Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.
Surv Ophthalmol. 2012 May-Jun;57(3):264-71. doi: 10.1016/j.survophthal.2011.09.006. Epub 2012 Feb 25.
Thirteen cases with myxomatous changes of the corneal stroma have been reported to date. We report six additional cases with clinical, histopathological, and immunohistochemical data. The clinical appearance is most often a gelatinous, whitish elevation with insidious onset. Histopathologically, there are inconspicuous spindle- and stellate-shaped cells in a loose, myxoid matrix. The typical location is in the anterior cornea beneath the epithelium, with varying degrees of extension into the stroma. Vimentin and smooth-muscle actin immunohistochemical stains are characteristically positive, and staining occasionally may be seen with muscle-specific actin, whereas CD34 staining usually is negative. In most cases, myxomatous changes are a degenerative process involving transformation of stromal keratocytes into cells with prominent secretory activity and myofibroblastic differentiation. Most occur in corneas with a history of ocular disease or trauma that disrupts Bowman's layer. We suggest labelling lesions with these features as "myxomatous corneal degeneration." So-called "primary corneal myxomas" also exist where there is no significant history. It remains unclear whether the myxomatous changes in such lesions are neoplastic or degenerative. Myxomatous corneal changes are likely under-recognized and under-diagnosed.
迄今为止，已有 13 例报告了角膜基质粘液样改变。我们报告了另外 6 例具有临床、组织病理学和免疫组织化学数据的病例。临床表现通常为潜伏性起病的胶状、灰白色隆起。组织病理学上，在疏松的粘液样基质中有不明显的梭形和星状细胞。典型位置在前部角膜上皮下，不同程度地延伸到基质中。波形蛋白和平滑肌肌动蛋白免疫组织化学染色通常为阳性，偶尔也可见到肌特异性肌动蛋白染色，而 CD34 染色通常为阴性。在大多数情况下，粘液样改变是一种退行性过程，涉及基质角膜细胞向具有明显分泌活性和肌成纤维分化的细胞转化。大多数发生在有眼部疾病或创伤史的角膜，这些疾病破坏了鲍曼层。我们建议将具有这些特征的病变标记为“粘液样角膜变性”。也存在所谓的“原发性角膜粘液瘤”，但没有明显的病史。这些病变中的粘液样改变是肿瘤性的还是退行性的仍不清楚。粘液样角膜改变可能被低估和漏诊。
