Amram, A.L., Rico, G., Kim, J.W., et al.
玻璃体 视网膜 病理
摘要：目的：最近对视网膜母细胞瘤玻璃体种子的分类方案在预测治疗反应方面有希望。我们首次将临床分型方案与其组织病理学特征联系起来。设计：回顾性研究。研究对象：2010年至2015年休斯敦视网膜母细胞瘤中心病理部摘除的眼。方法：对视网膜母细胞瘤患者摘除眼的肉眼照片进行分析，选择有玻璃体种子的眼。选择具有足够进行临床病理学关联的材料的病例进行进一步分析，并回顾其临床照片。回顾其常规组织病理学幻灯片，并与临床和肉眼照片进行比较。种子被分类为1型（“粉尘”），2型（“球形”）或3型（“云”）。使用CD68免疫组织化学染色来证实巨噬细胞的存在。使用突触泡蛋白染色视网膜母细胞瘤细胞。主要观察指标：将临床玻璃体种子与组织病理学特征相关。结果： 从138只眼中选择了14只具有足量肿瘤种子的眼以及临床和肉眼摄影相关。 1型种子由单个活的肿瘤细胞和分散的巨噬细胞组成。 2型种子由2个亚型组成：具有活细胞的球体和具有活细胞外缘的球体，但中心是坏死细胞。 3型种子由超过90％的坏死物质组成，其外缘混有几个巨噬细胞和活细胞。未治疗（8/14）和既往治疗（6/14）眼每种类型的种子的组织病理学特征类似。治疗眼有更多的1型和3型种子。结论：我们首次提出了视网膜母细胞瘤中的玻璃体种子的临床分类方案与组织病理学的相关性。 “粉尘”由散在的与巨噬细胞交替存在的单细胞形成。具有半透明中心的“球体”包含多层的肿瘤细胞，可能脱落单个细胞，并且可能更具临床攻击性。 “云”种子主要由坏死物质组成，可解释其缺乏治疗反应。预治疗眼显示与未治疗眼形态相似的肿瘤种子。知道玻璃体种子的基本组织病理学是分类的基本组成部分，可能有助于了解治疗临床反应。
PURPOSE:A recent classification scheme for retinoblastoma vitreous seeds has shown promise in predicting treatment response. For the first time, we correlate this clinical classification scheme with its histopathologic features.DESIGN:Retrospective review.PARTICIPANTS:Enucleated eyes received at the pathology department of the Retinoblastoma Center of Houston from 2010 to 2015.METHODS:Macroscopic photographs of the enucleated eyes of patients with retinoblastoma were analyzed to select those with vitreous seeds. Cases with adequate material for clinicopathologic correlation were selected for further analysis, and clinical photographs were reviewed. Routine histopathologic slides were reviewed and compared with the clinical and macroscopic photographs. Seeds were classified as type 1 ("dust"), type 2 ("sphere"), or type 3 ("cloud"). To confirm the presence of macrophages, CD68 immunohistochemical staining was used. Synaptophysin was used to stain retinoblastoma cells.MAIN OUTCOME MEASURES:To correlate clinical vitreous seed type with histopathologic features.RESULTS:A total of 14 eyes with adequate amounts of tumor seeds along with clinical and macroscopic photographic correlation were selected from a total of 138 eyes reviewed. Type 1 seeds consisted of individual viable tumor cells and scattered macrophages. Type 2 seeds consisted of 2 submorphologies: spheres with viable cells throughout and spheres with an outer rim of viable cells but necrotic cells centrally. Type 3 seeds were composed of more than 90% necrotic material admixed with few macrophages and viable cells at their outer rim. Untreated (8/14) and previously treated (6/14) eyes showed similar histopathologic features for each type of seeds. Treated eyes had more type 1 and 3 seeds.CONCLUSIONS:We provide the first histopathologic correlation of the clinical classification scheme for vitreous seeds in retinoblastoma. "Dust" is formed by scattered single cells alternating with macrophages. "Spheres" with translucent centers contain multiple layers of viable tumor cells that shed single cells and may be more clinically aggressive. "Cloud" seeds are mostly composed of necrotic material, explaining their lack of therapeutic response. Pretreated eyes showed tumor seeds morphologically similar to untreated eyes. Knowledge of the underlying histopathology of vitreous seed types is a fundamental component of classification and may aid in understanding clinical response to treatment.