De Potter P, Shields C L, Eagle R C, Shields J A, Lipkowitz J L
Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pa., USA.
Arch Ophthalmol. 1996 May;114(5):608-12. doi: 10.1001/archopht.1996.01100130600020.
A 67-year-old man was diagnosed as having a melanocytoma of the optic disc in the left eye. Observation during a 5-year period showed no change in the lesion. At age 72 years, he had abrupt visual loss to no light perception in the affected left eye. Clinical examination disclosed little enlargement of the papillary tumor but ultrasonographic evidence of optic nerve infiltration. Precontrast magnetic resonance imaging studies disclosed a hyperintense infiltrative lesion in the enlarged left optic nerve. Enhancement features of the lesion excluded a hemorrhagic process. The eye was removed with a 22.5-mm segment of optic nerve. Histopathologic examination showed a large, necrotic, mixed-cell malignant melanoma confined to the optic nerve. No choroidal involvement or viable melanocytoma cells were documented. This case stresses that it may be difficult to differentiate a melanocytoma from a primary malignant melanoma of the optic nerve.
一名67岁男性被诊断为左眼视盘黑色素细胞瘤。5年的观察期内病变无变化。72岁时，患侧左眼突然视力丧失至无光感。临床检查显示乳头瘤仅有轻微增大，但超声检查有视神经浸润的证据。增强前磁共振成像研究显示扩大的左侧视神经有高强度浸润性病变。病变的强化特征排除了出血性病变。眼球连同22.5毫米长的视神经段被摘除。组织病理学检查显示为局限于视神经的巨大、坏死、混合细胞恶性黑色素瘤。未记录到脉络膜受累或存活的黑色素细胞瘤细胞。该病例强调，区分黑色素细胞瘤与原发性视神经恶性黑色素瘤可能存在困难。
