使用23G玻璃体切割器进行诊断性活检后葡萄膜黑色素瘤的播散
Dissemination of Uveal Melanoma After Diagnostic Biopsy With 23-Gauge Vitrector.
作者信息
Chou Hung-Da, Anguita Rodrigo, Thaung Caroline, Alharby Lamis, Negretti Guy S, da Cruz Lyndon, Sagoo Mandeep S
机构信息
Moorfields Eye Hospital, London, UK.
Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Retina. 2025 Jul 7;45(9):1817-21. doi: 10.1097/IAE.0000000000004573.
PURPOSE
To report a case with tumor dissemination after diagnostic choroidal biopsy.
METHODS
Multimodal imaging and histopathology correlation.
RESULTS
A 64-year-old male presented with an atypical uveal mass and underwent a diagnostic transretinal 23-gauge vitrector biopsy to diagnose melanoma. Post-operative course was complicated by prolonged vitreous hemorrhage which required vitrectomy, delaying proton beam treatment by two months. One year after the biopsy, the tumor cells had disseminated to the retina, optic nerve, iris, iridocorneal angle, and extraocularly via the vitrectomy port. The patient died from metastatic melanoma one year later. To the best of our knowledge, there are 10 prior cases with biopsy-related tumor seeding in the literature, with risk features including multiple vitreous surgeries, a long interval between biopsy and treatment, and high-risk melanoma cytogenetics. Severe vitreous hemorrhage following biopsy further postpone treatments or warrant vitrectomy, both increasing the risk of tumor spread.
CONCLUSIONS
Biopsy of choroidal melanoma, especially when complicated by severe vitreous hemorrhage, can lead to dissemination of the malignant tumor.
目的
报告一例诊断性脉络膜活检后肿瘤播散的病例。
方法
多模态影像学与组织病理学相关性研究。
结果
一名64岁男性出现非典型葡萄膜肿物，接受了经视网膜23G玻璃体切割活检以诊断黑色素瘤。术后病程因持续性玻璃体积血而复杂化，这需要进行玻璃体切除术，导致质子束治疗延迟两个月。活检后一年，肿瘤细胞已扩散至视网膜、视神经、虹膜、虹膜角膜角，并通过玻璃体切除端口扩散至眼外。患者一年后死于转移性黑色素瘤。据我们所知，文献中有10例先前与活检相关的肿瘤播散病例，风险因素包括多次玻璃体手术、活检与治疗之间的间隔时间长以及高危黑色素瘤细胞遗传学。活检后严重的玻璃体积血进一步推迟治疗或需要进行玻璃体切除术，两者均增加了肿瘤扩散的风险。
结论
脉络膜黑色素瘤活检，尤其是当合并严重玻璃体积血时，可导致恶性肿瘤播散。
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