葡萄膜黑素瘤

葡萄膜黑素瘤是成年人中最常见的眼内原发性恶性肿瘤。但东方人的葡萄膜黑素瘤发病率明显低于白种人。因此,西方国家对葡萄膜黑素瘤的治疗更为先进。先进的诊断方式如超声波检查法、CT扫描和核磁共振使肿瘤的诊断更准确。近年来,对葡萄膜黑素瘤的处理有相当大的改变。尽管在过去的100多年中一直认为摘     

葡萄膜恶性黑色素瘤的临床治疗体会

葡萄膜恶性黑色素瘤是成年人最常见的原发性眼内恶性肿瘤.该肿瘤多由葡萄膜内的黑色素细胞或色素痣恶变而来,单眼发病多,脉络膜最为多见,自种人发病率较高. 1 体格检查要点 1.1 视力:可因眼内出血、视网膜脱离以及肿瘤直接侵犯黄斑区致视力下降.     

全身性非霍奇金淋巴瘤表现类似眼内原发性眼内淋巴瘤1例

目的:报道1例全身性非霍奇金淋巴瘤的罕见临床表现及组织病理检查,且非常类似原发性眼内淋巴瘤的病例。设计:观察性病例报道。方法:1例58岁女性患者患有全身性非霍奇金淋巴瘤,并行治疗,2年后其左眼出现视网膜下损害并有眼内炎表现。结果:行诊断性眼球摘除术,组织病理检查提示与原发性眼内淋巴瘤的表现一致,瘤细胞侵及视网膜内、视网膜下及视网膜色素上皮下,脉络膜未累及。结论:全身性非霍奇金淋巴瘤可以发生远处转移,其表现类似原发性眼内淋巴瘤。出现视网膜下浸润及眼内炎表现的患者,进行鉴别诊断时应考虑非霍奇金淋巴瘤。全身性非霍奇金淋…     

原发性睫状体黑色素瘤1例

葡萄膜的恶性黑色素瘤是成年人最多见的眼内肿瘤,多见于50-60岁患者[1],85%的葡萄膜黑色素瘤发生于脉络膜,其次为虹膜,发于睫状体的黑色素瘤较罕见[2].我科于2008年10月收治1例原发性睫状体黑色素瘤患者,现报告如下.     

精神恐惧导致葡萄膜出血一例报告

眼球内在的炎症、眼球受伤受震、眼内压增高等造成葡萄膜出血并不为奇,但精神恐惧导致葡萄谈出血尚属罕见,兹报告一例。     

关于眼内与眼眶淋巴瘤并发的病例报道

背景:眼内与眼眶淋巴瘤并发的情况极为罕见。累及眼周的淋巴增生性疾病可以是良性淋巴增生,亦可见恶性淋巴瘤。眼内淋巴瘤的发生往往与原发性中枢神经系统淋巴瘤并发。病例报道:报道3例脉络膜与眼周淋巴瘤并发患者的临床特征,标准A、B超声图像、彩色多普勒、计算机断层扫描和磁共振图像及免疫组织学检查结果。讨论:弥漫性脉络膜肿瘤的临床表现变化多样,仅依据临床表现诊断眼内淋巴瘤是困难的。准确性较高的彩色多普勒图像在鉴别肿瘤良恶性方面是有效的,并为低回声病变的鉴别诊断提供了有价值的信息。本研究认为,使用如超声、彩色多普勒等辅…     

脉络膜黑色素瘤手术患者的临床护理体会

脉络膜黑色素瘤为葡萄膜中常见的恶性肿瘤,是成年人最常见的眼内恶性肿瘤,多见于50～60岁,常为单侧性,与性别或左右眼无关,可以发生于脉络膜的任何部位,但常见于眼的后极部.主要起源于葡萄膜组织内的色素细胞和痣细胞.     

葡萄膜色素性肿瘤的诊断及术式选择

葡萄膜色素性肿瘤的诊断及术式选择张子英，杨美玲，王保君，陆丽红葡萄膜色素性肿瘤是成年人最常见的眼内肿瘤，恶性黑色素瘤的发病率高于黑色素细胞瘤，二者皆可发生于前后葡萄膜，但形态学不易鉴别。葡萄膜色素性肿瘤良恶鉴别及术式的选择至关重要。作者对１９８３年以...     

一例原发性眼内淋巴瘤患者出现完全相同的双眼单克隆基因

目的:报道1例原发性眼内淋巴瘤患者,其双眼的免疫球蛋白重链(IgH)基因的单克隆重排完全相同。设计:观察性病例报道。方法:1女性患者,78岁。患双眼玻璃体炎,右眼视网膜下浸润,中枢神经系统(CN S)未受累。右眼行经玻璃体视网膜下活检,组织病理学诊断为弥漫性大B细胞淋巴瘤。1月后,左眼玻璃体混浊加重,行玻璃体切除术。提取双眼玻璃体标本中的D NA,用聚合酶链反应及直接测序法分析IgH基因的第三补体决定区。结果:在双眼检测到了D N A行列相同的IgH基因单克隆重排。结论:本例未累及CNS的原发性眼内淋巴瘤患者,其双眼的单克隆化完全相同…     

萄葡膜黑色素瘤摘除术的评价

治疗葡萄膜黑色素瘤和视网膜母细胞瘤长期以来摘除术为标准的方法。虽然未作治疗的视网膜母细胞瘤的病程以及这种肿瘤的早期诊断和迅速治疗对挽救生命的重要性已有文章充分提及,但对葡萄膜黑色素瘤来说不是同样正确的。葡萄膜黑色素瘤摘除术的理由是假设多于临床资料根据,这种假设认为恶性葡萄膜黑色素瘤像皮肤的黑色素瘤一样,在其病程的早期就可能产生转移病变。虽然在上一世纪对葡萄膜黑色素瘤的研究已有大量报告,但仍然没有关于未作治疗的肿瘤其自然过程的报导。1882年Fuchs指出所有眼内黑色素瘤均用摘除术治疗。人们常引证Fuchs仅有6％的治愈率,但94％死亡的证据不能加以解释。虽然现在治疗上已有很多新的方法,但我们的注意集中在摘除术获得的结果,唯一重要的标准是:摘除术后病人是否继续生存或者由于转移病变的结果而死亡,以及手术     

原发性眼附属器非霍奇金淋巴瘤的特征

目的:探讨原发于眼附属器非霍奇金淋巴瘤的临床表现与病理特征.方法:对18例住院手术并经病理学检查确认为原发于眼附属器非霍奇金淋巴瘤患者的临床资料进行回顾性分析,对该病发生部位、临床及影像学表现、病理学特征进行总结.结果:全部患者均表现为眼部占位性病变,其中发生于眼眶者12例(含泪腺3例),占66.7%;发生于结膜者3例,占16.7%;发生于下睑者3例,占16.7%.全部病例中,8例患者被临床和影像学检查误诊为"炎性假瘤".8例被诊为眼部占位性病变性质待查.经病理学检查,16例(88.9%)诊断为黏膜相关淋巴组织型的结外边缘带B细胞淋巴瘤,2例诊断为NK/T细胞性非霍奇金淋巴瘤.结论:原发于眼附属器的非霍奇金淋巴瘤主要表现为无痛性肿块,多发生于眼眶,临床和影像学确诊难度大,大多数糖皮质激素治疗有效,容易被误诊为"炎性假瘤".黏膜相关淋巴组织B细胞淋巴瘤是最常见的病理类型.     

Primary lymphoma of bone

Primary lymphoma of bone is a rare clinical entity that accounts for less than one per cent of all non-Hodgkin's lymphomas. Although they occasionally present as a solitary lesion in bone, lymphoma involving bone is a manifestation of disseminated disease in many instances. All patients initially found to have a solitary lymphoma of bone need to be thoroughly investigated for systemic disease because more than half of the patients presenting with initially solitary bone lesions are found to have systemic disease involving lymph nodes and/or other organs. Choice of therapeutic management is based on the stage of disease. Stage I-E primary lymphoma of bone can be controlled in 70-90% of cases using local radiation therapy alone if adequate radiation doses are used. Patients with advanced disease should be treated with combination chemotherapy in addition to local radiotherapy. Loeffler et al reported long-term survival results of 90% 8-year actuarial overall survival rate for children with primary lymphoma of bone who received combined therapy with radiation and chemotherapy (adriamycin, prednisone and oncovin). The actuarial lymphoma-free survival rate was 100% at eight years. Regardless of stage of the disease, radiation treatment to the primary tumor appears to be critical for adequate local control of disease as well as rapid symptomatic relief.     

Metastatic tumor to the iris and ciliary body as an initial sign of lung cancer: a case report

The most common sites of lung cancer metastases are pleura, bone, brain,pericardium and liver. Tumor metastasis to the eye is a rare complication of lung cancer. Metastatic cancer to the ocular region most often involves the uveal tract, however, most uveal metastases occur in the posterior uvea, and iris metastases are relatively rare. We describe a patient with adenocarcinoma of the lung metastatic to the iris as the first clinical sign without symptoms of lung cancer.     

Melanoma of unknown origin: a case series

Introduction  

The natural history of metastatic melanoma involving lymph nodes, in the absence of a known primary site (cutaneous, ocular or mucosal) has, to date, been poorly defined; and the optimal management of this rare subtype of disease is therefore unclear. Melanomas of unknown primary site (MUP) are estimated to comprise between 3.7 and 6% of all melanomas (Anbari et al. in Cancer 79:1861–1821, 1997).     

眼附属器淋巴造血组织增生性疾病临床病理分析

目的：探讨眼附属器淋巴造血组织增生性疾病的临床病理学特征。方法回顾性分析210例首都医科大学附属北京同仁医院眼附属器淋巴造血组织增生性疾病患者的临床资料和临床病理资料。结果①该组眼附属器淋巴造血组织增生性疾病中最常见的是非霍奇金淋巴瘤（100例,47.6%）,其次为炎性假瘤（45例,21.4%）和良性淋巴上皮病变（Mikuliczs 病,41例,19.5%）。②该组病变部分类型在发病年龄和性别上有特点,组织病理学上的表现有交叉。③该部位非霍奇金淋巴瘤中最常见的为结外黏膜相关组织边缘区 B 细胞淋巴瘤（74例）,眼附属器的结外黏膜相关组织边缘区 B 细胞淋巴瘤有其不同于其他解剖部位的该肿瘤的特点。④免疫组织化学染色在该部位淋巴造血组织增生性疾病的诊断和鉴别诊断中有非常重要的作用。⑤眼附属器的 IgG4相关性疾病（10例）的诊断和临床病理表现有其独有的特征。结论眼附属器淋巴造血组织增生性疾病是一类比较常见的疾病,其在发病年龄、性别等临床表现和组织学类型上都具有明显的临床病理学特征,掌握这些对临床病理诊断将提供较大的帮助。     

可调整缝线与小梁切除术治疗闭角型青光眼的临床研究

目的研究可调整缝线在青光眼滤过术中的作用及常规小梁切除术与可调整缝线在原发性闭角型青光眼的疗效。方法对原发性闭角型青光眼作随访观察。原发性闭角型青光眼76例87只眼,分为治疗组A和对照组B。所有的对照组均行常规小梁切除术,所有治疗组在常规小梁切除术的基础上加可调整缝线。观察术后眼压、视力、前房、滤过泡、视野等情况,平均随访时间10个月。结果所有治疗组和所有对照组的术后6个月浅前房发生率、眼压控制率、功能性滤泡比例差异,有统计学意义。视野没有明显差异。结论可调整缝线在小梁切除术中的应用,可明显减少术后浅前房的发生率,有远期较好的眼压控制率及功能性滤泡形成率,是一种比较好的手术方式。     

Intraocular involvement of T-cell lymphoma presenting as inflammatory glaucoma,neurotrophic keratopathy,and choroidal detachment

Intraocular involvement of T-cell lymphoma is rare. We report a case presented with inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment. An 81-year-old man presented with unilateral high intraocular pressure and keratic precipitates. Polymerase chain reaction of the aqueous humor was negative for herpes simplex virus type 1 and 2, varicella zoster virus, and cytomegalovirus. Progressive pupil dilatation, cornea anesthesia with large epithelial defect, and choroidal detachment were noted in the following month. Diagnostic vitrectomy was then performed, and cytology of the vitreous suggested malignant lymphoma. Further systemic workup revealed ulcerative lesions in the stomach, and biopsy with special stains led to the diagnosis of peripheral T-cell lymphoma of the stomach with ocular involvement. Intraocular involvement of T-cell lymphoma is very rare. Most typically, the skin, followed by the central nervous system, has the most frequently occurring concurrent systemic involvement. In fact, stomach involvement has not been reported. Most cases of intraocular lymphomas presented with vitritis and anterior uveitis, and elevated intraocular pressure was not commonly observed. A review of the literature indicates that a large corneal epithelium defect has been described only in a case of peripheral T-cell lymphoma with the involvement of sclera and oropharynx. Although very rare, inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment can be the initial presentation of intraocular involvement of T-cell lymphoma.     

Bilateral primary renal lymphoma

Background Primary renal lymphoma is rare with no well-defined diagnostic criteria. Aim To describe the first reported case of bilateral and primary renal lymphoma and describe diagnostic criteria. Result and conclusion If a diagnosis of primary renal lymphoma is to be considered, then specific diagnostic criteria (as outlined) must first be satisfied.     

原发性肺淋巴瘤三例报道并文献复习

目的探讨原发性肺淋巴瘤的临床特点、诊断和治疗方法。方法回顾性总结原发性肺淋巴瘤3例,并结合文献对其临床表现、影像学特点、诊断及治疗方法进行分析。结果原发性肺淋巴瘤罕见,无特异性临床表现和影像学改变,易误诊。其主要症状为咳嗽、发热等。影像学可表现为单发或多发结节或片状影甚至实变,常见有充气支气管征。确诊依靠开胸手术、胸腔镜或经皮肺穿刺获取组织,结合病理学和免疫组化检查。主要治疗手段为化疗。结论及时进行有创检查有利于早期诊断原发性肺淋巴瘤。     

Primary lymphoma of the gallbladder.

A case of primary lymphoma of the gallbladder is described which is rare in the medical literature. A 76 year old man presented with acute cholecystitis and septicaemia. Investigation showed a lung abscess and a gallbladder mass. The mass was thought to be an empyema and cholecystostomy was performed. Biopsy of the gallbladder wall showed high-grade B cell lymphoma. The patient unfortunately succumbed to overwhelming septicaemia in the postoperative period. Postmortem examination confirmed primary lymphoma of the gallbladder without dissemination.