结膜色素痣422例的临床组织病理学分析

Analysis of clinicopathologic characteristics of 422 conjunctival melanocytic nevi specimens

目的总结分析422例结膜色素痣患者的临床组织病理学特点及其恶变情况。方法回顾性系列病例研究。分析首都医科大学附属北京同仁医院眼科病理室2004年6月至2016年5月存档的422例结膜色素痣的临床及组织病理学资料（包括性别、年龄、临床诊断及病理学诊断），将所有患者按年龄划分为少年组（〈18岁）、青年组（18-40岁）以及中老年组（〉40岁）共3组，对不同年龄、不同性别结膜色素痣的组织病理学类型及其恶变情况进行分析。其中，对两组平均年龄差异比较采用两样本均数比较t检验，多组平均年龄差异比较采用单因素方差分析，对不同色素痣的恶变情况差异比较采用χ2检验（SPSS 18.0统计学软件）。结果422例结膜色素痣患者中，男性195例，女性227例（男∶女=0.89∶1）；平均年龄（27.9±17.9）岁。结膜色素痣的病理类型包括复合痣、皮内痣以及交界痣。其中，结膜复合痣患者最常见（256例，60.7%），平均年龄（22.2±15.4）岁；皮内痣次之（130例，30.8%），平均年龄（37.7±16.6）岁；交界痣最少（36例，8.5%），平均年龄（32.7±22.4）岁。不同类型结膜色素痣患者平均年龄比较，差异有统计学意义（F=3.169，P=0.031）。结膜复合痣的发生以少年组最常见（113例，44.1%），其次为青年组（104例，40.6%），中老年组少见（仅为39例，15.2%）；结膜皮内痣以青年组最常见（59例，45.4%），其次为中老年组（58例，44.6%），少年组相对少见（仅为13例，10.0%）；交界痣的发生以中老年患者为主（16例，44.4%），但少年组也有13例（36.1%）；青年组少见（7例，19.4%）。422例结膜色素痣中，有37例发生恶变，恶变率为8.8%；恶变患者平均年龄为（48.6±12.1）岁，与不发生恶变患者的年龄（25.3±14.2）岁相比，差异有明显统计学意义（t=4.252，P=0.002）。其中，24例（64.9%）由复合痣恶变而来，13例（35.1%）来源于交界痣恶变，结膜皮内痣患者中无恶变病例发生。发生恶变的复合痣和交界痣患者中，男、女平均年龄差异均无统计学意义（P=0.730，0.993）。36例交界痣患者13例发生恶变，占所有交界痣患者36.1%，明显高于结膜色素痣恶变平均发生率（8.8%）；未恶变的交界痣患者以少年组最常见，恶变的交界痣患者以中老年最常见。结论不同年龄组结膜色素痣组织病理类型分布不同，且不同类型色素痣的好发年龄也具有一定差异；交界痣易恶变，且恶变者多为中老年患者。

ObjectiveTo describe the clinicopathologic characteristics of 422 conjunctival melanocytic nevi and detect the incidence of malignancy in those patients.MethodsRetrospective case series study. A retrospective study was conducted by reviewing 422 conjunctival melanocytic nevi specimens obtained at Beijing Tongren Eye Center from June, 2004 to May, 2016. The data included the information of gender, age, clinical and histopathological diagnosis of all collected conjunctival melanocytic nevi cases. All patients were divided into three groups according to age： juvenile groups （〈18 years old）, young group （18-40 years old） and the elderly group （〉40 years old）. The histopathology change and its malignant incidence of conjunctival nevi in different age and sex were analyzed by SPSS 18.0 software package.ResultsOf the 422 cases, 195 were males and 227 were females （male∶female=0.89∶1）. The average age at surgery was （27.9±17.9） years old. The pathological types of conjunctival nevi included compound nevus, intraepithelial nevus and junctional nevus. The most common type of conjunctival nevus was compound nevus （256 cases, 60.7%; mean age （22.2±15.4） years old）. The second was intraepithelial nevus （130 cases, 30.8%; mean age （37.7±16.6） years old）. The least was junctional nevus （36 cases, 8.5%, mean age was （32.7±22.4） years old）.The average age of patients with different types of conjunctival nevi was statistically significant （F=3.169, P=0.031）. Occurrence of conjunctival compound nevus was most common in juvenile group （44.1%）, followed by the young group （40.6%）, and the elderly group （only 15.2%）. Occurrence of conjunctival intraepithelial nevus was the most common in youth group （45.4%）, followed by the elderly group （44.6%）, and youth group was relatively rare （only 10%）. The junctional nevus appeared mainly in elderly group （44.4%）, but the junior group also had 13 cases （36.1%） and younger group had 7 cases （19.4%）. Among 422 cases of conjunctival nevi, 37 cases transformed into malignant tumor. The canceration rate was 8.8%. The average age of malignant patients was （48.6±12.1） years old. Comparing with the patients without malignant, the age was age （25.3±4.2） years old and there was a significant difference （t=4.252, P=0.002）. Among them, 24 cases （64.9%） came from conjunctival compound nevus and 13 cases （35.1%） came from the junctional nevus. Non malignant cases occurred in patients with conjunctival intradermal nevus. The male and female average age of patients with malignant transformation from compound nevus and junctional nevus were not statistically significant （P=0.730, 0.993）. Thirteen cases were occurred malignant change in 36 cases of patients with junctional nevus, accounting for 36.1% of all patients with junctional nevus. It was obviously higher than the average malignant incidence of conjunctival nevi （8.8%）. Non malignant junctional nevus were most common in juvenile group, and malignant junctional nevus were most common in the elderly group.ConclusionsThe pathological type distribution of conjunctival melanocytic nevi in different age groups was different, and the onset age of different types of melanocytic nevi was also different. Patients with junctional nevus were prone to malignant change, and most of them were middle-aged and elderly patients.