葡萄膜黑色素瘤中涡静脉侵犯的意义是什么？

What is the significance of vortex vein invasion in uveal melanoma?

机构信息

Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.

出版信息

Eye (Lond). 2009 Aug;23(8):1661-7. doi: 10.1038/eye.2008.345. Epub 2008 Nov 14.

DOI:10.1038/eye.2008.345

PMID:19011609

Abstract

PURPOSE

To correlate vortex vein invasion with established prognostic factors for uveal melanoma.

METHODS

Enucleated eyes with a confirmed histopathological diagnosis of uveal melanoma with vortex vein invasion were identified, over a 10-year period. Established uveal melanoma prognostic factors, with tumour genetics were correlated with vortex vein invasion and patient survival.

RESULTS

Microscopic vortex vein involvement was present in 29 of 244 (11.9%) uveal melanomas. Of 29, 6 (20.7%) tumours had macroscopic evidence of vortex vein invasion. Of 29, 14 (48.3%) tumours also showed evidence of non-vortex vein, 'direct' scleral invasion. 23 (79.3%) of 29 melanomas involved only the choroid. The mean maximum diameter of tumours with vortex vein invasion was 15.8 mm and the mean thickness was 9.7 mm. The uveal melanoma was a discrete nodule in 27 of 29 (93.1%) cases. Histologically, 8 of 29 tumours (27.6%) were spindle cell, 19 of 29 (65.5%) were mixed cell, and 2 of 29 (6.9%) were epithelioid cell type. Of 29, 22 (75.9%) uveal melanomas with vortex vein invasion contained extracellular matrix networks and loops. Genetic abnormalities correlated with poor prognosis were seen in 25 of 29 (86.2%) tumours with vortex vein invasion. Liver metastasis was confirmed in 19 of 29 (65.5%) patients with vortex vein invasion. No patients with uveal melanomas showing vortex vein invasion suffered orbital recurrence of disease following enucleation.

CONCLUSIONS

The trends show that vortex vein invasion is associated with a choroidal location, large tumour size, spindle cell bias, presence of extracellular matrix loops/networks and genetic markers. A higher proportion of patients with vortex vein invasion progress to develop liver metastasis compared with the general uveal melanoma population.

摘要

目的

探讨涡静脉侵犯与葡萄膜黑色素瘤既定预后因素的相关性。

方法

在 10 年期间，确定了经组织病理学证实存在涡静脉侵犯的葡萄膜黑色素瘤眼球标本。将肿瘤遗传学等既定葡萄膜黑色素瘤预后因素与涡静脉侵犯和患者生存情况进行相关性分析。

结果

在 244 例葡萄膜黑色素瘤中，有 29 例（11.9%）存在显微镜下的涡静脉受累。其中 6 例（20.7%）肿瘤有宏观的涡静脉侵犯证据，14 例（48.3%）肿瘤还存在非涡静脉、“直接”巩膜侵犯的证据。29 例肿瘤中，23 例（79.3%）仅累及脉络膜。有涡静脉侵犯的肿瘤的平均最大直径为 15.8mm，平均厚度为 9.7mm。29 例黑色素瘤中，27 例（93.1%）为局灶性结节。组织学上，8 例（27.6%）肿瘤为梭形细胞型，19 例（65.5%）为混合细胞型，2 例（6.9%）为上皮样细胞型。29 例中有 22 例（75.9%）有涡静脉侵犯的黑色素瘤含有细胞外基质网络和环。有 25 例（86.2%）有涡静脉侵犯的肿瘤存在与预后不良相关的遗传异常。在 19 例（65.5%）有涡静脉侵犯的患者中证实有肝转移。在接受眼球摘除术后，没有有涡静脉侵犯的黑色素瘤患者出现眼眶疾病复发。