20例眼部黑色素瘤的临床影像及病理特征的分析

Analysis of Clinical Image and Pathological Features of 20 Cases of Ocular Melanoma

目的:分析眼部黑色素瘤的临床影像及病理特征以及影响预后的因素。方法:收集自2008年1月~2018年12月在某院就诊的20例眼部黑色素瘤的患者资料进行临床影像和病理特征的回顾性分析及预后相关性。结果:发生部位:葡萄膜有16例其中虹膜3例,睫状体1例,脉络膜12例;结膜2例,眼睑皮肤1例,眼眶继发性肿瘤1例;病理分型:梭A细胞型9例,梭B细胞型5例,混合细胞型3例,上皮细胞型2例,其他型1例,其中梭形细胞型占70%(14/20),显著高于其他亚型30%(6/20)(χ2=6.4,P=0.011);免疫组化显示:S-100蛋白阳性20例,HMB-45呈阳性18例,Melan-A阳性有15例。三者联合检测的灵敏度为100%,特异度为88.33%。临床表现无特异性,与发生部位有关,预后与病理分型、肿瘤大小及发病年龄等相关。结论:眼部黑色素瘤在临床上比较少见,恶性程度高,预后不佳,病理分型以梭形细胞型为主,早期诊断和扩大切除是改善眼部黑色素瘤预后的重要手段。

Objective:To analyze the clinical imaging and pathological features of ocular melanoma and the factors affecting prognosis.Methods:From January 2008 to December 2018,20 patients with ocular melanoma treated in a hospital were collected for retrospective analysis of clinical imaging and pathological characteristics and prognostic relevance.Results:There were 16 cases of uveal,including 3 cases of iris,1 case of ciliary body,12 cases of choroid;2 cases of conjunctiva,1 case of eyelid skin,and 1 case of secondary orbital tumor.Pathological classification:there were 9 cases of A spindle cell type,5 cases of B spindle cell type,3 cases of mixed cell type,2 cases of epithelial cell type and 1 case of other types.Among them,spindle cell type accounted for 70%(14/20),which was significantly higher than other subtypes 30%(6/20)(χ2=6.4,P=0.011).Immunohistochemistry showed that 20 cases were positive for S-100 protein,18 cases were positive for HMB-45 and 15 cases were positive for Melan-A.The sensitivity and specificity of three combined detection were 100%and 88.33%,respectively.The clinical features were nonspecific and related to the site of occurrence.The prognosis was correlated to pathological type,tumor size and age of ocular melanoma.Conclusion:Melanoma of the eye is rare in clinic,with high malignancy and poor prognosis.Pathological classification is dominated by spindle cell,and early diagnosis and extended resection are important means to improve the prognosis of ocular melanoma.