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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (03) : 140 -145. doi: 10.3877/cma.j.issn.2095-2007.2022.03.003

论著

视网膜母细胞瘤经眼动脉灌注化学药物治疗与经静脉全身化学药物治疗后摘除眼球的组织病理学特征研究
刘雯1, 张楠2, 张诚玥3, 赵军阳4, 李莉1, 李宁东1, 李彬5,†()   
  1. 1. 100045　国家儿童医学中心　首都医科大学附属北京儿童医院眼科
    2. 100045　国家儿童医学中心　首都医科大学附属北京儿童医院病理科
    3. 100045　国家儿童医学中心　首都医科大学附属北京儿童医院眼科；071000　保定市儿童医院眼科
    4. 100045　国家儿童医学中心　首都医科大学附属北京儿童医院儿童肿瘤中心
    5. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　眼科学与视觉科学北京市重点实验室
  • 收稿日期:2022-04-18 出版日期:2022-06-28
  • 通信作者: 李彬
  • 基金资助:
    国家卫生健康委员会卫生行业科研专项项目(2014040)

Histopathological features of eyes enucleated due to retinal blastoma after intra-arterial chemotherapy or intravenous chemotherapy

Wen Liu1, Nan Zhang2, Chengyue Zhang3, Junyang Zhao4, Li Li1, Ningdong Li1, Bin Li5,†()   

  1. 1. Department of Ophthalmology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
    2. Department of Pathology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
    3. Department of Ophthalmology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China; Department of Ophthalmology, Baoding Children′s Hospital, Baoding 100045, China
    4. Department of Pediatric Oncology Center, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
    5. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology&Visual Sciences Key Lab., Beijing 100730, China
  • Received:2022-04-18 Published:2022-06-28
  • Corresponding author: Bin Li
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引用本文：

刘雯, 张楠, 张诚玥, 赵军阳, 李莉, 李宁东, 李彬. 视网膜母细胞瘤经眼动脉灌注化学药物治疗与经静脉全身化学药物治疗后摘除眼球的组织病理学特征研究[J]. 中华眼科医学杂志(电子版), 2022, 12(03): 140-145.

Wen Liu, Nan Zhang, Chengyue Zhang, Junyang Zhao, Li Li, Ningdong Li, Bin Li. Histopathological features of eyes enucleated due to retinal blastoma after intra-arterial chemotherapy or intravenous chemotherapy[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(03): 140-145.

目的

探讨视网膜母细胞瘤(RB)经眼动脉灌注化学药物治疗(IAC)或经静脉全身化学药物治疗(IVC)后摘除眼球的临床组织病理学特征。

方法

收集首都医科大学附属北京儿童医院眼科2020年1月至2022年3月期间经IAC或IVC治疗后行眼球摘除术的19例(19只眼)RB病例。其中，男性10例(10只眼)，女性9例(9只眼)；年龄4~45个月，平均年龄(24.7±11.9)个月。根据治疗手段不同分为IAC治疗组和IVC治疗组。记录患者的治疗方法、临床分期(cTNM)、组织病理学分期(pTNM)、组织病理学特征及组织病理学高危因素(HRF)，以例数(眼数)和百分比进行描述。

结果

采用IAC疗法治疗者8例(8只眼)，占42.11 %(8/19)，采用IVC疗法治疗者11例(11只眼)，占57.89%(11/19)。采用AJCC第8版TNM分期法进行分期，其中IAC治疗组cT2期、cT3期及cT4期分别有4例(4只眼)、3例(3只眼)及1例(1只眼)，分别占50.00%(4/8)、37.50%(3/8)及12.50%(1/8)，pT1期、pT2期及pT3期分别有5例(5只眼)、1例(1只眼)及2例(2只眼)，分别占62.50%(5/8)、12.50%(1/8)和25.00%(2/8)；IVC治疗组cT2期、cT3期及cT4期分别有1例(1只眼)、9例(9只眼)及1例(1只眼)，分别占9.09%(1/11)、81.82%(9/11)和9.09%(1/11)，pT1期、pT2期及pT3期及pT4期分别有1例(1只眼)、6例(6只眼)、3例(3只眼)和1例(1只眼)，分别占9.09%(1/11)、54.55%(6/11)、27.27%(3/11)、9.09%(1/11)。全部19例(19只眼)经IAC与IVC治疗的RB组织病理学检查显示肿瘤有不同程度的钙化、出血及坏死，IAC治疗组和IVC治疗组发生脉络膜广泛性萎缩患者分别有8例(8只眼)和2例(2只眼)，分别占100%(8/8)和18.18%(2/11)，IAC治疗组和IVC治疗组发生血管壁均质性增厚改变者分别有8例(8只眼)和1例(1只眼)，分别占100%(8/8)和9.09%(1/11)。全部19例(19只眼)中肿瘤存在HRF者7例(7只眼)，占36.84%(7/19)。其中，HRF在cT2期、cT3期及cT4期者分别有1例(1只眼)、4例(4只眼)及2例(2只眼)，分别占14.29%(1/7)、57.14%(4/7)及100.00%(2/2)。IAC治疗组和IVC治疗组存在HRF者分别为2例(2只眼)和5例(5只眼)，分别占25.00%(2/8)和45.45%(5/11)。

结论

IAC治疗后特征性组织病理学改变为脉络膜广泛性萎缩、血管壁呈均质性增厚改变。cTNM分期较高的患者存在组织病理学高危因素风险可能增加。

关键词: 视网膜母细胞瘤, 经眼动脉灌注化学药物治疗, 经静脉全身化学药物治疗, 组织病理学特征
Objective

To investigate the histopathological features of eyes enucleated due to retinoblastoma (RB) after ophthalmic intra-arterial chemotherapy (IAC) or intravenous chemotherapy (IVC).

Methods

From January 2020 to March 2022, 19 cases (19 eyes) of Rb who underwent enucleation after IAC or IVC treatment were collected from the Department of Ophthalmology, Beijing Children′s Hospital affiliated to Capital Medical University. Among them, there were 10 males (10 eyes) and 9 females (9 eyes) with the average age was (24.7±11.9) months (ranged from 4 to 45 months). According to treatment methods, they were divided into IAC treatment group and IVC treatment group. The treatment method, clinical stage (cTNM), histopathological stage (pTNM), histopathological characteristics and high-risk factors (HRF) of the patients were recorded and described in the number of cases (eyes) and percentage.

Results

There were eight patients (8 eyes) treated with IAC, accounting for 42.11% (8/19), and 11 patients (11 eyes) treated with IVC, accounting for 57.89% (11/19). The 8th Edition TNM staging method of AJCC was used for staging. In IAC treatment group, there were 4 cases (4 eyes), 3 cases (3 eyes) and 1 case (1 eye) in cT2, cT3 and cT4, accounting for 50.00% (4/8), 37.50% (3/8) and 12.50% (1/8), respectively. In pT1, pT2 and pT3, there were 5 cases (5 eyes), 1 case (1 eye) and 2 cases (2 eyes), accounting for 62.50% (5/8), 12.50% (1/8) and 25.00% (2/8), respectively. In IVC treatment group, there were 1 case (1 eye), 9 cases (9 eyes) and 1 case (1 eye) in cT2, cT3 and cT4, accounting for 9.09% (1/11), 81.82% (9/11) and 9.09% (1/11), respectively. There were 1 case (1 eye), 6 cases (6 eyes), 3 cases (3 eyes) and 1 case (1 eye) in pT1, pT2, pT3 and pT4, accounting for 9.09% (1/11), 54.55% (6/11), 27.27% (3/11) and 9.09% (1/11), respectively. The calcification, bleeding and necrosis to varying degrees were found in RB histopathological examination of all 19 cases (19 eyes) treated with IAC and IVC. There were 8 cases (8 eyes) and 2 cases (2 eyes) of extensive choroidal atrophy in IAC and IVC treatment group, accounting for 100% (8/8) and 18.18% (2/11), respectively. There were 8 cases (8 eyes) and 1 case (1 eye) of homogeneous thickening of vascular wall in IAC and IVC treatment group, accounting for 100% (8/8) and 9.09% (1/11), respectively. All 19 patients (19 eyes), there were 7 patients (7 eyes) with HRF, accounting for 36.84% (7/19). Among them, there were 1 patient (1 eye), 4 patients (4 eyes) and 2 patients (2 eyes) in cT2, cT3 and cT4, accounting for 14.29% (1/7), 57.14% (4/7) and 100.00% (2/2), respectively. There were 2 patients (2 eyes) and 5 patients (5 eyes) with HRF in IAC and IVC treatment group, accounting for 25.00% (2/8) and 45.45% (5/11), respectively.

Conclusions

The characteristic histopathological changes after IAC treatment were extensive atrophy of choroid and homogeneous thickening of vascular wall. Patients with higher cTNM stage may have an increased risk of histopathological high-risk factors.

Key words: Retinoblastoma, Intra-arterial chemotherapy, Intravenous chemotherapy, Histopathologic feature
图4 经眼动脉灌注化学药物治疗组患者眼球组织中血管病理改变　图4A示肿瘤组织内血管壁均质性增厚改变(白色箭头)(苏木精－伊红染色，×100)；图4B示脉络膜内血管管腔扩张、血栓形成(黑色箭头)；图4C示球后视神经外软组织内血管内皮下平滑肌增生(黑色三角)(苏木精－伊红染色，×200，德国蔡司研究级正置显微镜Axio Scope.A1)
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