蕈伞形葡萄膜黑色素瘤的临床病理学特征分析

目的观察蕈伞形葡萄膜黑色素瘤的临床病理学特征。方法回顾性临床研究。2001年6月至2013年4月于北京同仁医院眼科中心因葡萄膜黑色素瘤行眼球摘除手术并经病理学检查确诊的葡萄膜黑色素瘤患者102例102只眼的病理切片纳入研究。根据肿瘤切片最大截面外形,将切片分为蕈伞形葡萄膜黑色素瘤(A组),扁平形、半球形、球形葡萄膜黑色素瘤(B组),分别为30、72只眼。计算肿瘤高度-基底比值。根据美国眼黑色素瘤多中心研究组标准将肿瘤分为小、中等、大肿瘤。依据改良Callender分类法将肿瘤细胞类型分为梭形细胞型、混合细胞型、上皮样细胞型和其他。应用麦克奥迪数码医学图像分析系统(Motic Med 6.0)软件行图像采集和测量。A组、B组视网膜薄变率比较行χ^2检验。结果A组30只眼中,大肿瘤19只眼(63.3%),中等肿瘤11只眼(36.7%);B组72只眼中,大肿瘤49只眼(68.1%),中等肿瘤16只眼(22.2%),小肿瘤7只眼(9.7%)。A组、B组平均瘤体基底直径分别为(14.2±5.1)、(18.7±6.4)mm;平均瘤体高度分别为(10.0±2.1)、(7.6±3.9)mm;肿瘤高度-基底比值分别为0.77±0.29、0.44±0.28。A组30只眼中,梭形细胞型24只眼(80.0%),上皮样细胞型1只眼(3.3%),混合细胞型5只眼(16.7%);视网膜薄变22只眼(73.3%)。B组72只眼中,梭形细胞型52只眼(72.2%),上皮样细胞型5只眼(6.9%),混合细胞型11只眼(15.3%),其他4只眼(5.6%);视网膜薄变21只眼(29.2%)。两组视网膜薄变率比较,差异有统计学意义(χ^2=16.94,P=0.000)。结论蕈伞形葡萄膜黑色素瘤瘤体高度增加快,视网膜薄变率高。

Clinical pathology analysis of 30 patients with mushroom shaped uveal melanoma

Objective To analyze the clinical pathological features of mushroom shaped uveal melanoma.Methods Retrospective clinical study.From June 2001 to Aprilh 2013,pathological sections from 102 eyes of 102 patients with uveal melanoma diagnosed in Beijing Tongren Eye Center were included in the study.The sections were divided into group A(mushroom shaped uveal melanoma,30 eyes)and group B(flat,hemisperical and spherical uveal melanoma,72 eyes).The height-to-base ratio was calculated.The tumors size was divided into small,medium and large according to the standards of American Multicentre Study of Ocular Melanoma.The tumor cell type was divided into spindle,epithelioid,mixed and others by Improved Callender taxonomy.Motic Med 6.0 software was used to collect and measure the images.The retinal thinning rate of group A and B was compared byχ^2 test.Results In group A,large size in 19 eyes(63.3%),medium size in 11 eyes(36.7%).In group B,large size in 49 eyes(68.1%),medium size in 16 eyes(22.%),small size in 7 eyes(9.7%).In group A and B,the average tumor base diameter were 14.2±5.1 mm and 18.7±6.4 mm,respectively;the average tumor height were 10.0±2.1 mm and 7.6±3.9,respectively;the height-to-base ratio were 0.77±0.29 and 0.44±0.28,respectively.In group A,spindle type in 24 eyes(80.0%),epithelioid type in 1 eye(3.3%),mixed type in 5 eyes(16.7%).In group B,spindle type in 52 eyes(72.2%),epithelioid type in 5 eyes(6.9%),mixed type in 11 eyes(15.3%),and others in 4 eyes(5.6%).The proportion of retinal thinning were 73.3%(22 eyes)and 29.2%(21 eyes)in group A and B,respectively.The difference in the proportion of retinal thinning between group A and B was significant(χ^2=16.94,P=0.000).Conclusion The height of the tumor increased rapidly and the retinal thinning rate is high in mushroom shaped uveal melanoma.