McLean I W, Keefe K S, Burnier M N
Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Ophthalmology. 1997 May;104(5):777-80. doi: 10.1016/s0161-6420(97)30234-6.
This study was performed to determine the prognostic significance of the presence of loops defined as periodic acid-Schiff-positive fibrovascular septa that completely surround lobules of tumor cells in cases of uveal melanoma.
The presence of loops was evaluated using an ordinary light microscope and routinely stained periodic acid-Schiff and hematoxylin sections from 496 posterior uveal melanomas without knowledge of the follow-up data on the patient.
At 15 years, survival decreased from 67.5% to 33.8% when complete loops were present. Univariate Cox regression analysis indicated that the presence of loops was an indicator of poor outcome, and was better than age but not as good as the mean diameter of the largest nucleoli, cell type, or tumor size.
The presence of loops, as evaluated in this study, was not as strong an indicator of poor outcome as were loops assessed in a previous study of 234 cases from another laboratory. The authors suspect this difference may be due to their only using routinely stained sections without a green filter, as was used in previously reported studies. The authors description of loops does not require any special equipment and gives sufficiently useful results to justify its inclusion by the pathologist in reports of such specimens. A description of vascular loops should be added to the use of the modified Callender cell type, tumor dimensions, mitotic count, extraocular extension, and lymphocytic infiltration in the final pathologic report.
本研究旨在确定在葡萄膜黑色素瘤病例中，定义为完全围绕肿瘤细胞小叶的过碘酸希夫阳性纤维血管间隔的环状结构的预后意义。
使用普通光学显微镜和来自496例后葡萄膜黑色素瘤的常规染色过碘酸希夫和苏木精切片评估环状结构的存在情况，且不了解患者的随访数据。
15年时，存在完整环状结构时生存率从67.5%降至33.8%。单因素Cox回归分析表明，环状结构的存在是预后不良的一个指标，其优于年龄，但不如最大核仁的平均直径、细胞类型或肿瘤大小。
本研究评估的环状结构的存在，并非如另一实验室先前对234例病例研究中评估的环状结构那样是预后不良的有力指标。作者怀疑这种差异可能是由于他们仅使用了未加绿色滤光片的常规染色切片，而先前报道的研究中使用了绿色滤光片。作者对环状结构的描述不需要任何特殊设备，且能给出足够有用的结果，足以证明病理学家在这类标本报告中纳入该描述的合理性。在最终病理报告中，应在使用改良的卡伦德细胞类型、肿瘤尺寸、有丝分裂计数、眼外扩展和淋巴细胞浸润的基础上，增加对血管环状结构的描述。
