多模式检查在睫状体上皮瘤中的应用

Application of multi-mode detection on adenoma of the ciliary epithelium

目的探讨多模式检查在睫状体上皮瘤与恶性的睫状体黑色素瘤鉴别诊断中的价值。方法回顾2016—2021年在南京医科大学附属眼科医院眼底病科确诊为睫状体上皮瘤的3例患眼的临床资料,分析其眼底检查、彩色多普勒超声、超声生物显微镜检查(UBM)、眼底荧光血管造影(FFA)、磁共振(MRI)及病理检查的特征,与恶性睫状体黑色素瘤进行鉴别。结果所有患眼眼底检查可见肿瘤位于远周边部,较为隐蔽,瘤体大小不一,凸向玻璃体腔内,多呈椭圆形或不规则形。瘤体表面色多为灰黄色,当有色素沉着时可呈灰黑色,边界清晰,表面及边缘整齐。UBM显示瘤体位于睫状体前部玻璃体腔内,呈团状中等回声,内回声较均匀,位置固定,与睫状体相连。彩色多普勒超声检查显示瘤体多位于晶状体旁或睫状体前,为类椭圆形强回声团,与睫状体回声相连,可探及内部血流信号存在,脉冲多普勒为动脉型血流频谱。FFA显示眼底远周边部可见一类椭圆形高荧光病灶隆起,凸向玻璃体腔内,随时间延长渐渗漏增强,周围视网膜毛细血管扩张,晚期渗漏增强。当继发视神经病变时,可见视盘水肿呈高荧光渗漏。MRI检查可见眼球晶状体外后方斑点状异常信号,T1WI呈稍高信号、T2WI呈等信号,增强扫描见明显强化。病理检查结果示:瘤体组织及切面呈灰白色,质中,为良性睫状体上皮瘤。结论睫状体上皮瘤极为罕见,发病位置及临床体征与睫状体黑色素瘤极易混淆,病理检查是诊断金标准,临床可结合多模式检查对二者进行鉴别。

Objective To explore the effect of multi-mode detection on the diagnosis of adenoma of the ciliary epithelium(ACE).Methods The clinical data 3 patients(3 eyes)diagnosed as ACE was analyzed retrospectively.The characteristics of fundus examination,color Doppler ultrasound,fundus fluorescein angiography(FFA),magnetic resonance imaging(MRI)and pathological examination were analyzed for the differential diagnosis of ciliary body melanoma.Results Fundus examination showed that the tumor located on superior temporal,inferior temporal and superior nasal retina,with different sizes.The body of tumor was oval or irregular in shape and grey-and-black or grey-and-yellow in color,with straight edge.UBM manifested that crumby medium echo located besides ciliary body and was linked to it,implying the possibility of space-occupying lesions on ciliary body.In color Doppler ultrasound,the lesion could be observed lying besides lens,in front of ciliary body.Suborbicular strong echo which was linked to ciliary body with weak blood signal could also be observed.In FFA,a high-fluorescencing hump could be observed.The retina was surrounded by the angiotelectasis.The fluorescence leakage enhanced with the prolonging of time.MRI showed spotted abnormal signal.T1W showed high signal while T2W showed medium signal,with marked enhancement.The tissue and its section were manifested as grey-and-white and moderate texture.The tumor was benign ACE.Conclusions Combining fundus examination,color Doppler ultrasound,FFA,MRI and pathological examination may contribute to the valid diagnosis of ACE and correct differential diagnosis with the easily-confused ciliary body melanoma.