Subclinical metastasis of uveal melanoma.
Subclinical metastasis of uveal melanoma.
复制标题
葡萄膜黑色素瘤的亚临床转移。
DOI：
10.1097/00004397-199303330-00017
复制
发表时间：
1993
影响因子：
--
通讯作者：
Donoso,LA
中科院分区：
文献类型：
--
作者：
Wang,MX;Shields,JA;Donoso,LA
葡萄膜恶性黑色素瘤是成人人群中最常见的原发性眼内恶性肿瘤，年发病率约为6例/百万/年[1]。葡萄膜黑色素瘤的诊断通过使用间接检眼镜检查和明智地使用辅助研究如荧光素血管造影、超声检查、计算机断层扫描（CT）、磁共振成像（MRI）、放射性磷摄取试验和眼内活检来辅助[2]。使用单克隆抗体和免疫闪烁成像的免疫学技术也得到了评价[3]。传统的治疗方法，眼球摘除术，受到了挑战。甚至有人认为，眼球摘除术实际上可能会通过促进肿瘤细胞的传播或在手术时破坏患者的免疫机制来恶化患者的预后[4]。近年来，替代治疗方法，包括定期观察、光凝、放疗和局部切除，已被更频繁地用于治疗后葡萄膜黑色素瘤[1 - 3]。约40%接受眼球摘除术的葡萄膜黑色素瘤患者在10年内死于转移性黑色素瘤，通常转移至肝脏[5]。尽管如此，在原发性肿瘤最初出现时临床上明显的转移性疾病并不常见，使用常规方法（如血清肝酶和肝脏扫描）仅在1 - 2%的患者中检出[2]。这些发现表明亚临床转移性疾病可能比目前怀疑的更常见。例如，在一项研究中，治疗前血清肝酶和肝脏扫描在后来死于转移性黑色素瘤的患者中有12%异常[6]。在临床上，葡萄膜黑色素瘤的弥漫性肝转移已经在一个同时有正常血清肝转移的患者中手术证实。
Malignant melanoma of the uveal tract is the most common primary intraocular malignant tumor in the adult population, with an annual incidence of approximately 6 cases per million per year [1]. The diagnosis of uveal melanoma has been aided by the use of indirect ophthalmoscopy and the judicious employment of ancillary studies such as fluorescein angi-ography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), radioactive phosphorus uptake test, and intraocular biopsy [2]. Immunological techniques using monoclonal antibodies and immunoscintigraphy have also been evaluated [3]. The traditional form of treatment, enucleation, has been challenged. It has even been suggested that enucleation may actually worsen the patient's prognosis by promoting the dissemination of tumor cells or disrupting the patient's immune mechanisms at the time of surgery [4]. In recent years, alternative methods of treatment, including periodic observation, photocoagulation, radiotherapy, and local resection, have been used more frequently to manage poste-rior uveal melanoma [1–3].Approximately 40% of the patients with uveal melanoma who undergo enucleation die within 10 years of metastatic melanoma, usually to the liver [5]. Despite this, clinically evident metastatic disease at the time of initial presentation of the primary tumor is uncommon, being detected in only 1 to 2% of patients using conventional methods such as serum liver enzymes and liver scans [2]. These findings suggest that subclinical metastatic disease may be more common than is currently suspected. For example, in one investigation, pretreatment serum liver enzymes and liver scans were abnormal in 12% of the patients who later died of metastatic melanoma [6]. Clinically, diffuse hepatic metastasis of uveal melanoma has been documented surgically in a patient who had concurrent normal serum liver