后部葡萄膜恶性黑色素瘤

本文报告我院１１年期间经病理证实的３５例后部葡萄膜恶性黑色素瘤。病理学分型：棱形细胞Ａ型８例，梭形细胞Ｂ型１４例，混合细胞型８例，上皮细胞型３例，气球细胞型及坏死型各１例。     

葡萄膜恶性黑色素瘤的现代处理

葡萄腆恶性黑色素瘤Uveal Melanoma(简称U.M.)是成年人最常见的一种恶性眼内肿瘤,恶性度较高,易经血液转移,一经确诊,早期手术摘除患眼是过去最主要的治疗措施。近年来随着诊断和处理技术的不断改进,使得眼球摘出率大大降低。传统上做为主要治疗措施的跟球摘出巳受到了不同意见的挑战,成为当前争论的课题。很久以前人们就认识到U.M.病人眼球摘出后会加速瘤的全身转移。也许术前病人就已经有了亚临床转移,只是被宿主防预功能所抑制,处于暂停活动状态。在外伤、手术、肝炎等情况下被激活。大约有40％的     

色素膜转移癌临床病理分析

对我院２１例及我国已报道的８６例色素膜转移癌进行临床病理分析。结果表明：我国色素膜转移癌左，右眼无甚差别。原发癌部位最多者为肺４５例（４２．０５％），乳癌１４例（１３．０８％），在有记载眼部症状出现时间的原发肺癌４３例中，有３３例先出现眼部症状；而１４例原发乳腺癌中，竟无一例先出现眼部症状。这可能与肺发病率较高，且较乳腺癌难于发现，患者先天眼科就诊，摘除眼球病检证实者较乳腺癌者多有关。     

葡萄膜恶性黑色素瘤眼外蔓延

目的观察葡萄膜恶性黑色素瘤眼外蔓延的发生率、与病理组织学的关系、临床和影像学特征以及影响愈后的因素。方法采用我院20年间诊治的葡萄膜恶性黑色素瘤眼外蔓延9例进行回顾性分析。所有病例均经病理组织学确诊。结果葡萄膜恶性黑色素瘤眼外蔓延的发生率为15%。肿瘤在眼内呈扁平状生长者6例,蕈状生长者2例;上皮细胞型4例,梭形细胞型1力。本组随访患者5例表明预后与肿瘤大小、眼外蔓延程度、病理组织学分型有关。结论葡萄膜恶性黑色素瘤早期可向眼外蔓延,并与病理组织学分型有关,影像学检查有助于诊断。(中华眼底病杂志,1999,15:30-32)     

葡萄膜黑色素瘤临床病理特征与预后的相关因素分析

目的 观察葡萄膜黑色素瘤的临床及病理特征与肿瘤转移和肿瘤所致死亡的相关预后因素。方法 53例行眼球摘除手术并经组织病理学检查证实为葡萄膜黑色素瘤患者的临床资料纳入研究。记录患者年龄、性别、患眼眼别、视力、眼压、虹膜新生血管、肿瘤形态、肿瘤大小、继发视网膜脱离等临床特征,以及肿瘤细胞类型、是否侵犯睫状体、巩膜导管、视盘、...     

葡萄膜黑色素瘤局部切除术及其预后因素的研究进展

眼球摘除术作为葡萄膜黑色素瘤传统的治疗方法已受到挑战。放射治疗和肿瘤局部切除术等保留眼球的治疗方法在不少国家已成为主要的治疗手段。本文就葡萄膜黑色素瘤局部切除术的发展史、适应证、手术技术、并发症和预后等进行综述     

葡萄膜黑色素瘤多药耐药基因的表达与患者预后因素的分析

目的 探讨葡萄膜黑色素瘤多药耐药基因的表达与患者预后的相关关系。 方法选择石蜡包埋葡萄膜黑色素瘤组织96例，通过脱色素免疫组织化学检测细胞周期素D1(cyclin D1)、上皮生长因子受体(epithelial growth factor receptor, EGFR)、转移抑制基因23(non-metastasis gene 23, nm 23)、P糖蛋白(P glucose protein,P-gp)、多药耐药相关蛋白(multidrug resistance relation protein,MRP)、肺耐药蛋白(lung-resistance-protein,LRP)基因表达。选择病例资料较完整者，进行随访，随访结果分类统计。 结果 96例葡萄膜黑色素瘤中类上皮细胞型21例、混合细胞型56 例和梭形细胞型19例，其中眼内期76例，眼外期20例。随着转移抑制基因nm 23表达的减低和Cyclin D1、EGFR表达的增高，耐药相关基因表达有增高趋势，其中MRP和LRP的表达与nm 23的表达呈明显负相关关系，与Cyclin D1、EGFR的表达呈明显正相关关系。随访结果显示，回访人数58例，生存超过 5年者26例，5年内死亡者19例。 结论 葡萄膜黑色素瘤多药耐药基因尤其LRP的表达与患者预后具有明显的相关性。 （中华眼底病杂志，2003，19：1-4）     

葡萄膜黑色素瘤1 166例患者的临床特征及预后相关因素分析

目的分析中国葡萄膜黑色素瘤(UM)患者临床特征及预后相关因素。方法回顾性病例系列研究。收集2004年1月至2020年1月在首都医科大学附属北京同仁医院确诊为UM的1 166例患者的人口基线特征资料和临床资料, 对患者的眼球摘除情况及转移率、病死率等预后情况进行追踪随访, 运用Kaplan-Meier方法进行生存分析, Log-rank检验分析各临床特征与患者总生存率的关系;采用多因素Cox回归分析筛选影响患者预后的独立危险因素。结果 1 166例UM患者中男性598例, 女性568例, 确诊年龄为(47.6±12.2)岁, 中位随访时间为38个月。治疗包括巩膜外敷贴治疗(881例, 75.6%)、局部肿瘤切除(38例, 3.3%)、激光治疗(115例, 9.9%)和眼球摘除术(119例, 10.2%)。在881例接受初次敷贴治疗的患者中, 有120例患者在治疗后接受了眼球摘除术。Kaplan-Meier生存分析结果显示, UM患者5年和10年转移率分别为18.5%和26.8%, 黑色素瘤相关病死率分别为13.6%和22.2%;Log-rank检验提示, 患者年龄(χ2=5.01)、性别...     

葡萄膜黑色素瘤经巩膜表面敷贴放射治疗的预后及其影响因素

巩膜表面敷贴放射治疗是治疗葡萄膜黑色素瘤的一种近距离放射疗法,肿瘤局部控制率、转移率以及患者生存率与其他疗法相比并无差异,但能保留眼球并维持部分视力,对正常组织及全身损伤较小,安全且疗效可靠.治疗预后受肿瘤大小、位置、退行速度、生长方式、敷贴剂量率、放射性核素的种类、敷贴器放置的精准度、敷贴器的形状以及患者年龄等多种因素影响.     

Selected prognostic factors of malignant uveal melanoma

Malignant uveal melanoma is the most common intraocular tumor in adults. Despite very good local treatment results, patients' survival has not improved in the last decades. The main cause of death is metastatic spread, which occurs with a variable time delay after tumor discovery in 50% of patients. After metastasis development the mean survival rate decreases to less than 6 months. Progression to metastatic disease is associated with different prognostic factors. The spectrum of conventional clinical and histopathologic prognostic factors like age, tumor size, location, extrascleral growth, histopathologic cell type, vascularisation, invasion of sclera, etc., has been enlarged by using new immunological, molecular, immunohistochemical and cytogenetical methods. Current research also focuses on development of an adjuvant systemic therapy which could delay or prevent metastasis development in high-risk patients. It is necessary to determine reliable prognostic factors in order to select potential candidates for such a systemic treatment. In this article we present a short overview of known prognostic factors of uveal melanoma.     

Radiation pathomorphosis of malignant melanoma of the uveal tract of the human eye

The paper describes peculiarities of changes in uveal melanomas after beta application. It is shown that the degree of changes depends on the intensity of action, the cellular type of the tumor and the degree of its pigmentation. The most radiosensitive proved to be spindle cell B, mixed and epithelioid melanomas. Less radiosensitive are pigmented tumourous cells. The most intensive postradiation changes, were characterized by development of long-term existence of coagulation necrosis, growing of cellular polymorphism, hyperploidy, polynucleosis, appearance of apoptosis. The study of the reaction of monolayer culture of uveal melanomas on beta application has confirmed different radiosensitivity of melanoma cells of a different kind as well as has revealed that the growing of cellular polymorphism is a morphologic manifestation of a postradiation degeneration. The degree of postradiation changes correlated with the duration of monolayer culture of the tumor.     

Exudative retinal detachment from malignant uveal melanoma: predictors and prognostic significance

PURPOSE: To determine independent predictors of exudative retinal detachment (RD) in eyes with uveal melanoma and the significance of RD in melanoma-specific survival. METHODS: The extent of exudative RD was recorded retrospectively in a population-based cohort of 167 consecutive patients with eyes enucleated from 1972 through 1981 because of choroidal and ciliary body melanoma, representing all melanomas treated during that period. Histopathologic features including microvascular loops and networks, microvascular density (MVD), and tumor-infiltrating macrophages were determined. Clinical and histologic predictors of RD were modeled by multiple logistic regression with a split-sample, cross-validation design. Survival was assessed by Kaplan-Meier analysis and adjusted for the effect of competing predictors by Cox proportional hazards regression. RESULTS: Of 142 (85%) eyes with adequate data, 25% had no RD, 16% had subretinal fluid around the tumor, 43% had clinical RD in one to two quadrants, and 16% had RD in three to four quadrants. The RD was more extensive if the tumor was large (P < 0.0001) and had microvascular loops and networks (P = 0.0094) and less extensive if it involved ciliary body (P = 0.011). High MVD (P = 0.054) and ruptured Bruch's membrane (P = 0.065) tended to be associated with RD. Multiple logistic regression showed largest basal diameter (odds ratio [OR] 1.43 for each 1-mm change, P < 0.0001), microvascular loops and networks (OR 1.95 for each category change, P = 0.0095), and ciliary body involvement (OR 0.20, P = 0.0039) to be independently associated with RD; ruptured Bruch's membrane (P = 0.96) and MVD (P = 0.87) were not associated. Clinical RD predicted poor survival (0.59 vs. 0.37 at 20 years; P = 0.029) by Kaplan-Meier analysis, but not after adjusting for other prognostic factors by Cox regression (hazard ratio [HR] 1.00, P = 1.0). CONCLUSIONS: Tumor size, which may be a surrogate measure for total vascular content and decompensation of choriocapillaris and retinal pigment epithelium, is a strong predictor of exudative RD. Microvascular loops and networks are likewise associated with exudative RD. Exudative RD is not associated with survival after adjusting for tumor size and microvascular loops and networks.     

Intraocular malignant melanoma simulating uveal prolapse

An 87-year-old woman, who had undergone cataract surgery and vitrectomy OD two years previously, had a blind, painful right eye secondary to intraocular hemorrhage and glaucoma. At the initial examination, a flat area of darkly pigmented tissue was noted at the wound site of the previous cataract surgery, and uveal prolapse was diagnosed. One year later, pigmented tissue was also seen at the inferior limbus. Intraocular malignant melanoma was considered, and the eye was enucleated. Histologic study revealed areas of hemorrhage and epithelioid malignant melanoma. It is important to recognize that prolapse of tissue at a surgical wound site may represent an extension of an intraocular malignancy.