摘要
目的分析评估视网膜母细胞瘤(RB)玻璃体切除术后复发眼的组织病理学改变及组织病理学高危因素。方法回顾性系列病例研究。收集2014年4月至2019年4月于首都医科大学附属北京同仁医院北京同仁眼科中心病理室进行组织病理学会诊并存档的29例(29只眼)RB患者的组织病理学检查报告,全部患者均系在外院玻璃体切除术后肿瘤复发行眼球摘除术,外院病变组织切片由本科室病理医师会诊阅片并书写组织病理学检查报告。根据组织病理学高危因素,即肿瘤侵犯视神经,肿瘤侵犯大范围脉络膜(肿瘤侵犯范围的最大径线≥3 mm,且大部分肿瘤侵犯达到内层巩膜),肿瘤侵犯巩膜,肿瘤侵犯眼前节,肿瘤穿出巩膜壁至眼球外生长,分析该组患者的眼球组织病理学特征及高危因素特征。结果29例患者中男性18例(62.1%),女性11例(37.9%),年龄中位数为3岁(1~10岁)。29只眼按照肿瘤侵犯部位分类,其中19只眼(65.5%)肿瘤侵犯睫状体,14只眼(48.3%)肿瘤侵犯虹膜,10只眼(34.5%)肿瘤侵犯前房,7只眼(24.1%)肿瘤侵犯房角。29只眼中有27只眼(93.1%)存在组织病理学高危因素,以侵犯眼前节为主(77.8%,21/27)。结论RB玻璃体切除术后复发眼肿瘤组织最常见的侵犯部位是眼前节,以侵犯睫状体为主,90%以上复发眼具有组织病理学高危因素,提示应严格掌握手术适应证,审慎选择玻璃体切除术作为RB的治疗方法。
Objective To analyze the histopathological features and histopathological risk factors(HRF)of tumor recurrence after vitrectomy in patients with retinoblastoma(RB).Methods Retrospective case series.Twenty-nine patients(29 eyes)who underwent enucleation from April 2014 to April 2019 at the Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University due to tumor recurrence after vitrectomy in the other hospitals were enrolled and archived.The pathological sections of the other hospitals were read by the pathologists of the department and the pathological report was written.Histopathological features and HRF were analyzed in this group of patients.The HRF used in this study was defined as tumor invasion of the optic nerve,the choroid(the largest diameter≥3 mm and mostly reaching the inner sclera),the sclera,the anterior segment of the eye,and tumor passing through the scleral and growing outside the eyeball.Results Of the 29 patients with RB recurrence after vitrectomy,18(62.1%)were male and 11(37.9%)were female.The age was 1-10 years with a median age of 3 years.Among 29 eyes,the tumor invaded the ciliary body in 19 eyes(65.5%),the iris in 14 eyes(48.3%),the anterior chamber in 10 eyes(34.5%),and the anterior chamber angle in 7 eyes(24.1%).Of the 29 eyes,27 eyes(93.1%)had HRF.The most common HRF was invading the anterior segment of the eye(77.8%,21/27).Conclusions In patients with recurrence after vitrectomy for RB,the most common tumor invasion site in histopathology is the anterior segment of the eye,particularly the ciliary body.More than 90%of the patients have HRF.Vitrectomy for RB treatment requires a rigorous surgical indication assessment.
作者
张亚男
白海霞
毛英
李彬
Zhang Yanan;Bai Haixia;Mao Ying;Li Bin(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology&Visual Sciences Key Lab.,Beijing 100730,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2019年第11期854-859,共6页
Chinese Journal of Ophthalmology
基金
北京市自然科学基金(7162036)。
