Choroidal osteoma

Introduction to choroidal osteoma Choroidal osteoma is a benign tumor of the choroid composed of mature bone tissue. In 1978, it was officially named by Gass and others. Most of the tumors are located near the myopic disc. They are yellow-white or orange-red flat ridges. Pigmentation is visible. The edges of the tumor are irregular. The pseudo-foot protrudes around, forming a subretinal neovascular membrane with hemorrhagic or serous retina. Get rid of. Choroidal osteoma is more common in healthy women aged 20 to 30 years. Because of tumor growth and visual acuity changes, the clinical visit age is significantly later than the tumor age. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: subretinal neovascular membrane

Choroidal osteoma

(1) Causes of the disease

It is not clear that Gass once believed that osteoma may be secondary to trauma, ectopic ossification of inflammation, but in some cases there is no history of trauma, inflammation, and some cases may be related to long-term use of certain drugs, causing calcium deposition, Cunha Reported that the mother and daughter are suffering from this disease and therefore believe that there may be genetic factors, but these causes have not been fully confirmed, others believe that the disease is caused by ossification of hemangioma, choroidal hemangioma can occur ossification due to retinal pigment epithelium ( The proliferation and metaplasia of RPE) does not occur in the hemangioma itself. At present, most people think that the disease is developed from the primitive mesodermal tissue that is congenitally left in the choroid, and thus is called choristoma.

(two) pathogenesis

The pathogenesis of choroidal osteoma is not clear, it is speculated that it is a bud tumor, but the typical bud tumor has no gender similarity to choroidal osteoma, and it does not grow in adulthood, showing obvious inheritance in choroidal osteoma. Among the many family reports that are tending to be mainly binocular cases, including mother and daughter, father and son, siblings and twins, but no similar performance in monocular cases.

Choroidal osteoma prevention

Life restraint pays attention to rest, work and rest, life is orderly, and maintaining an optimistic, positive and upward attitude towards life is of great help in preventing diseases. Make tea and rice regular, live and live regularly, not overworked, cheerful, and develop good habits

Choroidal osteoma complications Complications, subretinal neovascular membrane

Secondary retinal degeneration, subretinal neovascular membranes, etc.

Choroidal osteoma symptoms common symptoms visual field deformation visual field defect visual impairment pigmentation

Patients with choroidal osteoma are asymptomatic, and symptoms appear as visual acuity, visual distortion and visual field defects. 80% of the cases have a visual acuity of more than 0.5, 10% of the cases have a visual acuity of less than 0.1, and chronic visual impairment is mostly a tumor. The surface of the retina is degenerated, and the acute loss of vision is mostly caused by the choroidal neovascularization in the macular area.

The external eye and the anterior segment of the eye are normal, and the fundus is clearly visible. The fundus examination shows that the tumor is mainly located at the edge of the optic disc or near the optic disc. It is mostly fan-shaped, and can also be surrounded by the optic disc. A few tumors can appear in the central region of the macula, which is approximately circular or elliptical. In the case of both eyes, the lesions are mostly symmetric, some of them may be asymmetrical or sequential, and the tumor is yellowish white or orange-red. The color depth is related to the thinning of the surface retinal pigment epithelium and the degree of depigmentation, and is affected by the degree of calcification of the bone. The effect, the longer part of the tumor, the degeneration of pigment epithelium and the deposition of calcium are more obvious, the color tends to white, while the new part of the peripheral part is mostly orange-red, and scattered pigment plaques are visible on the surface of the tumor. The tumor grows flat, the boundary is clear and often has a blunt pseudo-foot-like protrusion. The surface of the tumor with a long onset time is smooth but the hills are high and low, and the retinal blood vessels have no abnormalities except the shape of the tumor surface. The size of the tumor is usually 2.0 to 2.2 mm, and the height of the elevation is 0.5 to 2.5 mm. Sometimes, a short blood vessel branch is emitted from the deep part of the tumor. The spider vascular plexus formed on the surface of the tumor, these vascular plexuses do not cause bleeding and exudation, 33% to 58% of cases can occur choroidal neovascular membrane, mostly located near the fovea of the macula, can cause subretinal hemorrhage and infiltration Out.

Partial choroidal osteoma can grow slowly, similar to the reconstruction characteristics of normal bone tissue. Some bone tumors can see spontaneous absorption, especially at the edge of the optic disc, which is the main reason for the appearance of the hilly surface of the tumor surface. The site is concavely atrophied, and the fully absorbed site can penetrate the sclera.

Examination of choroidal osteoma

Pathological examination: choroidal osteoma is generally flat, its height is 0.5 ~ 2.5mm, the volume can be 2 ~ 22mm, some tumor surface is uneven and the edges are not neat, under the microscope, the tumor is composed of differentiated mature trabecular structure and A small number of blood vessels (Fig. 1), some bone cells, osteoblasts and osteoclasts are visible between them. The trabecular bone also contains loose connective tissue, mast cells and foamy mesenchymal cells, and the choroidal capillaries on the surface of the tumor. The vascular layer may be narrowed or occluded. In some areas, RPE cells become flattened, melanin particles disappear or degenerate, especially RPE cells near the top of the tumor often shrink and destroy, so the underlying bony tissue is exposed. Under the fundus microscope, it is yellowish white. Therefore, the color change of the tumor under the clinical ophthalmoscope is often related to the secondary lesion. In addition, if the tumor extends to the macula, it can cause retinal degeneration, subretinal neovascularization and hemorrhage, eventually leading to Loss of vision.

1. Fundus fluorescein angiography showed patchy strong fluorescence in the early lesions and diffuse fluorescence staining in the late stage.

2. Ultrasound examination A-type ultrasound examination can show the high echo peak of the tumor. B-type ultrasound examination can show the scaly light band of the strong reflection of the tumor on the image. The corrugated light band can reflect the surface of the hilly tumor and reduce After the gain, the echoes of other tissues in the eye disappeared, but the tumor echo still exists.

3. CT scan examination of choroidal osteoma presents a high-density image consistent with the tibia.

Diagnosis and diagnosis of choroidal osteoma

diagnosis

Clinical diagnosis of choroidal osteoma can be based on fundus findings and CT examinations, and family surveys are needed for multiple eye cases.

Differential diagnosis

Attention should be paid to family surveys in both eyes, and attention should be paid to sclerrochoroidal calcification, intraocular ossification, choroidal hemangioma, choroidal metastasis, intraocular lymphoma, achromatin-free choroidal melanoma and Identification of the inflammatory phase of the choroid,

1. The clinical manifestations of scleral choroidal calcification are yellow-white map-like lesions of the fundus with mild elevation. CT and ultrasonography can be seen in the same image as choroidal osteoma. However, scleral choroidal calcification is more common in middle-aged and elderly patients, and the lesion is mostly located in the peripheral fundus. Volcanic rock

From the beginning, patients may be accompanied by autosomal recessive hereditary syndrome characterized by hypokalemic metabolic alkalosis. Histopathological examinations are mainly cell-free, amorphous basophilic substances.

2. Ocular ossification often occurs in long-term atrophic eyes caused by trauma, inflammation or congenital dysplasia. CT and ultrasonography can be seen in the same intraocular bone image as choroidal osteoma, but intraocular ossification often Due to complicated cataract or other abnormalities in the anterior segment of the eye, the fundus cannot be found. The imaging axis is shorter than the normal eye. The loss of vision and medical history are helpful for differential diagnosis. The histopathological examination is in the metaplastic bone. The vascular component, and the osteoblasts and osteoclasts seen in choroidal osteoma, have only a small number of osteoblast-like cells, and their nuclei are small and concentrated, indicating that the bone itself has no growth ability.

3. Choroidal hemangioma, choroidal metastases, intraocular lymphoma and non-pigmented choroidal malignant melanoma are non-mapped, with smooth surface and no hilly undulations, which may be accompanied by serous retinal detachment.

4. Choroidal inflammation often has vitreous cell infiltration, CT and ultrasound examinations help to differentiate the diagnosis of these diseases,

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