眼眶内原发性恶性黑色素瘤一例

患者男 ,4 8岁。因左下眼睑肿胀 1个月 ,于 1996年 12月 3日入院。全身检查未见异常。眼部检查 :视力右眼 0 3,左眼 0 4。左下眼睑肿胀 ,皮肤表面呈青蓝色 ,眶外下可触及一光滑软性肿物 ,无粘连及压痛。外下结膜呈青紫色并轻度隆起。眼内及右眼未见异常。Ｂ超检查 :左眶外下占位性病变 ,形状不规则 ,边界不清 ,其内回声中等 ,不均匀。ＣＴ扫描 :左眶外下形状不规则高密度块影 ,边界清 ,其内密度不均匀。同月 7日在局麻下行左前路开眶术 ,切开下穹隆结膜见黑色肿物 ,质软 ,有假包膜 ,同受累骨膜及眶脂肪一并切除。病理诊断 :恶性黑色素瘤。…     

巨大脉络膜恶性黑色素瘤侵犯眼眶1例

临床资料患者 ,男 ,4 1岁。因右眼长肿物 ,不能视物 ,进行性长大4a于 2 0 0 3年 8月 12日来我院就诊。 4a前曾因车祸致右眼受伤 ,在当地医院按右眼视网膜脱离给予药物治疗 (具体不详 ) ,视力无增进 ,肿物进行性增大 ,以后未再进行任何治疗。患者既往体健 ,体查左颌下淋巴结肿     

眼眶恶性黑色素瘤的诊断与治疗

目的 探讨眼眶恶性黑色素瘤的发病情况、临床表现、影像学特征、病理特点及其治疗.方法 回顾分析1999年1月至2006年12月就诊的眼眶恶性黑色素瘤患者.结果 眼眶恶性黑色素瘤最常见的症状为眼球突出及眼睑皮下肿物伴眼睑肿胀;最常见的体征为眼球突出、眼球运动受限及眶压升高,其次为眼睑肿胀和扪及皮下肿物;除脉络膜恶性黑色素瘤侵及眼眶者外,患侧眼底多无明显改变.彩色多普勒血流显像示病变区均可见较丰富的血流信号核磁共振检查示,病变区显示特征性的短T1,短T2信号影.病理检查见瘤细胞为圆形、椭圆形、上皮样多角形和梭形等,胞浆内有黑色素沉着;免疫组化示黑色素相关抗原(HMB45)和S-100蛋白均呈阳性.全部病例均手术治疗,经随访0.5～6年,半数无复发及转移.结论 眶内恶性黑色素瘤较少见,多由脉络膜、结膜或眼睑蔓延而来,原发者甚为罕见.核磁共振检查的影像特点可做为重要的诊断依据,治疗以手术切除为主.     

脉络膜黑色素瘤眼眶蔓延二例

脉络膜黑色素瘤是眼内较常见的恶性肿瘤 ,但眼眶蔓延并不多见。现报告 2例 ,均有典型的影像学表现。例 1　患者男 ,6 7岁。主诉左眼球突出 2年 ,合并视力下降半年。于 2 0 0 1年 4月来我院就诊。入院检查 :全身情况无异常。眼科检查 :右眼视力 0 .7,左眼无光感 ,左眼球突出 ,轻度下移位 ,结膜水肿部分突出睑裂 ,下方角膜浸润 (图 1) ,眼底不能窥见。眼球突出度测量 :右眼 13mm,左眼 2 7mm,眶距 10 5 mm。眼眶扪诊阴性 ,眼眶压力增高。CT显示左眼眶内充满高密度占位病变 (未见眼内病变 )。标准化 A/B型超声检查显示 :左眼内下方球内扁平实…     

爆裂性眼眶骨折（附3例）

1889年Long首先指出,眼钝挫伤后出现运动受限性眼球陷没而眶缘完整,是由眶底骨折造成【1～2】;Pfeiffer(1942)从放射学现象中首先提出本病的基本机制,Linhart同年用同样的理论解释了内壁骨折。1957年Converse和Smiht,提出本病诊断名称;1978年重申其定义,爆裂性眶底骨折,其眶缘完整伴眶内压增高,眶内坎组织嵌于     

原发性眼眶肿瘤120例临床病理分析

目的:探讨原发性眼眶肿瘤的发病情况及组织学来源,为原发性眼眶肿瘤的诊断提供参考.方法:回顾性分析我院近5a来原发性眼眶肿瘤患者的病历资料,记录患者的性别、年龄、眼别、病理结果.结果:原发性眼眶肿瘤共120例,血管源性肿瘤32例(26.7%),泪腺源性肿瘤28例(23.3%),眼眶囊肿22例(18.3%),神经源性肿瘤19例(15.8%),淋巴瘤6例(5.0%),炎性假瘤5例(4.1%),肌源性肿瘤3例(2.5%),骨源性肿瘤2例(1.7%),其它未明确诊断的3例(2.5%).其中良性肿瘤93例(77.5%),依次为海绵状血管瘤、皮样囊肿、多形性腺瘤、毛细血管瘤、神经鞘瘤、脑膜瘤、炎性假瘤、表皮样囊肿、视神经胶质瘤、骨瘤、血管平滑肌瘤、淋巴管瘤、皮脂腺瘤、血囊肿、泪腺囊肿.恶性肿瘤24例(20.0%),依次为泪腺腺样囊性癌、淋巴瘤、多形性腺癌、横纹肌肉瘤、泪腺腺癌、恶性黑色素瘤.结论:眼眶肿瘤种类繁多,海绵状血管瘤和泪腺腺样囊性癌仍是最常见的良性和恶性原发性眼眶肿瘤.     

脉络膜恶性黑色素瘤的核磁共振表现：附3例报告

脉络膜恶性黑色素瘤的核磁共振表现（附３例报告）华西医科大学附一院眼科宋晋，夏瑞南脉络膜恶性黑色素瘤（ＭＭ）是成年人最为多见的眼内恶性肿瘤。临床早期诊断不易，文献报告误诊率为２．７％－３９．７％［１］。尤其伴有屈光间质混浊时，更易误诊。近年来，核磁共振...     

眼颧部褐蓝痣合并眼眶恶性黑色素瘤一例

患者女 ,36岁。因右眼突出 ,视力渐进性下降伴同侧头痛 6个月 ,于 2 0 0 0年 3月 3日以“右眼眶肿瘤”入院。患者自出生时右额部、眼眶周围皮肤、上睑结膜及上方球结膜呈灰蓝色 ,青春期后皮肤颜色逐渐变为青灰色。体检未见异常。眼部检查 :视力右眼 0 1,左眼 1 5。右侧额部、上下睑及内外眦皮肤均呈青灰色外观 ,边界清楚 ,边缘不规整 ,表面光滑(图 1)。右眼球向颞下方突出 ,眼球突出度 :右眼 2 3 0ｍｍ ,左眼 15 3ｍｍ ,内侧眶距 2 1 0ｍｍ ,外侧眶距 95 8ｍｍ。右眼内上方活动受限 ,右眼眶内侧壁可触及质地稍硬、表面不光滑、活动度差、…     

Desmoplastic malignant melanoma presenting with orbital involvement

Desmoplastic malignant melanoma (DMM) is a rare variant of spindle cell melanoma. We report a case of DMM of the forehead secondarily involving the orbit. The diagnosis was based on light microscopic features, including prominent peripheral cell nest formation and spindle cell fascicles in densely collagenous stroma. Immunohistochemical studies showed strong uniform staining for S100 antigen throughout the tumour. It was negative for HMB 45, smooth muscle actin, desmin, cytokeratins and Type IV collagen. Electron microscopy showed neither melanosomes nor myelin figures. The clinical and histological characteristics of desmoplastic malignant melanoma, and its differential diagnosis of malignant schwannoma, are discussed. DMM has a poor prognosis, since it tends to invade deeply, recur locally and metastasise readily.     

Enucleation combined with orbital implants for malignant melanoma of the uvea

Advanced malignant melanomas of the uvea unsuited for an eye salvaging approach require enucleation of the tumor containing eye. A series of 68 patients is reported who underwent enucleation combined with insertion of a spherical dura-encased implant after 30 Gray pre-irridiation therapy of the orbit. Postoperative results with special attention to cosmetic outcome and motility of the prosthesis suggest that the insertion of an orbital implant should be preferred to the enucleation with no implant.     

Malignant melanoma of the rectum presenting as orbital metastasis

An orbital mass being the presenting sign of disseminated systemic metastasis is a rare clinical picture. Here, the authors describe the case of a 52-year old Asian-Indian female who presented with unilateral proptosis and motility restriction. Imaging showed an irregular orbital mass infiltrating the right lateral rectus and with a significant intraconal component. Incisional biopsy helped to diagnose a malignant melanoma and exhaustive systemic imaging showed that the primary was found to be arising from the rectum. This represents the first reported case of malignant melanoma of the rectum metastasizing to the orbit and presenting with proptosis and reduced vision.     

Orbital inflammation in a patient with extrascleral spread of choroidal malignant melanoma

An elderly woman presented with fever, dehydration, orbital inflammation, total external and internal ophthalmoplegia and blindness, resembling the clinical appearance at presentation of severe orbital inflammatory disease or mucormycosis. Orbital computed tomography scanning demonstrated a retrobulbar orbital mass. Subsequent B-scan ultrasound examination confirmed the orbital mass but also demonstrated a mass within the eye. At lateral orbitotomy, extrascleral spread of an entirely necrotic intraocular melanoma was demonstrated. As computed tomography scanning may not be able to delineate an entirely necrotic intraocular malignant melanoma, B-scan ultrasonography should be considered in patients with orbital inflammation, especially in the presence of a retrobulbar mass.     

The role of orbital exenteration in choroidal melanoma with extrascleral extension

The management of choroidal melanoma with extrascleral extension has been a subject of controversy with some proposing orbital exenteration whenever extrascleral extension is demonstrated and others feeling it to be of no value in increasing survival. We reviewed the cases of 43 patients with extrascleral extension of choroidal melanoma. Although five-year survival had previously been demonstrated to be significantly improved in patients undergoing early orbital exenteration at our institution, extended follow-up in 16 consecutive cases revealed ultimate tumor related mortality to approach that of patients refusing exenteration. Only in cases with nonencapsulated or surgically transected extension did exenteration appear to improve survival. In ten cases with delayed recurrence of tumor in the orbit, exenteration proved to be palliative rather than curative.     

Choroidal malignant melanoma with no extraocular extension presenting as orbital cellulitis

This report describes a patient with choroidal malignant melanoma presenting as orbital cellulitis without extraocular tumor extension. It is an interventional case report with histopathologic correlation. A 68-year-old male presented with a 3-day history of painful hyperemia and swelling in the right eye. The examination showed edematous eyelids, mechanical ptosis and chemosis with conjunctival injection. B-scan ultrasonography showed a mass with medium level echogenicity that filled the vitreous cavity. Magnetic resonance imaging showed a solid choroidal mass with hemorrhagic and inflammatory changes with no obvious extraocular extension. Due to these suggestive findings of choroidal melanoma the right eye was enucleated. A spindle cell choroidal melanoma including intense pigmentation and necrosis was confirmed by histopathological examination. Although rare; choroidal melanoma may present as orbital cellulitis, particularly when the tumor is necrotic.