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.

The clinicopathological features of premalignant and malignant epithelial neoplasia of the limbus

Objective To analyze the classification and clinicopathological features ofpremalignant and malignant epithelial neoplasia of the limbus. Methods Retrospective study. The clinical data of 69 patients with premalignant and malignant epithelial neoplasia of the limbus treated and diagnosed at the Tianjin Eye Hospital fiom 1990 to 2008 were reviewed. According to recent diagnostic criteria, the pathological data of all cases were examined again and the clinicopathological features were analyzed. Results In the 69 cases,45 cases (65.2%) were conjunctival intraepithelial neoplasia (CIN), 6 (8.7%) actinic keratosis, 18 (26.1%) squamous cell carcinoma. The mean age of the 69 patients was 53.6 years old, age ranged from 34～83 years, included 58 males (84%) and 11 females (16%). Forty-two cases (61%) arose from nasal limbus, 21 (30.4%) from temporal limbus, 6 (8.6%) extended into the surface of cornea. The actinic keratosis and CIN usually appeared as a fleshy or pink, flat or minimally elevated neoplasia. In the 45 CIN cases, 11 cases (24.4%) were mild CIN,34 (75.6%) severe CIN. In the 18 cases of squamous cell carcinoma, 12 cases were papillary squamous cell carcinoma, 6 were invasive squamous cell carcinoma, which generally larger and more elevated than CIN. The CIN, actinic keratosis and squamous cell carcinoma of limbus usually encroached the neighbor corneal epithelium, especially the squamous cell carcinoma easy invaded to superficial corneal stroma. Conclusions The CIN, actinic keratosis and squamous cell carcinoma of ocular surface mainly arise from the limbus of palpebral fissure, early accurate diagnosis and treatment is very important.