眼表鳞状细胞癌的临床表现

Ocular manifestations of ocular surface squamous cell carcinoma

目的探讨眼表鳞状细胞癌(SCC)的临床表现。方法回顾性系列病例研究。收集2014年11月~2016年10月在本科治疗的眼表SCC患者22例,进行全面的眼科检查和全身检查。患者均在局部或全身麻醉下行眼表SCC切除手术。结果切除组织病理及免疫组织化学分析均证实为眼表SCC。肿瘤发生于颞侧14例(63.6%),发生于鼻侧5例(22.7%),环绕角膜生长2例(9.1%),位于角膜表面1例(4.5%)。其中累及角膜缘19例(86.4%),环绕角膜缘2例(9.1%),仅累及结膜2例(9.1%),累及半月皱襞1例(4.5%),累及巩膜13例(59.1%),侵犯至眼内2例(9.1%)。肿瘤的外观表现:结节状7例(31.8%)、菜花状5例(22.7%)、草莓状5例(22.7%)、乳头状4例(18.2%)、角结膜缘弥漫性增厚1例(4.5%)。多数肿瘤基底宽阔,厚度中等。伴有局部淋巴结肿大4例(18.2%)。4例患者(18.2%)手术后复发,再次手术,其中2例(9.1%)侵犯至眼内,行眼球摘除手术。结论睑裂部角膜缘是眼表SCC的好发部位,其中颞侧较为常见。临床表现多样,可侵犯眼内,少数患者伴有局部淋巴结增大。早期诊断和手术完整切除对于预后至关重要。

Objective To investigate the clinical presentation of ocular surface squamous cell carcinoma （SCC）. Methods This is a retrospective case series of 22 consecutive patients with ocular surface SCC representing between November 2015 and October 2016 at Eye and ENT Hospital of Fudan University. Each patient underwent complete ophthalmologic, systemic examination and surgery. Results Histopathological and immunohistochemical assessment revealed SCC in all patients. The lesion situated temporally in 14 patients （63.6%）, nasally in 5 patients （22.7%）, surrounding the cornea in 2 patients（9. 1% ）, extending onto the cornea surface in 1 patient （4.5%） , limbus in 19 patients（86.4% ）, surrounding the limbus in 2 patients （9.1%）, plica semilunaris in 1 patient （4.5%）, deep in the sclera in 13 patients （59.1%）and 2 patients（9.1% ）with intraocular involvement. The tumors may appear nodular in 7 patients （31.8%）, cauliflower-like in 5 patients （22.7%）, strawberry-like in 5 patients （22.7%）, papillary in 4 patients（ 18.2% ） or diffuse thickening in 1 patient （4.5%）. Involvement of regional lymph nodes was found in 4 patients （18.2%）. Four patients（ 18.2% ）relapsed after surgery and underwent reoperation. Two patients （9.1% ）had intraocular involvement and received enucleation. Conclusions Limbus is the predilection site of ocular surface SCC, and temporal quadrant is more common. The clinical presentations of ocular surface SCC are various and can present with intraocular extension. Involvement of regional lymph nodes may occur in some patients. Early diagnosis and complete excision are very important for prognosis. （Chin J Ophthalmol and Otorhinolaryngo1,2017 ,17 ：180-183 ）