摘要
目的：本文主要觀察葡萄膜惡性黑色素細胞癌，其臨床表現在亞洲黃種人與西方白人是否有所不同？病人與方法：我們收集由民國七十七年至民國八十八年在台大醫院被診斷為葡萄膜惡性黑色素細胞癌病例。以回溯性研究方式，探討其好發年齡、臨床症狀、腫瘤病理細胞形態、治療方法、有無腫瘤轉移及其可能的危險因子。結果：我們收集了18例，其中10例為男性、8例為女性。追蹤的懊間由4個月到7年，平均3.8年。發病的年齡以50歲到60歲為最多。原發腫瘤的位置以脈絡膜(choroid)為最多。症狀以視力喪失，視力模糊最常見。病理細胞形態以類上皮細胞型(epithelioid cel type)最多，5例轉移的病例中有4例在診斷後3個月內發生轉移。統計上發現睫狀體(ciliary body)的原發腫瘤易發生轉移，而腫瘤最大直徑與轉移的發生無關。結論：葡萄膜惡性黑色素細胞癌好發於成人，以50至60歲為最多。在亞洲黃種人仍以類上皮細胞型產生轉移為最多，預後也最差。治療方法仍以眼球摘除術為主。至於在腫瘤轉移的危險因子方面，我們的觀察發現(1)類上皮細胞，(2)前葡萄膜位置，如睫狀體轉移的機會較大，但與外國文獻不同的是轉移與腫瘤最大直徑無關。以肝臟功能生化檢查來預測腫瘤發生轉移的陽性預測值是相當不理想。利用核子醫學檢查：正子發散斷層掃瞄(positron emission tomography)及單一光子發散電腦斷層掃瞄(single photon emission computed tomography)來增加偵測腫瘤轉移的準確度，不失為未來的一個發展方向。
並列摘要
Objective: The purpose of this study is to compare the clinical features of malignant uveal melanoma in Caucasians with those in Asians. Patients and Methods: We retrospectively reviewed the records of patients who were diagnosed with primary malignant uveal melanoma from 1988 to 1999 in the department of Ophthalmology, National Taiwan University Hospital. Data were analyzed for age at onset, symptoms, pathological cell types, treatment, and possible risk factors for metastasis. Results: We collected 18 patients. Fifteen patients (83%) had disease involving the choroids. Blurring of vision was the chief complaint for 13(72%) patients with visual acuity less than 0.1 Mixed cell type melanoma was the most common pattern, yet the epithelioid type had the highest rate (75%) of metastasis. The liver was the most common site of metastasis. Enucleation was still the treatment of choice. Conclusions: We found that the epithelioid type of melanoma and an anterior location of the tumor were risk factors for metastasis in primary malignant uveal melanoma. However, the size of the tumor was not a risk actor in our study, which was different from previous reports in Caucasians.
延伸閱讀
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