脉络膜转移癌的临床和病理学特点分析

目的探讨脉络膜转移癌的临床表现及组织病理学特点。方法回顾性分析18例经组织病理学检查确诊为脉络膜转移癌患者的临床特征、组织病理学改变和原发肿瘤的来源、组织学分型。结果18例患者中大部分临床表现为严重视力障碍。眼底检查可见后极部视网膜下实性肿物,8例患者伴视网膜脱离。B超和CT检查显示眼内扁平或不规则的实性占位性病变。MRI扫描显示肿块在T1W上呈中高信号,T2W上呈低信号。病理学检查诊断为腺癌11例,鳞癌4例,未分化癌3例。来源于肺癌者10例（55％）,乳腺癌者4例（22％）。结论脉络膜转移癌以视力明显下降、眼底扁平实质性占位病灶为主要临床表现。原发肿瘤以肺癌发病率最高,组织病理学分型以腺癌常见。影像学检查有助于脉络膜转移癌的诊断。     

脉络膜转移癌的眼底表现

目的探讨脉络膜转移癌眼底表现的特点及原发癌的病理分型和预后。方法应用回顾性系列病例研究方法。分析16例20眼脉络膜转移癌患者的临床资料。眼部检查包括视力、眼前节、散瞳眼底、B型超声、彩色眼底照相和荧光素眼底血管造影（FFA）检查。全身检查包括肿瘤标记物筛查,支气管活检,头部、胸部和腹部影像学检查及全身骨扫描等。结果 16例患者中男6例,女10例;年龄31～72岁,平均年龄50.9岁;随诊1～60个月,平均12.6个月。双眼患者4例;单眼患者12例,其中右眼8例,左眼4例。首诊于眼科者9例,其中8例原发癌为肺癌,1例乳腺癌为原发癌。初诊视力：光感者2眼,手动/眼前～0.1者4眼,0.2～0.5者6眼,0.6～1.0者5眼,〉1.0者3眼。裂隙灯显微镜检查：15眼眼前节正常,5眼有继发性青光眼。散瞳眼底检查：19眼可见视网膜下黄白色、扁平隆起的实性肿物,12眼伴有不同程度的渗出性视网膜脱离。B型超声检查结果显示,20眼均为脉络膜实性占位性病变。FFA可见早期脉络膜肿物遮挡背景荧光,晚期可见融合成斑驳样的高荧光。原发癌为肺癌者10例,乳腺癌者4例,直肠腺癌者1例,子宫颈鳞癌者1例。结论脉络膜转移癌眼底表现的特点是视网膜下实性肿物,常伴有渗出性视网膜脱离,可继发青光眼。原发癌病理分型以肺腺癌为主,乳腺癌次之。     

超声检查和眼底血管造影在葡萄膜转移癌诊断中的价值

目的 探讨超声和荧光素眼底血管造影检查在葡萄膜转移癌诊断中的价值。方法 对9例(9只眼)葡萄膜转移癌病例的超声和荧光素眼底血管造影的检查结果进行同顾性分析,其中8例脉络膜转移癌,1例虹膜转移癌。结果 脉络膜转移癌者A超扫描为中-高强度反射且波峰不规则;B超检查为眼球后极部或视盘周围呈扁平状隆起的内回声不均病灶并伴有病灶周围渗出性视网膜脱离;眼底血管造影早期表现为无脉络膜背景荧光的暗区,而后逐渐显现斑点状高荧光,晚期荧光融合增强呈斑驳样。虹膜转移癌者超声生物显微镜检查可见虹膜实质层的广泛增厚隆起,边缘较整齐,内回声较均匀呈中等强度。结论 超声和荧光素眼底血管造影检查在葡萄膜转移癌诊断中具有重要的临床应用价值,尤其对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊。     

36例葡萄膜转移癌的临床表现和影像检查特征

目的 观察葡萄膜转移癌的临床表现和影像检查特征.方法 临床检查确诊的葡萄膜转移癌患者36例43只眼纳入研究.男性21例,女性15例;年龄28～71岁,平均年龄(47.3±10.2)岁;双眼7例,单眼29例.肺癌30例,乳腺癌3例,胃癌1例,未找到原发肿瘤2例.有原发肿瘤病史20例,首诊眼科16例.所有患者均行视力、眼压、裂隙灯显微镜检查及散瞳眼底检查.行眼部B型超声和(或)彩色多普勒超声血流成像(CDFI)检查22例26只眼;荧光素眼底血管造影(FFA)联合吲哚青绿血管造影(ICGA)检查12例12只眼;双眼MRI和(或)CT检查17例22只眼.观察分析患者临床表现和影像检查特征.结果 43只眼中,转移癌位于虹膜者4只眼;睫状体者3只眼;脉络膜者32只眼.玻璃体重度混浊,眼底不能窥见者4只眼.脉络膜脱离32只眼和睫状体3只眼中,眼底单个病灶26只眼,2个及以上病灶9只眼.睫状体和虹膜转移癌表现为睫状体和虹膜上菜花样肉红色或灰白色肿物,表面呈不规则形,肿物内血管丰富.脉络膜转移癌表现为眼底后极部不规则形、圆形灰黄色或灰白色扁平隆起肿物;B型超声和(或)CDFI检查可见后极部扁平形或表面不规则波浪形眼内占位性病变,内回声分布不均匀,瘤体内血流丰富.FFA和(或)联合ICGA检查可见瘤体上有特征性针尖样或点状强荧光;MRI检查可见T1 WI呈与玻璃体一致或稍高信号,T2 WI呈低信号.结论 葡萄膜转移癌以单眼单个病灶多见;大部分位于后极部脉络膜,呈扁平灰黄色隆起.FFA和(或)ICGA检查可见瘤体上有特征性针尖样或点状强荧光;B型超声和(或)CDFI可见扁平不规则实性占位,血流丰富;MRI检查T2 WI呈低信号.     

脉络膜转移癌临床特征的分析

目的 研究脉络膜转移癌的临床特征,以便早期诊断及与其他脉络膜肿瘤进行鉴别诊断.方法 本研究为回顾性系列病例研究.通过病历,收集患者视力检查、裂隙灯显微镜眼前节检查、问接检眼镜眼底检查、荧光素眼底血管造影(FFA)、吲哚氰绿血管造影(ICGA)、相干光断层扫描(OCT)及A超和B超扫描、磁共振(URI)以及胸部CT检查等资料.结果 共5例(9只眼)脉络膜转移癌,单眼1例,双眼4例.男性1例,女性4例;年龄31～56岁,中位数年龄45岁.症状:视力减退4例,视物变形1例.眼部检查:视力≤0.05且<0.3者4只眼;≤0.3且<0.7者2只眼;≥0.7者3只眼.原发癌来自肺癌者3例,乳腺癌1例,胃癌1例.肿瘤转移至眼的时间:2例为眼科首诊发现,3例分别为1年半、4年及5年.眼底特征:脉络膜转移癌表现为黄白色扁平形隆起者比球形隆起更多见,或伴斑驳样色素沉着及视网膜下液体或视网膜脱离.转移癌位于黄斑部和近视乳头者共6只眼,黄斑和赤道部之间3只眼.孤立转移灶5只眼,多个转移灶4只眼.FFA表现为瘤体呈现斑驳样强荧光,晚期有荧光素渗漏.ICGA表现为遮蔽荧光和弱荧光.A超扫描显示转移灶呈现中等不规则内反射.B超扫描显示扁平实质性隆起.眼部MRI显示肿瘤处表现为中等短T1W和短T2W信号.血清肿瘤标志物增高:3例癌抗原分别为16.28 μg/L、4.95μ/L、癌抗原125增高为160.50 kU/L.结论 脉络膜是最常发生转移癌的部位.脉络膜转移癌可发生在原发癌诊断之前,当患者眼底有黄白色扁平形隆起病灶时,尤其是双眼有病灶者,眼A、B超扫描、胸部CT及癌抗原检查以排除来自肺和乳腺的原发癌是很重要的.     

葡萄膜转移癌的临床及影像学分析

目的 总结葡萄膜转移癌的临床及影像学特点.方法 回顾性分析12例葡萄膜转移癌病例,其中11例脉络膜转移癌,1例虹膜转移癌.结果 12例中,男性5例,女性7例.6例原发于肺癌,3例原发于乳腺癌,1例原发于胃癌,2例不明原因.主要症状为出现突然视力下降.11例脉络膜转移,病变均位于眼底后极部.B超检查、CT检查为眼球后极部呈扁平状或多发性较小结节状;MRI检查为T1WI呈等或高于玻璃体的信号,在T2WI中呈低信号.结论 对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊.     

葡萄膜转移癌的临床及影像学分析

目的 总结葡萄膜转移癌的临床及影像学特点.方法 回顾性分析12例葡萄膜转移癌病例,其中11例脉络膜转移癌,1例虹膜转移癌.结果 12例中,男性5例,女性7例.6例原发于肺癌,3例原发于乳腺癌,1例原发于胃癌,2例不明原因.主要症状为出现突然视力下降.11例脉络膜转移,病变均位于眼底后极部.B超检查、CT检查为眼球后极部呈扁平状或多发性较小结节状;MRI检查为T1WI呈等或高于玻璃体的信号,在T2WI中呈低信号.结论 对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊.     

葡萄膜转移癌的临床及影像学分析

目的 总结葡萄膜转移癌的临床及影像学特点.方法 回顾性分析12例葡萄膜转移癌病例,其中11例脉络膜转移癌,1例虹膜转移癌.结果 12例中,男性5例,女性7例.6例原发于肺癌,3例原发于乳腺癌,1例原发于胃癌,2例不明原因.主要症状为出现突然视力下降.11例脉络膜转移,病变均位于眼底后极部.B超检查、CT检查为眼球后极部呈扁平状或多发性较小结节状;MRI检查为T1WI呈等或高于玻璃体的信号,在T2WI中呈低信号.结论 对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊.     

葡萄膜转移癌的临床及影像学分析

目的 总结葡萄膜转移癌的临床及影像学特点.方法 回顾性分析12例葡萄膜转移癌病例,其中11例脉络膜转移癌,1例虹膜转移癌.结果 12例中,男性5例,女性7例.6例原发于肺癌,3例原发于乳腺癌,1例原发于胃癌,2例不明原因.主要症状为出现突然视力下降.11例脉络膜转移,病变均位于眼底后极部.B超检查、CT检查为眼球后极部呈扁平状或多发性较小结节状;MRI检查为T1WI呈等或高于玻璃体的信号,在T2WI中呈低信号.结论 对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊.     

葡萄膜转移癌的临床及影像学分析

目的 总结葡萄膜转移癌的临床及影像学特点.方法 回顾性分析12例葡萄膜转移癌病例,其中11例脉络膜转移癌,1例虹膜转移癌.结果 12例中,男性5例,女性7例.6例原发于肺癌,3例原发于乳腺癌,1例原发于胃癌,2例不明原因.主要症状为出现突然视力下降.11例脉络膜转移,病变均位于眼底后极部.B超检查、CT检查为眼球后极部呈扁平状或多发性较小结节状;MRI检查为T1WI呈等或高于玻璃体的信号,在T2WI中呈低信号.结论 对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊.     

A case of diode laser photocoagulation in the treatment of choroidal metastasis of breast carcinoma

To report a single case of improvement on choroidal metastasis of breast cancer after laser photocoagulation. A 52-year-old female patient who complained of visual disturbance of the right eye with multiple states of metastasis of breast carcinoma. On initial examination, the right best-corrected visual acuity was 0.63. Right fundoscopy revealed an elevated mass-like lesion temporal to the macule with serous retinal detachment. The mass had a 3.5-disc diameter. A right fluorescein angiogram revealed hypofluorescence during the prearterial and arteriovenous phase and hyperfluorescence during the venous phase. The venous phase showed almost total masking of background choroidal fluorescence at the elevated lesion because of leakage and neovascularization. The patient was treated 4 times by diode laser photocoagulation in addition to chemotherapy. Fifty days after the diode laser treatments, the funduscopy examination and fluorescein angiogram revealed that the serous retinal detachment had been absorbed, the choroid had become flat, the lesion had been reduced in size and hyperfluorescence. The right best-corrected visual acuity was improved to 0.8. Laser photocoagulation appears not to cause any problems for the patient and may be an efficient treatment for patients with choroidal breast carcinoma.     

Metastatic adenocarcinoma with rupture through the bruch membrane simulating a choroidal melanoma

PURPOSE: To report a case of adenocarcinoma metastatic to the choroid with rupture through the Bruch membrane, thus, simulating a choroidal melanoma. METHODS: Interventional case report. Evaluation in a university-based clinic, including a complete eye examination, fluorescein angiography, and ultrasonography; oncological evaluation; and eventual enucleation with histopathological study, including immunohistochemical stains. RESULTS: A 62-year-old Hispanic female presented with visual loss, right eye, of short duration because of a choroidal mass with retinal detachment. Ultrasonography showed a dome-shaped lesion with an eccentric collar-button projection and medium internal reflectivity, which suggested a choroidal melanoma. Initial systemic evaluation was negative. Severe pain necessitated enucleation, RE, and histopathology of the choroidal mass demonstrated an adenocarcinoma. Further examination revealed a left, upper lobe, nonsmall cell lung carcinoma. CONCLUSION: Metastatic choroidal tumors may present, although rarely, with collar-button configurations.     

Electron microscopic demonstration of hormone-producing metastatic carcinoma of the choroid from the bronchus.

Clinical, laboratory and pathological findings of a patient in bronchial carcinoma with choroidal metastasis were presented. X-ray examination of the chest suggested the tumor shadow in the posterior segmental bronchus of the right upper lobe of the lung (r-B2b), while funduscopy and fluorescein angiography revealed the presence of choroidal tumor. ACTH levels in tumor tissues at autopsy and in serum were measured and definitely demonstrated and elevated. Histopathologically, the primary lesion was r-B2b and diagnosed as a mucocellular type of adenocarcinoma. The choroidal lesion was metastatic carcinoma. Electron microscopic examination of the choroidal lesion reembedded for electron microscopy from celloidin-embedded materials for light microscopy could reveal the presence of characteristic cytoplasmic granules referred to as neurosecretory-type granules. It is extremely rare that a hormone-producing metastatic carcinoma of the choroid from the bronchus has been proved.     

脉络膜血管瘤误诊病例的临床病理学分析

目的探讨因临床误诊而行眼球摘除的脉络膜血管瘤的临床和病理特征。方法对本院病理科从1978年至1997年间收检的7例病理检查证实为脉络膜血管瘤但临床误诊的眼球标本及其临床资料进行分析。结果手术前7例中1例被误诊为继发性青光眼绝对期，6例被误诊为脉络膜黑色素瘤。这些病例的临床表现大部分为视力进行性减退，眼底视盘旁扁平隆起的肿物，伴广泛渗出性视网膜脱离。病理证实均为脉络膜海绵状血管瘤，一般呈扁平圆盘状，表面有小灶状或条块状色素沉着斑。结论后极部脉络膜扁平形肿物是本组脉络 膜血管瘤患者的临床病理学特征，应注意与脉络膜黑色素瘤鉴别。(中华眼底病杂志,1999,15:91-93)     

Choroidal metastasis from submandibular salivary gland adenoid cystic carcinoma.

A case of choroidal metastasis from an adenoid cystic carcinoma ofsubmandibular salivary gland is described. A 50-year-old woman with loss of vision in her left eye for 1 week was evaluated clinically, radiologically, and pathologically. A fundus image of the left eye showed an amelanotic, plateau-shaped choroidal mass measuring 17 x 12 X 4 mm with overlying exudative retinal detachment. A choroidal biopsy was consistent with metastatic adenoid cystic carcinoma from her submandibular salivary gland treated 5 years previously. She was treated with external beam radiotherapy but developed liver and lung metastases 3 months later and died within 1 month. All of the metastases demonstrated a basaloid histologic variant of adenoid cystic carcinoma that is known for its aggressive potential. Salivary gland carcinoma rarely metastasizes to the choroid; however, evaluation of patients with this carcinoma should include ophthalmic examination.     

Just another metastatic carcinoid tumour to the uveal tract

We describe the clinic, image, and histopathologic features of a well differentiated neuroendocrine carcinoma (carcinoid tumour) metastatic to choroid and ciliary body in a 52-year-old Mexican Mestizo man. The ophthalmologic examination showed an inferior choroidal mass accompanied by exudative retinal detachment. Ultrasound B-Scan study revealed a diffuse thickened choroid with overlying serous retinal detachment, ultrasound A-Scan revealed a high internal reflectivity solid lesion. Ultrasound biomicroscopy (UBM) evidenced a dome shaped ciliary body mass, presumptive diagnosis was uveal tract metastatic disease. Scleral flap choroidal incisional biopsy was performed. Microscopic evaluation demonstrated a hypercellular lesion replacing choroid, composed by cohesive oval-round cells with finely granular chromatin arranged in organoid pattern. Immunohistochemical reactions were Pankeratin AE1/AE3 (+), Cytokeratin CK5/6 (+), Chromogranin A (+), Ki67 (20%), typical well differentiated neuroendocrine carcinoma (carcinoid tumour) was diagnosed. Patient had a mediastinal carcinoid diagnosed 3?years earlier. Metastatic cancer to the eye is perhaps the leading cause of intraocular tumour, despite this fact metastases are rarely seen by the ophthalmologist while the patient is alive. Intraocular metastasis should be considered in the presence of ciliary body or/and choroidal amelanotic or pigmented mass and serous retinal detachment in a patient with history of carcinoid tumor, althought its low frequency (2.2%).     

Presumed eccrine carcinoma metastatic to the choroid

The purpose of this article is to describe a patient with presumed choroidal metastasis from an eccrine adenocarcinoma of the scalp. A 45-year-old Caucasian woman presented with decreased visual acuity. Ophthalmologic examination was unremarkable. Her past medical history was significant for eccrine carcinoma of the scalp. The patient developed bilateral cervical lymph node metastases, and received chemotherapy and radiotherapy. She had recurrence of the scalp lesion and developed bone metastasis. The patient was again referred to an ophthalmologist owing to reduced visual acuity. Multiple choroidal metastases were detected in right eye, and one metastatic lesion in left eye. The patient passed away 2 months after choroidal metastases. This is the first report of choroidal metastases from an eccrine carcinoma. This is a rare aggressive neoplasm with poor outcome in most cases of metastatic disease, and in this case report, uveal metastasis was indicative of poor prognosis.