Braun U C, Rummelt V C, Naumann G O
Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg.
Klin Monbl Augenheilkd. 1998 Dec;213(6):331-40. doi: 10.1055/s-2008-1034998.
Focal malignant melanomas involving only the iris have a very good prognosis. Involvement of the iris and/or diffuse growth makes the prognosis worse. The prognostic parameters of diffusely growing malignant anterior uveal melanomas are analysed.
From 1981-1995 serial sections of 39 eyes, 23 women and 16 men, of diffusely growing malignant anterior uveal melanomas were histologically examined. Patients were between 9 and 80 years old (median 56 years). Follow-up was between 2 months and 15 years. At the end of the study, 13 patients had died from metastasis, all showed involvement beyond the iris. Four patients died from other causes.
The 39 diffuse malignant melanomas were categorized into 10 affecting only the iris, 18 iris and ciliary body and 11 involving iris, ciliary body and choroid. 14 spindle-cell, 23 mixed-cell and 2 epithelioid-cell tumors were identified. We observed between 0 and 4 mitoses in 40 high-power fields. Only 4 melanomas showed more than 100 tumor-infiltrating lymphocytes in 20 high-power fields. Nine tumors showed extra-scleral spread, nine displayed vascular networks. Univariate Kaplan-Meier survival curves showed as significant prognostic factors: localization in the iris only (p = 0.0008), spindle cell type (p = 0.0002) and absence of vascular networks (p = 0.01). This was confirmed by multivariate Cox analysis.
Patients with diffuse malignant melanoma confined to the iris alone have a good prognosis for survival. Diffuse tumor cell spread can be diagnosed at the slitlamp with high magnification. Conservative follow-up is acceptable, as long as ciliary body involvement is ruled out. Eye with medically uncontrollable secondary glaucoma should be enucleated. Anti-glaucoma filtering procedures are contraindicated because of the danger of extraocular spreading malignant cells.
仅累及虹膜的局限性恶性黑色素瘤预后非常好。虹膜受累和/或弥漫性生长会使预后变差。本文分析了弥漫性生长的恶性前葡萄膜黑色素瘤的预后参数。
对1981年至1995年间39只眼睛（23名女性和16名男性）的弥漫性生长的恶性前葡萄膜黑色素瘤连续切片进行组织学检查。患者年龄在9岁至80岁之间（中位数56岁）。随访时间为2个月至15年。研究结束时，13名患者死于转移，均显示超出虹膜的受累情况。4名患者死于其他原因。
39例弥漫性恶性黑色素瘤分为仅累及虹膜的10例、累及虹膜和睫状体的18例以及累及虹膜、睫状体和脉络膜的11例。识别出14例梭形细胞瘤、23例混合细胞瘤和2例上皮样细胞瘤。在40个高倍视野中观察到0至4个有丝分裂象。只有4例黑色素瘤在20个高倍视野中显示超过100个肿瘤浸润淋巴细胞。9例肿瘤显示巩膜外扩散，9例显示血管网。单因素Kaplan-Meier生存曲线显示为显著预后因素的有：仅位于虹膜（p = 0.0008）、梭形细胞类型（p = 0.0002）和无血管网（p = 0.01）。多因素Cox分析证实了这一点。
仅局限于虹膜的弥漫性恶性黑色素瘤患者生存预后良好。高倍放大裂隙灯下可诊断弥漫性肿瘤细胞扩散。只要排除睫状体受累，保守随访是可以接受的。药物无法控制的继发性青光眼的眼睛应摘除。由于存在眼外扩散恶性细胞的风险，抗青光眼滤过手术是禁忌的。
