视网膜母细胞瘤脉络膜浸润的组织学分期与转移和预后的关系

目的探讨视网膜母细胞瘤(retinoblastoma,RB)脉络膜浸润的组织学分期及与预后的关系。方法光镜下复习观察1985年6月到1995年6月期间297只RB眼摘除眼球的组织病理切片。为估量此病患者预后的危险因素， 着重对患眼脉络膜浸润进行分级，并对患者进行随访。结果根据肿瘤细胞对眼内组织结构的影响，以脉络膜为中心将其分为5期：0期：视网膜色素上皮反应前期(144/297，48.48%)；Ⅰ期：视网膜色素上皮反应期(81/297，27.27% )；Ⅱ期：脉络膜浸润早期(29/297，9.76%)；Ⅲ期：脉络膜浸润中期(17/297，5．72%)； Ⅳ期：脉络膜浸润晚期（26/297，8.75%)。Ⅱ～Ⅳ期为脉络膜浸润期。24.24%的切片中发现有脉络膜浸润。患者经平均51.8个月的随访，0～Ⅲ期的患者死亡率为0.4%，Ⅳ期患者为12.0%。结论脉络膜浸润晚期(大范围的脉络膜浸润)肿瘤细胞转移率较高，患者预后差。(中华眼底病杂志,1999,15:88-90)

Histological classification of choroidal invasions with metastasis and prognosis of retinoblastoma and its relations

Objective To approach histologically the degree of choroidal invasions of retinoblastoma and their relations with metastasis and prognosis. Methods The pathological sections of 297 enucleated eyeballs with retinoblastom from June 1985 to 1995 were reviewed under light microscope.For the sake of assessing the risk factors of the prognosis of the disease,the graduation of the choroidal invasion was in vestigated in particular,and the followup of this genesis were performed as well. Results According to the degree of affection of the intraocular tissues from the tumor cells especially the choroid as the crucial structure,the choroidal invasions were classified into the following 5 categories:0,prereactive phase of retinal pigment epithelium(144/297,48.48%).,reactive phase of retinal pigment epithelium(81/297,27.27%).,early phase of choroidal invasion(29/297,9.76%).,middle phase of choroidal invasion(17/297,5.72%)., advanced phase of choroidal in vasion(26/297,8.75%).24.24% of cases were found in phases (so called choroidal invasion).The mortality inpatients with phases 0 was found to be 0.4% in the average followup period of 51.8 months,and inpatients with phase was found to be 12.0%. Conclusion The retinoblastoma patient with the advanced phase of choroidal invasion (choroidal invasion with great extent) had relative high metastatic rate and poor prognosis.