结膜乳头状瘤和尖锐湿疣18例分析

目的：分析和探讨结膜乳头状瘤、结膜尖锐湿疣的发病特点、临床与病理特征、治疗方法及预后。方法：回顾性总结、分析18例21眼眼结膜乳头状瘤、尖锐湿疣感染者的临床和病理资料。结果：经病理证实，系鳞状细胞乳头状瘤者15例18眼，结膜尖锐湿疣者3例3眼；除1个瘤体位于外眦部球结膜，6个位于上、下方睑结膜，1个位于下泪小管外，其余18个瘤体均位于内眦部球结膜、睑结膜、泪阜等处；患者行瘤体切除联合热灼术后随访时间为6个月～3年，平均2．1年，无复发者20眼，复发1眼。结论：结膜乳头状瘤、结膜尖锐湿疣好发于眼内眦部，表现为结膜尖锐湿疣者不容忽视，瘤体切除联合热灼术是有效的治疗方法。     

自体角膜缘干细胞移植术治疗角膜缘乳头状瘤疗效观察

目的:观察自体角膜缘干细胞移植术治疗角膜缘乳头状瘤疗效,探讨角膜缘乳头状瘤的治疗方法.方法:采用前瞻性研究方法.连续观察2014-01/12在同济医院眼科临床诊断为角膜缘乳头状瘤患者.采用标准手术切除联合游离结膜瓣自体角膜缘干细胞移植术治疗,手术获取标本行常规病理检查,明确病理诊断.手术后采用抗炎、预防感染及促进上皮修复药物治疗,并于10 ～14d拆除缝线.手术前后采用裂隙灯显微镜照相、眼前节OCT进行观察记录,随访观察6～ 12mo.结果:共4例患者纳入观察,男3例,女1例.患者年龄48 ～ 62(平均55.5±5.8)岁;乳头状瘤病变直径5～12(8.25±2.99) mm;侵犯角膜缘范围5～12(平均7.25±3.20)mm.手术后角膜上皮愈合时间2～5(平均3.25±1.26)d.眼前节OCT未见明显前弹力膜破坏.随访期间未见新生物复发,角膜缘干细胞供区未见干细胞失代偿表现.结论:单纯切除联合自体角膜缘干细胞移植术是治疗角膜缘乳头状瘤的有效方法.     

眼球表面鳞状细胞性肿物的临床病理学分析

目的:提高对眼球表面鳞状细胞性肿物的诊断和治疗水平。方法:对天津眼科医院1978～1997年收治的180例眼球表面鳞状细胞性肿物进行临床和病理学分析。结果:本组病变可分为三大类:1良性病变73例(40.4%),包括鳞状细胞增生、乳头状瘤和假上皮瘤样增生;2交界性病变42例(23.3%),主要是非典型增生;3恶性病变65例(35.9%),包括原位癌、鳞状细胞癌和粘液表皮样癌。本组病变好发于角膜缘部位(118例),男性多见(145例),通常为单眼发病,多数发病时间为半年～1年内。手术后复发主要与肿物切除不彻底有关。结论:对眼球表面鳞状细胞性肿物的术前正确诊断、手术设计和手术边缘的病理学检查是非常重要。     

角膜肿瘤39例临床分析

目的分析各类角膜肿瘤的发病比率、诊断及治疗。方法对1996年1月至2002年12月经病理证实的39例角膜肿瘤进行回顾性分析。结果39例角膜肿瘤中,男性31例(31只眼),女性8例(8只眼)。右眼24例,左眼15例。年龄3岁～88岁(平均45.7岁)。以鳞状细胞癌最常见,占46.15%,其次为色素痣(30.77%)和乳头状瘤(7.69%),而恶性黑色素瘤、瘤样增生、内翻性乳头状瘤、继发性黑病变、淀粉样变性、和炎性假瘤(各占2.56%)等较少见。角膜肿瘤多发于单眼,以角膜缘为好发部位。结论角膜肿瘤以鳞状细胞癌和色素痣多见,应尽早手术切除明确诊断,早期手术治疗效果好。     

手术切除眼表面鳞状细胞性肿物29例临床分析

目的 提高对眼表面鳞状细胞肿物的诊断和治疗水平。方法 对我院1988年5月—2001年10月手术切除的29例眼表面鳞状细胞肿物进行临床分析。结果 本组病例中男性多见(69％)，病变好发于角膜缘部(62．1％)，可分为：良性病变(14例，48．3％)，包括鳞状细胞良性增生、鳞状细胞乳头状瘤；交界性病变(6例，20．7％)，主要是非典型性增生；恶性病变(9例，31．0％，)，包括原位癌、浸润性鳞状细胞癌3大类。手术完整切除是治疗的主要手段。结论 对眼表鳞状细胞肿物早期的正确诊断、合理的手术设计是治疗本病的关键。     

角结膜缘上皮性癌前病变和恶性肿瘤的临床病理学特点

目的 分析角结膜缘上皮性癌前病变和恶性肿瘤的类型和临床病理学特点.方法 回顾性研究收集天津眼科医院从1990年至2008年间收治的69例角结膜缘上皮性癌前病变和恶性肿瘤的临床资料,按照目前病理学分类和诊断标准,重新核对所有病例的病理诊断,分析临床病理学特征.结果 所有病变包括结膜上皮内瘤变(conjunctivalintraepithelial neoplasia,CIN)45例(65.2%),日光性角化病6例(8.7%),鳞状细胞癌18例(26.1%).男性58例(84%),女性l1例(16%),发病年龄34～83岁,平均年龄53.6岁.42例发生于鼻侧角结膜缘(61%),21例发生于颞侧角结膜缘(30.4%),6例肿瘤位于角膜表面(9%).CIN和日光性角化病表现为角结膜缘扁平状或轻度隆起、灰白色或粉红色肿物,肿物周围通常有充血扩张的血管.45例CIN病例中,11例(24.4%)为低级别CIN,34例(75.6%)为高级别CIN.鳞状细胞癌通常表现为结节状或乳头状,肿瘤体积通常大于CIN和日光性角化病,其中乳头状鳞状细胞癌12例,浸润性鳞状细胞癌6例.角结膜缘CIN、日光性角化病和鳞状细胞癌容易累及邻近的角膜上皮,尤其浸润性鳞状细胞癌容易侵及角膜浅实质层,但很少穿透眼球壁侵入到眼球内.结论 睑裂部角膜缘是眼球表面CIN,日光性角化病和鳞状细胞癌好发部位,早期正确的诊断和治疗非常重要.     

角膜肿物患者135例的临床及病理学特征

目的　分析角膜肿物患者的临床及病理学特征。方法　收集2002年1月至2016年6月天津市眼科医院存档的135例（136眼）患者角膜肿物病例资料进行回顾性分析。分析患者的临床特征和肿物的病理学特点。结果　在135例角膜肿物患者中,良性肿物共118例（87.41%）,包括角膜皮样瘤100例、角膜上皮细胞增生8例、角膜缘色素痣6例、鳞状上皮乳头状瘤2例、上皮细胞性囊肿1例及肉芽组织增生1例;癌前病变及恶性肿瘤共有17例（12.59%）,包括日光性角化病5例、鳞状细胞癌5例、原位癌4例、不典型增生3例。5例鳞状细胞癌中有2例乳头状鳞状细胞癌和3例浸润性鳞状细胞癌。角膜良性肿物在 0～17岁患者组中发病率最高,角膜癌前病变及恶性肿瘤在60岁及以上患者组中发病率最高。结论　角膜肿物中角膜皮样瘤是最常见的角膜良性肿物,日光性角化病是最常见的角膜癌前病变,鳞状细胞癌为最多见的角膜恶性肿瘤。     

眼部乳头状瘤的治疗

眼部乳头状瘤是人类乳头状瘤病毒(HPV)感染所致的一种原发的上皮增殖病变，表现为眼睑及眼眶周围皮肤的寻常疣、扁平疣及乳头状瘤。目前本病发病因素不明了、治疗效果不确切，复发率高，部分可恶变。治疗手段有激光治疗、低温冷冻治疗、手术切除、羊膜移植、药物治疗(抗病毒药、抗肿瘤、中药)等，HPV疫苗、光动力疗法正在研究中。     

眼部乳头状瘤的诊疗及预后现状

眼部鳞状细胞乳头状瘤普遍被认为是一种常见的与人乳头瘤病毒(HPV)感染、紫外线照射等因素密切相关的眼部良性肿瘤,但是其病因尚未明确。病变往往表现为菜花或海绵状的灰白或肉粉色肿物,可见于结膜、泪阜、角膜缘、眼睑皮肤及眼眶等部位,采用前节高分辨率光学相干断层扫描(HR-OCT)、超声生物显微镜(UBM)等检查手段结合术后病理检查可以确诊。该疾病有一定的复发倾向,一些学者认为生长部位、细胞异型性、治疗方式等可能是影响疾病复发的因素。目前临床治疗以手术切除为主,部分加以术中冷冻、羊膜移植、丝裂霉素(MMC)、干扰素α-2b(IFNα-2b)、5-氟尿嘧啶(5-FU)等辅助治疗方法,有研究发现合理规范的辅助治疗对于减少复发有一定作用,但仍需要进一步的大样本研究证实。     

人乳头瘤病毒与眼肿瘤

人乳头瘤病毒(HPV)与许多良、恶性肿瘤发生有关,具有致癌性。近年的研究在眼部乳头状瘤、鳞状上皮癌、视网膜母细胞瘤等多种眼部肿瘤中检出HPV,提示HPV可能参与眼部肿瘤的发生。了解其在眼肿瘤中的作用有利于深入了解眼肿瘤的发病机制,从而更好地预防和治疗。     

Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma.

PURPOSE: To report a pigmented conjunctival squamous cell carcinoma that clinically simulated a conjunctival melanoma. DESIGN: Interventional case report. METHODS: Ocular examination, surgical excision, and clinicopathologic correlation. RESULTS: A 78-year-old white man developed a lightly pigmented mass at the temporal limbus of his right eye. The differential diagnosis included pigmented squamous cell carcinoma and malignant melanoma. Histopathologic examination revealed a malignant squamous cell tumor that contained foci of melanin pigment. The final diagnosis was pigmented conjunctival squamous cell carcinoma. CONCLUSION: Conjunctival squamous cell carcinoma may rarely be pigmented and simulate a conjunctival melanoma.     

Intraocular extension of conjunctival squamous cell carcinoma

Conjunctival squamous carcinoma, which is regarded as a low-grade malignancy, usually originates at the limbus. Most cases remain superficial to the sclera. Intraocular invasion is rarely reported. We describe a woman misdiagnosed as conjunctivitis and pterygium before a clinical diagnosis of conjunctival squamous cell carcinoma. The diagnosis was made by histopathological examination of the biopsy specimen. Examination revealed an elevated mass on the nasal limbus extending intraocularly. White flaky mass occupied approximately 3/7 space of the anterior chamber. Exenteration was performed for control of local lesion. Histopathologic analysis confirmed that intraocular involvement occurs through the emissary vessels near the area of limbus. The case highlights the need for accurate diagnosis and prompt intervention. A brief review of the clinical and histopathologic features of conjunctival squamous cell carcinoma is also presented.     

Expression pattern of sonic hedgehog and effect of topical mitomycin C on its expression in human ocular surface neoplasms

PURPOSE: To examine if the cells of human ocular surface neoplasms express sonic hedgehog (Shh) and the effects of topical mitomycin C on its expression. METHODS: Conjunctival tissues obtained from two normal subjects, two patients with squamous cell carcinoma of the ocular surface (conjunctiva), and one patient with ocular epithelial dysplasia were used in this study. Histological sections were processed for light microscopic immunohistochemical analysis for Shh. RESULTS: Faint immunoreactivity for Shh was detected in basal epithelial cells of limbus, bulbar, and palpebral conjunctival epithelial cells. On the other hand, squamous cell carcinoma cells markedly expressed Shh with positive staining for Patched 1(Ptc), the cell surface receptor of Shh. Similar marked expression of Shh was detected in the patient with ocular epithelial dysplasia, and this Shh expression was almost eliminated following topical mitomycin C treatment. A cell culture experiment was conducted to examine the effect of mitomycin C on Shh expression in a cultured squamous cell carcinoma cell line. CONCLUSIONS: Conjunctival epithelium constitutively expresses a low level of Shh, and its expression increases during malignant conversion of epithelial cells. Reduction of Shh expression might be involved in the therapeutic efficacy of topical mitomycin C for ocular surface epithelial neoplasms.     

Staining of the conjunctiva and conjunctival tear film.

Both the distribution of tear fluid over the conjunctiva and any injury to the conjunctival epithelium can be made visible by instilling a fluorescent solution into the eye and observing with an appropriate combination of excitation and barrier filters. Sulphorhodamine B, which has an orange fluorescence that can be separated from the green natural fluorescence of the ocular tissues, gives a greater contrast than fluorescein. The tear film is seen to cover the surface of the conjunctiva and to be concentrated in its folds. Small circular areas of thin tear film appear transiently in the neighbourhood of the limbus after a blink. Occasional cells stain on the normal conjunctiva, particularly in the interpalpebral area. The density of the staining increases in dry eye conditions. Conjunctival trauma is sensitively revealed by the method, and its healing can be followed. Hard contact lenses are seen to traumatize continually the inferior limbal conjunctiva in symptomless wearers.     

Malignant epibulbar tumours: new strategies in diagnostics and therapy

In this article we discuss the complex diagnostic approaches and therapeutic options for the most important conjunctival malignancies. Conjunctival melanoma can be a diagnostic challenge as it can be difficult to distinguish from benign melanocytic conjunctival tumours. Complete surgical excision accompanied by a coherent adjuvant concept is the key for a curative therapy. Moderate and severe conjunctival intraepithelial neoplasias (CIN) are precancerous lesions and can progress to invasive squamous cell carcinoma. The involvement of large parts of the ocular surface can prevent an R 0-resection. Adjuvant therapeutic concepts are therefore especially important to gain tumour control and preserve the function of the affected eye. Lymphomas are the most common malignant primary tumours of the orbit and ocular adnexa. They can present as primary or secondary tumours of the conjunctiva, the lacrimal gland, the orbital fat, the eye lid or the lacrimal sac. The most common manifestation site of ocular MALT lymphoma is the conjunctiva with 20 - 33 % of all epibulbar lymphomas. More than 75 % of ocular lymphoma patients develop only one lymphomatous lesion. Immunophenotyping allows the exact differentiation between the lymphoma entities. Infectious agents (e.g., Chlamydia psittaci) seem to play a role in the pathogenesis. An overview over radiotherapeutic approaches that are conclusively applicable at the conjunctiva completes the article.     

Inverted mucoepidermoid papillomas of the epibulbar conjunctiva

Juxtalimbal epibulbar inverted papillomas that were locally excised without recurrence developed in two women, aged 42 and 51 at the time of initial presentation. There is only one previous report of this unusual conjunctival neoplasm, which documented involvement of the plical, caruncular, or tarsal conjunctiva. The tumor grew by acanthosis of the surface nonkeratinizing squamous epithelium, with invagination into the underlying connective tissue in the absence of inflammation or a tendency toward keratinization. The initial invaginations may be cystic in character, but solid lobules secondarily originated from their walls to push into the connective tissue. Mucus-producing goblet cells were scattered throughout the lesions; highly distinctive eosinophilic globoid bodies, probably reflecting inspissated mucoid material, were found in the walls of the cysts and entrapped within their secretions. Conjunctival inverted papilloma does not exhibit locally aggressive behavior, does not involve extensive segments of the conjunctival epithelium, and does not display diffuse spread or multicentricity. The authors therefore believe that it should be clearly separated from inverted squamous (Schneiderian) papillomas of the nasal cavity and sinuses.     

Different Types of Conjunctival Papilloma Presenting in the Same Eye

A 31-year-old Black man presented with two oval masses in his right conjunctiva. The tumors were completely excised and histology showed that the inferior lesion was a conjunctival squamous papilloma with pigmentation while the superior one was an inverted conjunctival papilloma, which grew in an endophytic manner. Follow up examination one year later showed no recurrence. Literature search revealed no previous report of simultaneous appearance of these types of papilloma in the same eye. Management of conjunctival squamous papillomas is difficult and is complicated by multiple recurrences in contrast to inverted conjunctival papillomas where no recurrences have been reported after complete excision. Thus, histopathology is an absolute necessity even when papillomas appear in the same eye.     

Massive intraocular invasion of conjunctiva by squamous cell carcinoma--a case report

BACKGROUND: Squamous cell carcinoma of the conjunctiva is a mostly solitary growing tumor located at the limbus region, which seldom invades the eye. We present an unusual case of conjunctival carcinoma with marked intraocular involvement, which appeared primarily as a chronic inflammation with corneal ulcer. CASE REPORT: A 89-year-old female patient was referred to our institution with a suspected ulcus rodens of the cornea. Since one year a refractory conjunctivitis persisted despite of different local treatment. At first presentation, a marked bacterial keratoconjunctivitis with circular necrosis of the conjunctiva, corneal infiltration and perforation was seen. Visual acuity of the right eye was light perception. The left eye was unremarkable. Enucleation of the right eye was performed. Histopathologic examination revealed the diagnosis of squamous cell carcinoma of the conjunctiva with intraocular involvement. There was a marked infiltration of the choroid even behind the equator. No metastases were found. CONCLUSION: Advanced squamous cell carcinoma associated with superinfection may present as a primary inflammatory process. There may be extensive involvement of the choroid. Metastases are probably rare even in advanced cases of this type of carcinoma.