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。     

日光性角化病、翼状胬肉以及结膜的鳞状细胞癌地理分布的探讨

有些作者认为,结膜的鳞状细胞癌在非洲比气候温和的地区更常见,提示了这些肿瘤是由前已存在的病变经紫外线长期辐射而发生的。这些病变通常诊断为睑裂斑或翼状胬肉,其特点为靠近角膜缘呈楔形肥厚的混浊,从球结膜可伸展到角膜上。病理组织学通常将这种损害描述为日光性角化病,以及上皮异常或发育不良。作者在非洲马拉维对234例进行结膜活检,     

表现为角膜溃疡的结膜上皮原位癌

眼表面的鳞状瘤表现形式不同 ,可表现为良性异常增生 ,也可发展为浸润性鳞状细胞癌 ,单纯依靠临床表现很难区分结膜上皮原位癌和鳞状细胞癌。结膜上皮原位癌呈白色半透明的珍珠状 ,也可呈凝胶状或乳头状外观 ,多发生于角膜缘附近睑裂部球结膜。损害较小的病人多无症状 ,但如病变较大或角质化损害可引起眼部刺激症状 ,疼痛 ,少数病人有视力模糊。作者报告一例年轻的结膜上皮原位癌患者 ,其病变发生于角膜缘而表现为角膜溃疡。患者 ,男性 ,2 8岁 ,突然右眼疼痛 ,发红 ,流泪而初步诊断为浸润角膜的翼状胬肉。该患者已局部应用 0 3 %庆大霉素眼…     

局部应用干扰素α-2b治疗原发性角结膜上皮内肿瘤

角结膜上皮内肿瘤 (ＣＩＮ)也称为上皮瘤、角膜缘乳头瘤、上皮斑、Ｂｏｗｅｎ氏病、上皮角化病、角膜缘上皮瘤、结膜胼胝病、结膜硬皮病等 ,是一类位于眼表的癌前病变 ,它具有潜在低度恶性变的可能 ,是鳞状上皮细胞癌的前体。目的 :本文采用局部单独应用干扰素α 2ｂ(ＩＦＮα 2ｂ)治疗拟原发性角结膜上皮内肿瘤并评价其疗效。方法 :作者对 1 999年 2月至 1 0月期间诊断为拟原发性ＣＩＮ的 7例病人 ,进行干扰素α～ 2ｂ眼药水 ( 1 0 0万单位 /ｍｌ)局部点眼治疗。每天 4～ 6次 ,每两周复诊一次 ,直到通过裂隙生物显微镜检查ＣＩＮ病变完全临…     

定量测定DNA含量在角膜结膜上皮性肿瘤诊断中的意义

目的测定角膜结膜上皮性肿瘤中的DNA含量,并分析其在角膜结膜上皮性肿瘤诊断及鉴别诊断中的意义。方法用流式细胞术测定30例角膜结膜上皮性肿瘤石蜡标本(乳头状瘤10例、非典型增生8例、鳞状上皮癌12例)的DNA含量。结果乳头状瘤,非典型增生和鳞状细胞癌的DNA指数(DI)均值分别为1.01,1.38和1.75;其DNA异倍体率均值分别为10%,37.5%和91.7%;其S期百分比(SPF)均值分别为13.87%,24.18%和33.97%。在不同病变中,其DI值,DNA异倍体率及SPF均有统计学显著性差异(P<0.05)。结论应用流式细胞术进行DNA定量分析,对提高角膜结膜上皮性肿瘤的早期诊断率有一定的意义。     

复发性角膜缘型结膜鳞状上皮乳头状瘤1例及文献回顾

结膜乳头状瘤是结膜上皮组织呈乳头状增生的良性肿瘤,根据发病部位可分为结膜型和角膜缘型。结膜型多见,好发于儿童或青少年;角膜缘型少见,好发于中老年人,过度增生有演变成鳞状上皮细胞癌的可能。结膜乳头状瘤发病原因与人乳头状瘤病毒(HPV)感染有关,而HPV在结膜鳞状上皮细胞癌的发生过程中也起着重要作用。因此对结膜乳头状瘤患者进行常规HPV检测对于治疗和随访是非常重要的。手术切除是结膜乳头状瘤基本的治疗方法,但单纯手术切除复发率高,目前采用多种方法防治复发,包括冷冻及电灼、细胞毒药物及干扰素的应用。我们报道了成功应用多种方法综合治疗1例复发性角膜缘型鳞状上皮乳头状瘤的病例。     

角膜鳞状上皮癌

眼球表面肿瘤中,临床上以角膜、结膜上皮起源的恶性肿瘤多见,也最重要,按照病理组织的改变可分为鳞状上皮癌、基底细胞癌,基底鳞状细胞癌(混合型),而以鳞状上     

结膜印痕检查法及其临床应用

正常角结膜上皮细胞为非角化鳞状上皮,其中杯状细胞能产生粘液,参与泪膜的组成。角结膜上皮非角化并产生粘液的特性,对于维持眼球表面组织的完整性至关重要。分泌性或非分泌性的非角化上皮细胞转变成角化的上皮细胞的病理过程称为鳞状上皮化生。许多作者的研究结果表明,这种病理变化存在于许多眼球表面疾患之中,而在临床上处理这类疾患时,对病变程度的精确估计又是十分重     

共聚焦显微镜在活体角膜上皮肿瘤鉴别诊断中的应用

目的 通过活体共聚焦显微镜在角膜上皮肿瘤诊断中的应用,分析、鉴别角膜上皮肿瘤性质.方法 7例角膜上皮肿瘤患者术前均行常规眼部裂隙灯检查、眼前节OCT和活体共聚焦显微镜检查.所有患者均实施角膜肿瘤切除术,术后行肿瘤组织病理学检查,与术前共聚焦显微镜结果比较.结果 7例角膜上皮肿瘤均侵犯透明角膜、角膜缘和球结膜,突起于眼球表面,形状似桑葚,血管丰富.在眼前节OCT检查中5例角膜肿瘤显示密度均匀,与角膜组织之间界限清晰,浅层基质中未见肿瘤密度影;另外2例角膜肿瘤显示,密度不均,与角膜组织界限不清,而且侵犯前弹力层和浅层角膜基质.在活体共聚焦显微镜中7例均显示角膜上皮细胞非典型增生,其中2例非典型增生明显,侵犯前弹力层,在角膜上皮层和浅基质层内形成“癌巢”,5例诊断为角、结膜乳头状瘤,2例诊断为角膜鳞状上皮细胞癌,与术后组织病理学诊断结果一致.结论 活体共聚焦显微镜检查对角膜上皮肿瘤术前诊断肿瘤性质提供重要依据.     

The intraoperative use of mitomycin-C in excision of ocular surface neoplasia with or without limbal autograft transplantation.

PURPOSE: To evaluate the efficacy of intraoperative mitomycin-C in excision of ocular surface neoplasia for prevention of recurrence. METHODS: Seven patients (eight eyes), three men and four women, aged 56 to 87 years (mean, 73.8 years), with lesions suspicious for corneal or conjunctival neoplasia, were operated on between October 1998 and March 2000. During excision of the lesion, mitomycin-C 0.02% was applied intraoperatively for 5 minutes. In two cases, excision was combined with conjunctival limbal autograft transplantation. All excised lesions were sent for histopathologic evaluation. RESULTS: During the follow-up period ranging from 6 to 28 months (mean, 16 months) one patient (one eye) died of an unrelated cause. Histopathologic study showed four cases of squamous cell carcinoma, one case of carcinoma in situ, two cases of dysplasia, and one case of actinic keratosis. Of the eight eyes, no clinical recurrence of the lesion occurred in seven eyes, whereas one eye with squamous cell carcinoma showed mild recurrence 5 months after surgery and was successfully treated with topical mitomycin-C. Up to the last follow-up of this case 10 months later, the lesion did not recur. CONCLUSION: The excision of conjunctival and corneal epithelial neoplasia combined with the intraoperative use of mitomycin-C seems to reduce the recurrence rate. The combined use of mitomycin-C and conjunctival limbal autograft transplantation in two cases did not alter the surgical outcome. More cases and a longer follow-up are needed to establish the efficacy of such an approach.     

Complications of mitomycin C therapy in 100 eyes with ocular surface neoplasia

AIM: To determine the complications associated with mitomycin C (MMC) in the treatment of ocular surface neoplasia. METHODS: A retrospective and consecutive study of 100 eyes in 91 patients with ocular surface neoplasia treated with MMC in a single centre between November 1998 and January 2005. Outcome measures included complications of MMC and the treatment required for these complications. RESULTS: One to three 7 day cycles of topical MMC 0.04% four times a day were given to 59 eyes with localised corneal-conjunctival intraepithelial neoplasia (CIN), 19 eyes with diffuse CIN, six eyes with recurrent CIN, one eye with ocular surface squamous cell carcinoma, three eyes with primary acquired melanosis (PAM) with atypia, nine eyes with conjunctival malignant melanoma (MM), two eyes with sebaceous carcinoma with pagetoid spread, and one eye with recurrent atypical fibroxanthoma. Nine patients had bilateral CIN. 31 (34%) cases developed an allergic reaction to MMC and 14 (14%) eyes had epiphora secondary to punctal stenosis at a mean follow up period of 26.5 months. CONCLUSION: In the largest study looking at complications of topical MMC in the treatment of ocular surface neoplasia, allergic reaction and punctal stenosis are relatively common. Serious complications were not observed suggesting the safe use of MMC in mid-term follow up.     

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。     

发展中地区的结膜上皮内瘤

目的:回顾尼日利亚东南部结膜上皮内瘤(CIN)的人口统计学及其它方面的特点。方法:回顾分析了1970/2000尼日利亚东南部一家中心实验机构有关CIN的组织病理学记录。结果:共有来自6所医院的12名医生报告了27例CIN组织病理记录,包括14例男性患者和13例女性患者。平均年龄为46.8岁,50～69岁组发病率最高。CIN多发生在颞侧或鼻侧缘,持续时间从1a以内(15例,55.6%)到10a(1例,3.7%)。仅有5例在CIN切除以后出现复发生长。结论:CIN主要见于黑人患者的水平缘部位,男女患者比例相当。眼科医生应对其尽早实施有效的治疗。     

Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours

PURPOSE: To evaluate the long-term results of combined treatment with excision and cryosurgery for malignant epithelial tumours of the conjunctiva. METHODS: We retrospectively reviewed the medical records of patients diagnosed with conjunctival malignant epithelial tumours and treated with excision and cryosurgery between 1980 and 1998. The demographic features of the patients, characteristics of the tumours, and the peculiarities of the recurrences were recorded. The SPSS V 9.05 computed program was used for the statistical analysis of the results. Kaplan-Meier plots were used to determine the recurrence-free survival, and the logrank test was used to compare the recurrences according to histological classification. RESULTS: A total of 55 subjects (57 eyes), 19 female and 36 male, were included in the study. Their ages ranged between 15 and 82 years (mean 55+/-14 years). Histological diagnosis was conjunctival intraepithelial neoplasia (CIN) in 26 (46%) and invasive squamous cell carcinoma (SCC) of the conjunctiva in 31 eyes (54%). All eyes were treated with excision and cryosurgery with nitrous oxide probe. During the follow-up period of 6 months to 15 years, seven (12.3%) recurrences were observed. The success rate for patients with CIN and invasive SCC was 88.5 and 87.1%, respectively. There was no difference for recurrence rates between CIN and invasive SCC groups according to logrank test (P=0.68). CONCLUSIONS: Over the long-term follow-up, cryosurgery following excision is a successful method in the treatment of conjunctival intraepithelial tumours and invasive squamous cell carcinoma of conjunctiva with favourable outcome and minimal complications.     

Combined intraepithelial squamous neoplasia and atypical fibroxanthoma of the cornea and limbus

PURPOSE: To investigate a case of an unusual neoplasm of the cornea and limbus. METHODS: A 59-year-old man presented with a highly vascularized, nodular mass involving the left cornea and limbus. An excisional biopsy and, subsequently, a superficial lamellar keratectomy and multiple conjunctival biopsies were performed. At the 6-month follow-up examination, repeat conjunctival biopsies were performed. RESULTS: Histopathologic examination of the corneal specimen showed a high-grade intraepithelial squamous neoplasia (in situ carcinoma) overlying an atypical fibroxanthoma. CONCLUSION: We report the clinical and histologic appearance of a corneal/limbal neoplasm consisting of an intraepithelial squamous neoplasia and an atypical fibroxanthoma.     

Expression of p63 in conjunctival intraepithelial neoplasia and squamous cell carcinoma

Background p63 is a homologue of the tumour suppressor gene p53, which is expressed in human basal squamous epithelium. Some investigators maintain that p63 plays a role in the development of squamous epithelium and, despite its homology to p53, it is considered to act as an oncogene. This study investigated the expression of p63 in conjunctival intraepithelial neoplasia of different grades, and conjunctival squamous cell carcinoma and its correlation to the proliferation marker MIB-1. Material and methods Seventeen conjunctival specimens excised with the suspicion of either conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma were diagnosed histologically as follows: 2 squamous cell carcinomas of the conjunctiva, 2 CIN grade I, 3 CIN grade II, 7 CIN grade III, 2 CIN with beginning invasion and 1 normal conjunctiva with no dysplasia. Sixteen microscopically-normal postmortem conjunctival specimens and normal conjunctiva, CIN and carcinoma specimens were stained immunohistochemically with antibodies against p63 and MIB-1. At least 500 cells per specimen were counted and the percentage of positively-stained cells of each antibody was calculated. Results A mean of 80% (57–89%) of the dysplastic cells from the CIN specimens stained positively with antibodies against p63, especially in the lower two-thirds of the epithelium, statistically significantly more compared with the normal specimens (9–55%, mean 36%, p<0.001). Nevertheless, we did not find a correlation between the percentage of p63-positive cells and the differentiation grade of the malignant specimens. MIB-1 positivity was shown by 0–1% of the cells in the normal postmortem controls, by 3–30% (mean 12%) of the cells in the basal and occasionally in the middle layer of the CIN specimens, and 16–61% (mean 23%) in the carcinoma specimens. Conclusion In conjunctival intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, p63 is preferentially expressed in the immature dysplastic epithelial cells. Its staining does not correlate with MIB-1-expression, and therefore does not appear to be linked to cell proliferation.     

眼球表面鳞状细胞肿瘤107例临床分析

为探讨眼球表面鳞状细胞肿瘤（Ｏｃｕｌａｒｓｕｒｆａｃｅｓｑｕａｍｏｕｓｎｅｏｐｌａｓｉａ，ＯＳＳＮ）的分型及临床特点。对赞比亚恩多拉中心医院眼科门诊１０７例眼球表面鳞状细胞肿瘤进行回顾性分析。结果：在１０７例眼球表面鳞状细胞肿瘤中，结角膜上皮内肿瘤（Ｃｏｎｊｕｎｃｔｉｖａｌａｎｄｃｏｒｎｅａｌｉｎｔｒａｅｐｉｔｈｅｌｉａｌｎｅｏｐｌａｓｉａ，ＣＩＮ）５３例，鳞状细胞癌（Ｓｑｕａｍｏｕｓｃｅｌｃａｒｃｉｎｏｍａ，ＳＣＣ）５４例，在ＣＩＮ中，非典型增生（Ｄｙｓｐｌａｓｉａ）４４例，原位癌（Ｃａｒｃｉｎｏｍａｉｎｓｉｔｕ）９例，在ＳＣＣ中，４例侵犯眼球或眼眶。患者多为年轻人，年龄最小１４岁，最大６２岁，平均年龄ＣＩＮ为３４岁，ＳＣＣ为３６岁。女性略多于男性，病变多为早期，较少侵犯眼内。结论：该肿瘤为赞比亚常见眼病，年轻患者多，紫外线照射和感染可能是其主要发病因素；早期诊断、早期手术是治疗本病的关键     

Assoziation von Bindehautneoplasien und HIV-Infektionen in Kinshasa (D. R. Kongo)

BACKGROUND: Conjunctival carcinomas are tumors especially of the 6th/7th decades. They occur in Germany with a frequency of 1/20,000. For years it has been well known that in Africa the number of malignant tumors of the conjunctiva has been increasing. The reasons for that are not well known. HIV is a possible pathogenetic cofactor. METHOD: A histological examination of 34 specimens was performed in Rostock on conjunctival tumors removed at the Ophthalmologic Department of the University of Kinshasa in 2001. The study included 23 female and 11 male patients aged 20-75 years (mean 42). All patients underwent serological investigation for HIV infection. RESULTS: Of 34 patients 18 were HIV positive. Of the HIV-positive patients, six had a squamous cell carcinoma, seven a CIN (conjunctival intraepithelial neoplasia) I-III, and five a pinguecula. Of the HIV-negative patients, five showed a squamous cell carcinoma, eight a CIN I-III, one a pinguecula, one a sebaceous gland carcinoma, and one a papilloma. The average age of the HIV-positive patients with a squamous cell carcinoma was 41 years compared to the HIV-negative patients with 58 years. CONCLUSIONS: There was no difference in frequency of conjunctival intraepithelial neoplasia between HIV-positive or HIV-negative patients. HIV-positive patients with a squamous cell carcinoma were on average 17 years younger. UV radiation is the main risk factor and HIV infection is a possible carcinogenic cofactor. Investigations on additional viral infections as possible pathogenetic factors and on changed tumor suppressor genes are needed.