葡萄膜黑色素瘤和视网膜组织相关性的病理学分析

Histopathological analysis of the correlation between uveal melanomas and retinal tissue

摘要:

目的：分析葡萄膜黑色素瘤的形状对视网膜结构的影响。

方法：回顾性分析葡萄膜黑色素瘤患者的病理切片和临床资料，分析肿瘤形状、大小、高度-基底比值、视网膜薄变和浸润的差异。

结果：本研究包括102例患者(102眼)，平均年龄45.6±12.4岁。其中葡萄膜黑色素瘤76眼(75%)为梭形细胞型，6眼(6%)为上皮样细胞型，16眼(16%)为混合细胞型，其它4眼(4%)。按肿瘤部位分：睫状体黑色素瘤3眼(2.9%)，睫状体和脉络膜黑色素瘤28眼(27.5%)，脉络膜黑色素瘤71眼(69.6%)。视网膜组织的分析中，43眼(43%)发现视网膜变薄，86眼(84%)发现视网膜浸润。肿瘤的高度在1.2～15.6(平均8.3±3.6)mm，肿瘤基底直径为4.8～31.2(平均17.3±6.5)mm。肿瘤峰高度-基底R值为0.53±0.32。视网膜薄变组(n=43)的平均R值显着高于无视网膜薄变组(n=59)(0.69±0.31与0.42±0.27； P<0.01)。视网膜肿瘤浸润组(n=86)的平均R值比无视网膜浸润组(n=16)略高(0.56±0.33比0.41±0.25； P=0.09)，但无统计学意义。

结论：高R值的肿瘤与其邻近视网膜薄变有关，与视网膜内肿瘤细胞浸润相关性不大。葡萄膜黑色素瘤的切面形状和邻近视网膜组织的受累情况关系紧密。

Abstract:

AIM: To analyze the impacts of the shape of uveal melanoma on retinal structure.

METHODS: Histopathological sections and clinical data from patients with uveal melanoma were retrospectively observed and analyzed, and key indicators including the tumor's shape, size, height-to-base ratio, retinal thinning and retinal invasion were analyzed.

RESULTS: The study included 102 patients(102 eyes)with a mean age of 45.6±12.4 years, with 76(75%)uveal melanomas showing the spindle cell type, 6(6%)showing the epitheloid cell type, 16(16%)showing the mixed cell type and 4(4%)showing predominantly other cell types. Differentiated by tumor locations: 3 cases of ciliary body melanoma(2.9%), 28 cases of ciliary body and choroid melanoma(27.5%), 71 cases of choroid melanoma(69.6%). Retinal thinning was detected in 43(43%)eyes and retinal invasion by the tumor cells in 86(84%)eyes. Maximal tumor height ranged between 1.2 and 15.6(mean: 8.3±3.6)mm, and mean maximal tumor base diameter was 17.3±6.5(range: 4.8-31.2)mm. Mean R-value as ratio of tumor peak height to maximal tumor base diameter was 0.53±0.32. Mean R-value was significantly higher in the group with retinal thinning(n=43)than in the group without retinal thinning(n=59)(0.69±0.31 vs 0.42±0.27; P<0.01). R-value was slightly, however statistically not significantly higher in the group with retinal tumor invasion(n=86)than without retinal tumor invasion(n=16)(0.56±0.33 vs 0.41±0.25; P=0.09).

CONCLUSION: A high R-value indicating a prominent tumor is associated with tissue thinning in the adjacent retina, and marginally significantly with intra-retinal tumor cell invasion. Shape of uveal melanomas's corss section is of importance for the secondary involvement of the adjacent retina.