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。     

104例角膜肿瘤的病理学分析

目的 分析角膜肿瘤的病理学分类以进一步探讨角膜肿瘤切除的原因.方法 对2001年1月至2007年8月眼病理室存档的104例角膜肿瘤病例进行临床分析及组织病理学分析,并分析临床膊诊断与病理诊断是否相符合.结果 良性肿物共82例,占78.85%,包括角膜皮样瘤61例(58.65%)、角膜上皮细胞增生8例(7.69%)、鳞状上皮乳头状瘤5例(4.81%)、角膜缘色素痣6例(5.77%)及肉芽组织增生2例(1.92%);恶性肿物共22例,占21.15%,包括不典型增生4例(3.85%)、原位癌14例(13.46%)、鳞癌3例(2.88%)及视网膜母细胞瘤眼外转移1例(0.96%).结论 角膜肿瘤切除最常见的原因是角膜皮样瘤,其次是上皮内瘤变.     

眼角膜病变1082眼的病理分类

目的:探讨华西医院眼科角膜病变的手术指征以及角膜标本的病理类型。方法:回顾性分析1990-01/2009-12华西医院眼病理室收检的1082眼角膜病变标本的临床病理资料。结果:角膜标本1030例1082眼,21种病理类型,构成比由高到低依次为:角膜瘢痕340眼(31.42%),角膜炎157眼(14.51%),圆锥角膜134眼(12.38%),迷芽瘤133眼(12.29%),大泡性角膜病变61眼(5.64%),角膜瘢痕伴慢性炎症59眼(5.45%),角膜表面纤维组织增生、新生血管,伴或不伴炎细胞浸润43眼(3.97%),角膜变性28眼(2.59%),鳞状细胞癌23眼(2.13%),角膜营养不良21眼(1.94%),非典型增生18眼(1.66%),角膜穿孔15眼(1.39%),乳头状瘤11眼(1.02%),色素痣10眼(0.92%),假上皮瘤样增生7眼(0.65%),ICE综合征、原位癌、恶性黑色素瘤和上皮角化或角化不良各5眼(0.46%),钙化上皮瘤、淀粉样变性各1眼(0.09%)。2000/2009年较1990/1999年手术量大幅增加(912/170)。14岁以下儿童206例211眼,先天性迷芽瘤和角膜白斑是儿童进行角膜手术的主要原因,分别占44.55%和36.49%。结论:角膜斑痕、角膜炎、圆锥角膜和迷芽瘤是华西医院角膜移植手术的主要原因。     

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。     

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.     

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。     

426例眼部肿瘤病理分析

目的:对426例眼部肿瘤进行病理分析。方法:复习我院病理科1982～1997年间所检查的457例眼科病理资料,对其中的426例眼部肿瘤进行分析。结果:良性肿瘤290例（68.1％）,恶性肿瘤136例（31.9％）。按发病解剖学部位分类:眼睑肿瘤272例（63.8％）,角结膜肿瘤44例（10.3％）,视网膜肿瘤34例（8％）,眼眶肿瘤76例（17.8％）。按组织学分类,眼睑良性肿瘤前5位为色素痣83例,各种囊肿39例,基底细胞乳头状瘤34例,鳞状上皮乳头状瘤17例,脉管瘤14例。眼睑恶性肿瘤为:基底细胞癌33例,鳞状细胞癌16例,睑板腺癌10例,恶性黑色素瘤7例。角结膜肿瘤较少。视网膜肿瘤34例,全部为视网膜母细胞瘤。眼眶良性肿瘤前5位为:各种上皮性囊肿17例,神经纤维瘤10例,泪腺混合瘤10例,炎性假瘤9例,血管瘤5例。眼眶恶性肿瘤以鳞状细胞癌10例占首位,其余依次为泪腺混合瘤恶变4例、基底细胞癌2例,间叶组织来源的血管肉瘤、平滑肌肉瘤、横纹肌肉瘤各1例。     

眼睑恶性肿瘤的临床分析

目的 :探讨眼睑恶性肿瘤的发病特点和治疗效果。方法 :按病理诊断对我院近 10年手术摘除的眼睑肿瘤做一回顾性分析。结果 :总计眼睑恶性肿瘤 5 2例 5 3眼 ,占全部眼睑肿瘤的 2 1 1%。男性 3 0例 ,女性 2 2例 (约 1 3∶1)。年龄 44～ 81岁 ,平均60 5岁。病程 3个月～ 2 0年。发生在下睑者为多 (2 8眼 ,5 2 8% )。其中居前三位者为基底细胞癌 (2 4眼 ,45 3 % )、睑板腺癌(14眼 ,2 6 4% )、鳞状细胞癌 (11眼 ,2 0 7% )。平均发病年龄依次为 63岁、 60岁和 5 6岁 ,平均病程依次为 6年、 2 0个月和1年。其中基底细胞癌发生在左下睑 13眼 (5 4 2 % ) ,睑板腺癌上睑 11眼 (68 8% ) ,鳞状细胞癌左下睑 7眼 (63 6% )。随观3 8眼 ,复发 5眼 ,死亡 3例。结论 :上述三种主要恶性眼睑肿瘤均以老年发病为主 ,其发病年龄依次下降 ,病程依次缩短。发病部位各有特点 ,治疗以手术为主。     

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。     

20例眼眶继发性肿瘤的原因及组织病理学分析

目的分析眼眶继发性肿瘤的组织病理学分类及原因。方法对本院2001年1月至2007年9月眼病理室存档的20例(20只眼)眼眶继发性肿瘤手术切除标本进行组织病理学分析。结果眼睑皮脂腺癌7例,占分析病例的35%,眼睑鳞状细胞癌6例(30%),眼睑黑色素瘤3例(15%),视网膜母细胞瘤3例(15%),眼睑基底细胞癌1例(5%)。结论眼眶继发性肿瘤最常来源于眼睑,以皮脂腺癌最常见,其次是鳞状细胞癌。     

Clinicopathological analysis of 39 patients with corneal tumor

 Purpose:Corneal tumors are rare in clinical practice. There was a paucity of data on the incidence of various corneal tumors, their clinical and pathological features and surgical management, especially on large patient samples.  Methods:The medical records of 39 patients with corneal tumors referred to Zhongshan Ophthalmic Center, Sun Yat-sen University, China from Jan 1,1996 to Dec 31,2002 were reviewed retrospectively. Results: Of the 39 cases with corneal tumors, 31 were males and 8 were females. The right eye was affected in 24 cases and the left one in 15 cases. The mean age at diagnosis was 45.7 years, ranged from 3 to 88 years. Squamous cell carcinoma was the most common tumor in the cornea (18 cases, 46.15%), followed by pigmented naevus (12 cases,30.77 %), papillary epithelioma (3 cases, 7.69%), melanoma (1 case, 2.56%), oncosis hyperplasia（1 case, 2.56%）, inverting papilloma （1 case, 2.56%）, primary acquired melanosis（1 case, 2.56%）,amyloid degeneration（1 case, 2.56%）,inflammatory pseudotumor（1 case, 2.56%）. They arose most commonly in the limbal region. All tumors were unilaterally involved. Squamous cell carcinoma of the cornea usually appears as a whitish, rough, irregular lesion or a telangiectatic, gelatinous epibulbar mass. Nevus in the cornea generally becomes clinically apparent in the first or second decade of life and the lesion may enlarge or more deeply pigmented afterwards. The corneal tumors were completely excised microsurgically in 22 cases. Six cases were treated with surgical resection combined with amniotic membrane graft. Three cases with surgical excision plus transfer of conjunctival flap. Two cases with surgical excision plus lamellar keratoplasty. Two cases with surgical excision plus cryosurgery. Two cases with orbital exenteration. One case with enuleation. One case with incision biopsy and observation. Conclusion: Squamous cell carcinoma and nevus, the most common corneal tumors, accounted for 76.92% of all cases. The therapeutic outcomes depended upon early pathologic diagnosis and early surgical management.     

Clinicopathological Analysis of 39 Patients with Corneal Tumors

Purpose:Corneal tumors are rarely seen in clinical practice.There is a paucity of data on the incidence of various corneal tumors,their clinical and pathological features and surgical management,especially on large patient samples.Methods:The medical records of 39 patients with corneal tumors referred to Zhongshan Ophthalmic Center,Sun Yat-sen University,China from January 1,1996 to December 31,2002 were reviewed retrospectively.Results:Of the 39 cases with corneal tumors,31 were males and 8 were females.The right eye was affected in 24 cases and the left one in 15 cases.The mean age at diagnosis was 45.7 years,ranged from 3 to 88 years.Squamous cell carcinoma was the most common tumor in the cornea (18 cases,46.15％),followed by pigmented naevus (12 cases,30.77％),papillary epithelioma (3 cases,7.69％),melanoma (1 case,2.56％),oncosis hyperplasia( 1 case,2.56％),inverting papilloma (1 case,2.56％ ),primary acquired melanosis (1case, 2.56％),amyloid degeneration (1 case,2.56％),inflammatory pseudotumor (1 case,2.56％ ).They arose most commonly in the limbal region.All tumors were unilaterally involved.Squamous cell carcinoma of the cornea usually appears as a whitish,rough,irregular lesion or a telangiectatic,gelatinous epibulbar mass.Nevus in the cornea generally becomes clinically apparent in the first or second decade of life and the lesion may enlarge or more deeply pigmented afterwards.The corneal tumors were completely excised microsurgically in 22 cases.Six cases were treated with surgical resection combined with amniotic membrane graft.Three cases with surgical excision plus transfer of conjunctival flap.Two cases with surgical excision plus lamellar keratoplasty.Two cases with surgical excision plus cryosurgery.Two cases with orbital exenteration.One case with enuleation.One case with incision biopsy and observation.Conclusion:Squamous cell carcinoma and nevus,the most common corneal tumors,accounted for 76.92％ of all cases.The therapeutic outcomes depended upon early pathologic diagnosis and early surgical management.     

"非接触技术"切除联合带角膜缘的板层角膜移植术治疗角结膜恶性黑色素瘤

目的探讨“非接触技术”切除联合带角膜缘的板层角膜移植术治疗角结膜恶性黑色素瘤的临床效果.方法选择1989年10月至2004年1月在中山大学中山眼科中心就诊的6例（6只眼）角结膜恶性黑色素瘤患者,对患眼采用“非接触技术”行一次性整块切除肿瘤,术中避免手术器械与瘤体组织直接接触,结膜切除范围以带色素性结膜外4～6 mm为界,角膜切除区以肿瘤外2 mm为界,角膜和巩膜的切除深度以植床上无色素残留为准则.选择新鲜有活力的供体组织,同时行手术切除区的带角膜缘的部分板层角膜移植术或全板层角膜移植术,根据结膜切除的范围选择行联合羊膜移植术.术后密切随访6例患者,观察肿瘤复发和全身转移情况,随访间隔时间均不超过6个月.结果 6例患者均成功地施行了肿瘤局部切除术,同时行游离结膜边缘冷冻,其中3例为联合“带角膜缘的部分板层角膜移植术”,2例为联合“带角膜缘的全板层角膜移植术”,1例为联合“带角膜缘的全板层角膜移植＋羊膜移植术”.术后给予抗生素、糖皮质激素及免疫抑制剂眼液联合常规化疗,平均随访43.5个月（6个月至14.6年）,未见原位复发和全身转移发生.结论采用“非接触技术”一次性、完整地切除肿瘤,同时联合带角膜缘的板层角膜移植术,可以有效地治疗角结膜恶性黑色素瘤.     

Brown cornea

Background A brown cornea is relatively rare. We report a case of progressive brown corneal pigmentation in a patient with a primary acquired melanosis of the conjunctiva. Later the patient developed an iris melanoma. Methods Case report with clinico-pathological correlation and discussion of possible mechanisms of particle clearance of the cornea. Results A 36-year-old female developed a corneal stromal pigmentation adjacent to a pigmented conjunctival lesion of the left eye. The corneal pigmentation had progressed through 8 years. The conjunctival lesion was surgically removed, and proved histopathologically to be a compound nevus with slight atypia and an acquired melanosis. Despite surgery the corneal pigmentation increased, and visual acuity dropped in the diseased eye. A perforating keratoplasty was performed, and two small pigmented iris nodules were now noted. Three years after grafting, growth of the two iris tumours was obvious. In addition, pigmentation of the trabecular meshwork and large, pigmented endothelial precipitates were observed. The corneal pigmentation also increased. The eye was enucleated. Histopathologic evaluation demonstrated a marked accumulation of melanophages on the endothelium of the graft. The host cornea contained pigmented cells in the mid-stroma. The iris contained two melanomas. Conclusions The brown pigmentation of the cornea was due to pigment granules from the iris tumours liberated to the anterior chamber. The pigment was transported into the cornea through the endothelium and accumulated in melanophages between corneal lamellas. The pigment subsequently cleared via the corneal limbus in a process resembling clearance of corneal haemochromatosis. No financial relationships with organisations or firms exist for any of the authors. All data are original and are in full control of the authors. The authors agree that Graefe’s Archive for Clinical and Experimental Ophthalmology may review primary data on request.     

静吸复合麻醉下行婴儿角结膜皮样瘤摘除术

目的:观察静吸复合麻醉下行婴儿角结膜皮样瘤摘除术的临床效果。方法:18例年龄为1～6(平均3.8)mo的儿童角结膜皮样瘤行皮样瘤单纯切除术,术区用结膜或羊膜覆盖。麻醉采用静吸复合麻醉,术前肌注阿托品0.02mg/kg,诱导麻醉:本组药物均用咪唑安定0.1mg/kg,氯胺酮0.1mg/kg,万可松0.1mg/kg静脉注入快速诱导麻醉;麻醉维持:吸入10～150g/L异氟醚以及异丙酚静脉泵注。结果:18例均位于眼球颞侧角膜缘,无1例伸入角膜中央。麻醉期间患儿呼吸循环各项指标均正常,且无任何并发症发生,术毕迅速苏醒。术后随访6mo～5a,17例治愈,达到无并发症愈合,仅1例复发。结论:6mo以内在静吸复合麻醉下行婴幼儿角结膜皮样瘤摘除术值得提倡。     

Corneally displaced malignant conjunctival melanomas

PURPOSE: To characterize and classify malignant conjunctival melanomas with exclusively corneal invasive growth. DESIGN: Population-based, nationwide retrospective cross-sectional study. PARTICIPANTS: Patients with primary malignant conjunctival melanoma diagnosed between 1967 and 2000 in Finland. METHODS: On the basis of all available clinical and histopathologic data of tumors diagnosed during the study period, malignant conjunctival melanomas that first demonstrated invasive growth on the cornea without evidence of conjunctival tumors other than primary acquired melanosis were identified, their prevalence calculated, and their characteristics reviewed. On the basis of these cases and literature data, a classification for "corneal melanoma" was developed. MAIN OUTCOME MEASURES: Frequency and type of corneal involvement, recurrence, and survival. RESULTS: Patients with exclusively corneal invasive tumor accounted for 5% (95% confidence interval, 1-12) of 85 consecutive primary conjunctival melanomas. Two were separated from the limbus by clear cornea (type I), and two paralleled but did not invade the limbal conjunctiva (type II). Two were associated with clear evidence of primary acquired melanosis. None of the tumors recurred after local excision, and no metastases were observed during a median follow-up of 2 years 5 months (range, 1 year 8 months-7 years 10 months). CONCLUSIONS: Primary malignant conjunctival melanomas can grow on the cornea without conjunctival involvement other than acquired melanosis. They are easily removed and do not cause lymphatic metastases. The term "corneally displaced malignant conjunctival melanoma" would best describe their supposed conjunctival origin and actual corneal location.     

Tumors of the cornea and conjunctiva

This article reviews literature regarding tumors and tumor-like lesions of the conjunctiva and cornea as published in 1995. Causative and prognostic factors, as well as treatment options, are discussed. Ocular surface squamous neoplasia has been suggested as an "umbrella" term for dysplastic and carcinomatous lesions of the cornea and conjunctiva. Squamous cell carcinoma shows a higher incidence in patients with AIDS. A high prevalence (36%) of primary acquired melanosis is reported in one article, and the need for biopsy of all these lesions is questioned. Reviews of conjunctival myxoma, corneal pyogenic granuloma, and limbal juvenile xanthogranuloma are also included. The pathogenesis and newer treatment options for pterygia are discussed. Simple excision or resection of the pterygium followed by conjunctival autografting or intraoperative or postoperative mitomycin C application seems to be equally effective in reducing the rate of recurrence.     

Excision with Corneoscleral Lamellar Keratoplasty and Amniotic Membrane Transplantation of a Corneal Displaced Recurrent Conjunctival Melanoma

An 81-year-old woman with a raised pigmented nodule over her left cornea for 7 months duration was examined. Dark conjunctival pigmentation was observed in the upper bulbar fornix conjunctiva. She had previously undergone primary surgical excision of a malignant conjunctival melanoma four years earlier. The tumor separated easily from the corneal surface, but remained slightly attached to the corneoscleral surface. A corneoscleral lamellar dissection of 3 mm in width and 2 mm in depth as well as a corneoscleral lamellar keratoplasty for the reconstruction of the corneoscleral defect were performed. The wide upper bulbar and fornix conjunctiva were excised, and an amniotic membrane transplantation was performed. Biopsy revealed an invasive melanoma with a depth of 1 mm. Left, right, and inferior tumor margins of the corneoscleral lesion and the pigmentary lesion in the conjunctiva were free of the tumor. After surgery, 0.04% mitomycin was administered topically 4 times daily for 4 weeks. There was no recurrence 2 years after surgery, and systemic evaluation revealed no metastasis.     

Corneal topographic results after eccentric,biconvex penetrating keratoplasty

PURPOSE: To study the surgical outcomes and postoperative corneal topographies in 5 patients who had eccentric, biconvex penetrating keratoplasty (PKP) for peripheral corneal disorders whose extent did not allow the use of round grafts without involving the center of the cornea. SETTING: 1st Department of Ophthalmology, Semmelweis University, Medical School, Budapest, Hungary. METHODS: Eccentric, biconvex PKP that spared the optical axis of the cornea was performed in 5 eyes. Indications for surgery were perforated peripheral ulcerative keratitis (n = 3), extensive infiltrated peripheral ulcerative keratitis with impending perforation (n = 1), and ulcerated corneal degeneration caused by an intracameral foreign body for 9 years (n = 1). Computer-assisted corneal topography was performed postoperatively. The follow-up ranged from 8 to 27 months. RESULTS: All grafts were tectonically effective. Postoperative corneal topography showed normal central corneal regularity in 4 cases (1 case, normal pattern with surface regularity index [SRI] and surface asymmetry index [SAI] within the normal range; 3 cases, normal surface regularity within the central area of the cornea but moderate or high central corneal asymmetry). One eye had irregular astigmatism with a high SRI and SAI. In the first 4 cases, the best spectacle-corrected visual acuity was 0.8 (20/25) or better. CONCLUSIONS: The results show that eccentric, biconvex PKP sparing the central cornea may be an option in some eyes with perforated peripheral corneal disorders. Postoperative visual acuity may be good as the procedure may result in a regular central anterior corneal surface.     

Limbal papilloma with massive corneal extension

The authors report a case of limbal papilloma with extensive corneal involvement. The limbal lesion was excised completely, leaving a clear corneal bed. Histopathologically, the lesion was found to be a limbal papilloma. Massive superficial involvement of the cornea by papilloma is rare. Simple excision is effective in treating the condition with restoration of vision and cosmesis.