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视网膜色素上皮细胞(RPE)形成的肿瘤较少,常见肿瘤类型有黑色素瘤,少见类型包括RPE形成的腺癌,这两种肿瘤在临床和病理特点上都有所不同。本文报道1例60岁的男性患者,因为进展性视力丧失,眼科诊断为黑色素瘤而行右眼摘除术。病理学检查发现后极部接近视神经处可见实性、界限清楚的病灶。组织学检查见构成肿瘤的细胞,具有大的多形、浓染的核,核仁突出,色素极少;肿瘤细胞多呈乳头状排列。为和黑色素瘤进行区别,进一步行免疫组织化学染色。结果显示上皮膜抗原(EMA)为强阳性,HMB45阴性,支持RPE来源的腺癌诊断。系统检查排除了转移癌。总之,虽然RPE来源的腺癌非常少见,但必须清楚它与脉络膜黑色素瘤在诊断上的异同点。
Retinal pigment epithelial cells (RPE) to form fewer tumors, common types of cancer melanoma, rare forms include adenocarcinoma of RPE, the two tumors in clinical and pathological features are different. This article reports a case of a 60-year-old male patient undergoing right-eye excision for progressive ophthalmologic diagnosis and ophthalmologic diagnosis of melanoma. Pathological examination revealed that the posterior pole near the optic nerve can be seen in solid, well-defined lesions. Histological examination of cells that constitute the tumor, with a large pleomorphic, stained nuclei, prominent nucleoli, pigment rarely; tumor cells mostly arranged in papillary. To differentiate from melanoma, immunohistochemical staining was performed further. The results showed that the epithelial membrane antigen (EMA) was strongly positive, HMB45-negative, supporting the diagnosis of RPE-derived adenocarcinoma. Systemic examination excludes metastases. In conclusion, although adenocarcinoma of the RPE origin is rare, it must be clear about its diagnostic and choroidal melanoma similarities and differences.