ciliary body melanoma
Introduction
Introduction to ciliary body melanoma Ciliary melanoma (ciliary melanoma) refers to a melanotic mass of the ciliary body composed of malignant melanoma cells, which organizes melanocytes in the matrix of the ciliary body. basic knowledge The proportion of illness: the incidence rate is about 0.004%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: glaucoma, anterior chamber hemorrhage, vitreous opacity, retinal detachment
Cause
Ciliary body melanoma etiology
(1) Causes of the disease
The cause is unclear and may be related to family, ethnicity and endocrine factors.
(two) pathogenesis
Tumors are caused by abnormal changes in the biological behavior of melanocytes, which are primary to the ciliary body melanocytes.
Prevention
Ciliary body melanoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Ciliary body melanoma complications Complications glaucoma anterior chamber hemorrhage vitreous opacity retinal detachment
Low ocular hypertension and secondary glaucoma can be seen, and there may be anterior chamber hemorrhage, lens opacity, vitreous opacity and hemorrhage, and exudative retinal detachment.
Symptom
Ciliary body melanoma symptoms Common symptoms Eye pain, congestion, lens, anterior shadow, dark shadow, lens opacity
When the tumor is small, there is generally no symptom. It is difficult to find the routine eye examination. When the tumor is enlarged, there may be black shadows in front of the eye. The tumor squeezes the lens, which may cause changes in the refractive state. In severe cases, the lens may be dislocated or Turbidity, visual acuity decreased significantly, tumor invasion of the iris cornea can appear secondary glaucoma, red eyes, eye pain symptoms.
The corresponding area of the ciliary body melanoma is scleral congestion, vasodilatation, and partially visible large and tortuous blood vessels. When the iris cornea and iris are involved, black tumors can be seen, the tumor pushes the iris, the iris is swollen in the area where the tumor is located, and the anterior chamber becomes shallow. The tumor pushes the lens, which can cause the lens to shift, or localized turbidity, or even complete turbidity. After the large pupil, the slit lamp microscope can directly observe the posterior mass of the iris, mostly black and small with different sizes and smooth surface. Object, tumor invasion of the ciliary epithelium, can cause low intraocular pressure, invading the iris corneal angle trabecular meshwork can be secondary to glaucoma, tumor necrosis, anterior chamber may have pigmentation and deposition, but also anterior chamber hemorrhage, vitreous opacity, Vitreous hemorrhage, exudative retinal detachment, etc., a small part of the ciliary body melanoma is diffusely growing, involving the entire ciliary body, this type of early retinal detachment and extraocular spread, poor prognosis, some ciliary body melanin The tumor is diffusely enlarged, showing irregular thickening of the entire ciliary body, called ring melanoma, the surface layer of the corresponding part of the tumor. Film vasodilation and spotty pigmentation is often an important feature of the ciliary body melanoma.
Examine
Examination of ciliary body melanoma
No special laboratory tests.
In addition to routine examination methods, ultrasound biomicroscopy is of great value in the early diagnosis of ciliary body and iris tumors. UBM is a new microscopic examination of the anterior segment of the eye using ultra-high frequency (50-100 MHz) ultrasound. The imaging examination method is characterized by clear imaging and high resolution, and can clearly display the corneal, anterior chamber, lens, angle of the anterior chamber, ciliary body and other organizational structures, especially prominently showing the posterior chamber structure and making up In the past, the lack of detailed examination of the posterior chamber in living tissue has its own unique features. The diagnosis of the anterior segment of the tumor has its own unique features. It can measure the thickness of the lesion, determine the extent of the tumor, and observe the change in the size of the lesion to provide follow-up. A quantitative method, in the early stage of ciliary body tumors, before the routine examination method can not be displayed, UBM can clearly show that the differential diagnosis of the anterior segment of the tumor is also of great value, whether it is to distinguish the iris tumor, or involve the iris corneal angle The best method for primary ciliary body tumors of the iris, therefore, UBM has become a clinical diagnosis of ciliary body tumors, identification Diagnostic, treatment options, follow-up and other important means.
UBM manifestations of ciliary body tumors:
1 The boundary of the lesion is clear, the ciliary body is thickened and thickened, and the shape is hemispherical or mushroom-shaped;
2 The echo in the lesion is uneven, the echo of the near ball wall is strong, the echo of the far ball wall is weak, and some of the spotted high echo group can be seen. In some cases, the circular echo-free zone is visible, which is the blood vessel inside the lesion;
3 part of the lesion edge accompanied by iris cyst;
4 secondary changes: iris morphological changes and choroidal leakage;
5 no choroidal concavity and hollowing out, because the incidence of ciliary body tumors in Chinese people is low, under the current conditions, only the size of the lesions, the relationship between the lesions and the surrounding tissues can be observed, and the ciliary body tumors are not yet available. Good and bad make a more accurate UBM diagnosis, tumors with a height of more than 5mm can not measure its size, combined with ordinary ultrasound examination (Figure 1).
Combined with color Doppler ultrasound and B-ultrasound (Figure 2) and scleral transillumination test, MRI examination is conducive to the diagnosis of this disease, MRI shows T1 weighted to high signal, T2 weighted to low signal (Figure 3).
Diagnosis
Diagnosis and diagnosis of ciliary body melanoma
Due to the concealed part of the ciliary body melanoma, the tumor is small, generally no clinical symptoms, difficult to find early, often missed diagnosis, misdiagnosis, slit lamp microscopy found that some areas of the iris bulging, anterior chamber shallow or lens displacement, unknown The cause of lens opacity and other signs should be alert to this disease.
Differential diagnosis
Ciliary body cyst
The surface is smooth and there is no progressive growth. UBM examination can confirm the diagnosis.
2. Ciliary body melanoma
Ciliary body melanoma is a benign tumor, which is clinically indistinguishable from ciliary body melanoma. Except for the general appearance of melanoma, which is characterized by dark black, it is determined by histopathology. The main difference is melanoma. It is mainly composed of large, round or polygonal melanocytes with uniform cell size. Tumor cells contain a large number of dense melanin particles, small nuclei, round, no cell atypia and pathological mitotic figures.
3. Ciliary body adenoma
Ciliary body a pigment-free epithelial adenoma with clear boundary, smooth surface, pale pink, no pigmentation, proliferating ciliary body a pigment-free epithelial cells are the main components of tumors, epithelial hyperplasia forms irregular cord-like or nested structures, cells Lightly stained, there are more pigmented, unstructured basement membranes between cells (Figure 5).
4. Ciliary body neurofibroma
Peripheral nerve fiber hyperplasia, clear boundary, smooth surface, porcelain white, no pigment, dense tissue, UBM examination lesions within the echo uniform, strong echo.
5. Other ciliary body tumors
Such as ciliary body hemangioma, ciliary body leiomyomas, ciliary body metastatic tumors, etc. need to be identified by histopathological examination.
