Positive isotope 32 phosphorus absorption test

Introduction Uveal malignant melanoma. Uveal melanoma is a malignant tumor, and it is the most common malignant intraocular tumor in adults. Its incidence in foreign countries accounts for the first place in the eye, and in China it is second only to retinoblastoma. The second place in the eye tumor. The tumor has a high degree of malignancy and is easily metastasized to blood flow. It is more common in adults and is easily confused with many fundus diseases in clinical work. Therefore, it should be given full attention in the clinical work of ophthalmology. The disease is more than middle-aged patients.

Cause

Uveal malignant melanoma. Uveal melanoma is a malignant tumor with no obvious cause. In China, it is second only to retinoblastoma, which is the second largest tumor in the eye. The tumor has a high degree of malignancy and is easily metastasized to blood flow. It is more common in adults and is easily confused with many fundus diseases in clinical work. Therefore, it should be given full attention in the clinical work of ophthalmology. The disease is more than middle-aged patients. The posterior pole of the eye is a good site, and the incidence rate is decreasing in the forward direction.

an examination

Related inspection

Magnetic resonance imaging (MRI) blood test

Diagnose based on

1. Choroidal malignant melanoma, early symptoms such as visual distortion, small, central dark spots and changes in diopter (continuous increase in hyperopia), is also an important clinical manifestation, enough to prove that a substantial mass under the retina continues to increase . There is no obvious symptom in the early stage of choroidal melanoma in the margin. After retinal detachment, the corresponding visual field defect appears. A special feature of melanoma at the upper edge is the combination of macular flat retinal detachment early in the course of the disease. If you do not expand the details of the peripheral fundus, it is easy to misdiagnose.

2. Since choroidal melanoma originates from the ciliary nerve, fundus lesions can be combined with pupillary abnormalities (the corresponding pupil of the pupil is not reactive, not easy to be scattered or not round), or a fan-shaped sensation is found in the corresponding part of the cornea.

3. Blood flow reflux disorder or local tumor necrosis caused by scleritis, manifested as localized scleral congestion. There is granulation tissue hyperplasia inside and outside the sclera.

4. Eye pain. The cause of pain can be caused by secondary glaucoma or tumor necrosis-induced ophthalmia (uveitis or endophthalmitis), and a small number is caused by tumor infiltration or compression of the ciliary ganglia.

5. Anterior chamber or vitreous hemorrhage is caused by tumor necrosis.

6. The eyeball is prominent and the tumor is caused by the spread of the ball behind the ball.

7. Scleral transillumination test: It has great value in differential diagnosis. In inflammatory lesions, macular degeneration, choroidal metastasis or choroidal hemangioma, all can transmit light; in choroidal melanoma, it is generally opaque.

8. B-type ultrasonic diagnostic apparatus scanning: B-type ultrasonic examination has important reference value, and is more helpful for turbidity of refractive medium. The tumor showed a smooth mushroom-like appearance; the ultrasound of the tumor was followed by an echo-negative area (acoustic shadow) and a choroidal depression.

9. Fluorescent fundus angiography

(1) The retinal blood vessels and the tumor blood vessels simultaneously have a double circulation.

(2) Early non-fluorescent development, increased late fluorescence, and high and low fluorescence mixed mottled morphology.

10. Isotope 32 phosphorus absorption test is positive.

11. CT, magnetic resonance examination is also helpful for diagnosis.

Differential diagnosis

Differential diagnosis of isotope 32 phosphorus absorption test positive:

Choroidal melanoma: due to the external sclera, limited by the glass membrane, early expansion along the choroid. Before the glass membrane was not pierced, the tumor was flat and elliptical, and the bulge was not high. The retina on the surface of the tumor did not change much and the development was slow. Once the glass film is broken, the tumor rapidly expands in the subretinal space due to the loss of the original restriction, forming a large mushroom, a round head, and a thin neck with a typical mushroom-like appearance. Tumor heads can have a large number of sinusoids due to blood flow barriers, and can be rapidly increased, blood supply is limited, and necrosis and hemorrhage occur. At this time, the retina of the tumor is highly elevated, and the extent of retinal detachment can be gradually enlarged. The top of the tumor is closely attached to the retina and is not easily detached. A small number of tumors pierce the apical retina and expose the tumor to the vitreous. Intraocular pressure is normal or low in the early stage, and in most cases, the intraocular pressure increases after a certain stage of development. If the tumor originates near the scleral aqueduct, it usually spreads out of the eye before the intraocular pressure rises. On the other hand, the tumor is located near the vortex vein, and although the tumor is small, the intraocular pressure may increase. Finally, in the case of a large amount of necrosis of the tumor, causing a severe inflammatory reaction, the eyeball rapidly shrinks and the intraocular pressure is low. Ciliary body malignant melanoma: may have different clinical manifestations due to different parts. It is easy to cause increased intraocular pressure and the root of the iris in the forward direction; backward development may lead to peripheral retinal detachment. At this time, it may only be clinically similar to central retinopathy or papillitis, such as non-expansion examination. It is often prone to misdiagnosis or missed diagnosis. A mass that develops from the ciliary body to the center can compress the lens and cause it to shift or dislocate. In the early outward spread, the mass may appear under the anterior bulbar conjunctiva.

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