环模式可能与临床上表现的肿瘤恶性程度和增牛程度有关。

Background Biological behavior of choroidal melanoma is closely related with angiogenesis. The microcirculation pattern in which tumor cells may be involved is different from neovascularization. Objective This study was to observe the microeirculation pattern of the ehoroidal melanoma tissue and analyze its relationship with the clinical pathology factor and the degree of cellular proliferation. Methods Forty-eight specimen of ehoroidal melanoma tissue were collected at Beijing Tongren Eye Centre from November 1997 through March 2006. Periodate acid Sehiff staining was used to determine the microcirculation pattern of choroidal melanoma. The morphology of the tumor cells and the distribution of microcireulation pattern in the tumor were observed under a fluorescence microscopy with 544 nm wavelength,and the Ki-67 expression in the tumor was detected by immunochemistry. The relationships between the choroidal melanoma clinical pathology factor with Ki-67 expression and microcirculation pattern were evaluated by multiple stepwise regression model. Results A total of 9 kinds of microcirculation patterns were found by periodate acid Schiff staining. The occurring rate of loop- or network-like vascular pattern showed a significant elevation in the tumor tissue with epithelial cells in comparison with the tumor with spindle-like cells （66.7% vs. 30.6% ） （P=0. 027）. The expression rates of Ki-67 were 18. 961±10. 995 and 19. 481±12. 167 in the tumor tissue with loop- or network-like microvascular pattern, and those in the tumor tissue without loop- or network-like mierovascular pattern were 10. 261 ＋5. 669 and 12.021±6. 802, presenting significant differences between them （P = 0. 000, P = 0. 010 ）. Loop-like microvascular pattern was determined as the risk factor of the proliferation and metastasis of ehoroidal melanoma by multiple stepwise regression analysis （ P= 0. 002）. Conclusions Among the nine microcirculation patterns in ehoroidal melanoma, networks pattern is the most fashion, and Ki-67 expression is more strong in the tumor with epitheliod cells, suggesting that this microcirculation pattern is associated to the malignant degree and extent of proliferation in choroidal melanoma.