Uveal malignant melanoma
Introduction
Introduction to uveal malignant melanoma The gonadom melanoma (mligmentmelanomaofuveal) is the most common malignant intraocular tumor in adults. Its incidence in foreign countries accounts for the first place in the eye, and in the country it is second only to retinoblastoma. The second place. The tumor has a high degree of malignancy and is easily metastasized to blood flow. It is more common in adults and is easily confused with many fundus diseases in clinical work. Therefore, it should be given full attention in the clinical work of ophthalmology. The disease is more than middle-aged patients, the posterior part of the eye is a good site, and the incidence rate is decreasing in the forward direction. The prognosis of uveal malignant melanoma is better than that of the skin. The former has a mortality rate of 50%, while the latter can reach 80%. Most local recurrence or metastasis occurs within 1 year after surgery, and individual cases can be extended for 5 years or more. The prognosis is closely related to the type of tumor cells, the spindle cell type mortality is lower, and the epithelial cell type mortality is higher. basic knowledge The proportion of illness: 0.0005%-0.0008% Susceptible people: the most common among adults Mode of infection: non-infectious Complications: glaucoma Scleritis
Cause
The cause of uveal malignant melanoma
Uveal melanoma is a malignant tumor with no obvious cause.
Prevention
Uveal malignant melanoma prevention
The prognosis of uveal malignant melanoma is better than that of the skin. The former has a mortality rate of 50%, while the latter can reach 80%. Most local recurrence or metastasis occurs within 1 year after surgery, and individual cases can be extended for 5 years or more. The prognosis is closely related to the type of tumor cells, the spindle cell type mortality is lower, and the epithelial cell type mortality is higher.
Complication
Uveal malignant melanoma complications Complications glaucoma scleritis
1. Secondary glaucoma or tumor necrosis-induced ophthalmia (uveitis or endophthalmitis).
2. Fundus lesions can be combined with pupillary abnormalities at the same time (the corresponding pupil of the pupil does not respond, not easy to be scattered or not in a perfect circle).
3. Blood flow reflux disorder or local tumor necrosis causes scleritis.
Symptom
Symptoms of uveal malignant melanoma Common symptoms Visual impairment High intraocular pressure of uveitis Spontaneous intrabulbar hemorrhage Visual field defect Choroidal sinus Deformation center Dark spot and flexion... Iris root is abnormally broken pupil
Uveal melanoma is a malignant tumor that is diagnosed as soon as possible and treated in time to save the patient's life.
Clinical manifestation
The uveal malignant melanoma can develop inward or outward, and the outward development causes early spread of the eye. Clinically, there can be eyeballs protruding, while the fundus changes little, and the inward development causes a spherical bulge under the retina. Rapid development, short course of disease, early visual impairment and extensive retinal detachment are clinically common. There is also a rare type that develops along the choroid plane, forming diffuse, flattened proliferation without limiting. Sexual uplift, this type of development is slow, the course of disease is easy to be missed, and the types are now described as follows:
Choroidal melanoma, because of the external sclera, is limited by the glass membrane, and extends along the choroid surface in the early stage. Before the glass membrane is not pierced, the tumor is flat and elliptical, the elevation is not high, and the retinal surface of the tumor does not change. Large, development is also relatively slow, once the glass film is worn, the tumor loses its original limit, but rapidly expands in the subretinal space, forming a large bottom, round head, thin neck is a typical mushroom-like appearance, the tumor head can be A large number of sinusoids appear due to blood flow obstruction, and due to rapid growth, blood supply is limited, and necrosis and hemorrhage occur. At this time, the retina of the tumor is raised, and the extent of retinal detachment can be gradually enlarged. Because the adhesion to the retina is relatively close, it is not easy to detach, and a few tumors pierce the top of the retina, making the tumor exposed in the vitreous.
Intraocular pressure is normal or low in the early stage. In most cases, the intraocular pressure increases after a certain stage of development. If the tumor originates from the scleral aqueduct, the extraocular spread often occurs before the intraocular pressure rises. On the other hand, The tumor is located near the vortex vein. Although the tumor is small, the intraocular pressure may increase. Finally, in the case of a large amount of necrosis of the tumor, causing a severe inflammatory reaction, the eyeball rapidly shrinks and the intraocular pressure is low.
Ciliary body malignant melanoma, which may have different clinical manifestations due to different parts, may cause increased intraocular pressure and iris root disconnection in the forward direction; backward development may lead to peripheral retinal detachment, which may be clinically only Similar to central retinopathy or papillitis, if it is not dilated, it is often prone to misdiagnosis or missed diagnosis. The mass that develops from the ciliary body to the center can oppress the lens and cause displacement or dislocation. In the early outward spread, the mass may appear under the anterior bulbar conjunctiva.
The intraocular diffusion of uveal melanoma and the spread along the optic nerve are rare, but the systemic metastasis along the bloodstream is more common. The metastasis is most common in the liver, the subcutaneous tissue and the lungs, and can also invade the central nervous system. The incidence of metastasis is related to the cell type of the tumor. The epithelioid cell type is the highest and the spindle cell type is the lowest. If the reticular fiber is used as the standard, the higher the reticular fiber content, the lower the transfer rate; otherwise, the reticular fiber The lower the content, the higher the transfer rate.
Examine
Examination of uveal malignant melanoma
1. Physical examination focuses on the fundus.
2. Auxiliary examination of fluorescein fundus angiography, B ultrasound scan, MRI examination, help to confirm the diagnosis.
Diagnosis
Diagnosis and differentiation of uveal malignant melanoma
Diagnose based on
1, choroidal malignant melanoma, early symptoms have visual distortion, smaller, central dark spots and changes in diopter (hyperopia continue to increase), is also an important clinical manifestation, enough to prove that a substantial mass under the retina continues to increase The choroidal melanoma in the margin may have no obvious symptoms in the early stage. After the retinal detachment, there is a corresponding visual field defect. The melanoma located at the upper edge is very special. It is combined with the macular flat retinal detachment in the early stage of the disease. Expanding and looking at the peripheral fundus in detail, it is easy to misdiagnose.
2, because choroidal melanoma originates from the ciliary nerve, fundus lesions can be combined with pupillary abnormalities (the corresponding pupil of the pupil does not respond, not easy to be scattered or not in a perfect circle), or a fan-shaped sensation loss zone appears in the corresponding part of the cornea.
3, blood flow reflux disorder or local tumor necrosis caused by scleritis, manifested as localized scleral congestion, granulation tissue proliferation inside and outside the sclera.
4, eye pain, the cause of pain can be caused by secondary glaucoma or tumor necrosis induced uveitis (Uveitis or endophthalmitis), a small number due to tumor infiltration or compression of the ciliary ganglia.
5, anterior chamber or vitreous hemorrhage caused by tumor necrosis.
6. The eyeball is prominent and the tumor is caused by the spread of the ball.
7, scleral transillumination test: in the differential diagnosis of greater use value, in inflammatory lesions, macular degeneration, choroidal metastasis or choroidal hemangioma, can be transmitted; and in the choroidal melanoma, generally not transparent.
8, B-type ultrasound diagnostic instrument scanning: B-type ultrasound examination has important reference value, more helpful for refractive media turbidity cases, tumors are smooth mushroom-like protrusion; tumor ultrasound behind echo-negative area (acoustic shadow), choroid Depression.
9, fluorescent fundus angiography:
(1) The retinal blood vessels and the tumor blood vessels simultaneously have a double circulation.
(2) Early non-fluorescent development, increased late fluorescence, and high and low fluorescence mixed mottled morphology.
10. The isotope 32 phosphorus absorption test is positive.
11, CT, phosphorus resonance check is also helpful for diagnosis.
Should be identified with the following diseases:
1. Choroidal fistula.
2. Choroidal hemangioma.
3. Choroidal metastases.
4. Wet age-related macular degeneration.
5. Choroidal hemorrhage.
