病例2　25歲男性，主訴右眼癢，粉紅色新生物生長半年

CASE 2　A 25-year-old male complaining of itchy and pink neoplasm in right eye for half a year

見圖1-2。See Fig. 1-2.

鑒別診斷

Differential Diagnosis

◎ 結膜乳頭狀瘤：是結膜上皮組織呈乳頭狀增生的良性腫瘤，根據發(fā)病部位可分為結膜型和角膜緣型，與人乳頭狀瘤病毒(human papillomavirus, HPV)感染有關。結膜型多發(fā)于兒童或青年，多為單眼發(fā)病，好發(fā)于淚阜、內眥皺襞及穹窿結膜，外觀呈桑葚狀或菜花狀隆起于結膜表面，粉紅色，有蒂，活動度好；角膜緣型少見，好發(fā)于中老年人，常起于球結膜并向角膜表面生長，外觀呈半透明或粉紅色，扁平膜狀或草莓樣隆起，基底較寬，較為固定。

◎ Conjunctival papilloma: most are benign tumor with papillary hyperplasia of conjunctival epithelium, which is related to human papillomavirus (HPV) infection and can be classif ied as conjunctival type and limbal type according to the location of tumor. Conjunctival type is mostly monocularly found in children and young adults,usually occurring in lacrimal caruncle, inner canthus fold and fornix, with a classic mulberry like or caulif lower like appearance, pink and pedicled appearance rising from the surface of conjunctiva, and with good mobility. Limbal type is rare and often occurs in the elderly. It usually starts from the bulbar conjunctiva and grows towards the cornea surface, with the appearance of translucent or pink, f lat membrane or strawberry like protuberance and wide base,and is relatively f ixed.

◎ 角膜緣皮樣瘤：先天性良性腫瘤，出生后即可發(fā)現，常位于顳下方角膜緣，可累及角膜，多呈半圓形、黃白色或粉紅色隆起的實質性腫塊，表面可見毛囊。

◎ Limbal dermoid: Congenital benign tumor, usually located in the inferotemporal quadrant of the limbus,can involve the cornea. Lesions are usually semicircular,yellow-white or pink, solid, fairly well circumscribed,elevated, and can have hair arising from their surface.

◎ 皮樣脂肪瘤：少見，多為雙側，常表現為顳上方較大的黃白色的球結膜下實質性病變，內含脂肪和皮膚組織，表面可見毛囊。

◎ Dermolipoma: rare, mostly bilateral. Yellow-white, solid tumor, usually occurring under the bulbar conjunctiva superotemporally, containing fat and skin tissue, with hair follicles on the surface.

病史詢問

Asking History

◎ 詢問發(fā)病時間和腫塊的生長情況。初發(fā)還是復發(fā)。

◎ Ask the onset time and growth rate of the mass. Whether it was initial or recurrent.

◎ 是否伴有紅腫、異物感、刺癢、疼痛及分泌物。

◎ Whether accompanied by redness, foreign body sensation,itching, pain, secretion.

◎ 過敏性鼻炎和結膜炎病史。是否有揉眼的習慣。眼表手術史、外傷史及全身疾病史。

◎ History of anaphylactic rhinitis and conjunctivitis. Habit of eye rubbing. History of ocular surface surgery, trauma and systemic diseases.

檢查

Examination

◎ 視力和眼壓。

◎ Visual acuity and IOP.

◎ 對外眼及眼表進行裂隙燈檢查。檢查腫塊的大小、部位，是單發(fā)還是多發(fā)，無蒂（基底部寬而扁平）還是有蒂（藻樣），觀察其外觀、色澤和邊界。

◎ Slit lamp examination of the external eye and ocular surface. Check the size, location, color, margine, surface,single or multiple, sessile (wide base and flattish prof ile) or pedunculated (frond-like).

實驗室檢查

Lab

◎ 病理活檢（圖1-3）。

◎ Biopsy (Fig. 1-3).

◎ 尿道脫落細胞及腫瘤組織HPV檢測。

◎ HPV testing in tumor tissue and exfoliated cells.

診斷

Diagnosis

結膜鱗狀上皮乳頭狀瘤。

Conjunctival squamous papilloma.

治療

Management

◎ 較小的病變可以不治療，密切隨診觀察。

◎ Small lesions with asymptome can be left untreated with close follow-up.

◎ 較大的病灶，尤其是老年患者，首選的治療方法是完全切除并進行活檢或聯(lián)合冷凍治療。

◎ Complete excision with biopsy and combined with cryotherapy the margin are the preferred treatments for large lesions, especially in elder patients.

◎ 結膜下干擾素-α、二氧化碳激光汽化、局部絲裂霉素C、免疫抑制劑和口服西咪替丁對于復發(fā)病例和降低復發(fā)率有一定幫助。

◎ Subconjunctival interferon-α, carbon dioxide laser vaporization, topical mitomycin C, immunosuppressants and oral cimetidine are helpful in recurrent cases and in reducing the recurrence rate.

患者教育和預后

Patient Education & Prognosis

◎ 結膜乳頭狀瘤是一種預后較好的良性腫瘤，與人乳頭狀瘤病毒感染密切相關，尤其是6型和11型。

◎ Most conjunctival papilloma is a benign tumor with good prognosis and strongly associated with human papillomavirus infection, especially types 6 and 11.

◎ 本病具有一定的自發(fā)消退傾向，手術切除術后復發(fā)率高，總體癌變概率很小，但應警惕老年人中的無蒂型結膜乳頭狀瘤有較高的惡變風險，故定期隨訪尤為重要。

◎ Regular follow-up is important because of their tendency for spontaneous resolution, high rate of recurrence after surgical excision and small chance of cancerization. However,there is a higher risk of malignant transformation in the elderly with a sessile lesion.

◎ 應教育患者避免揉眼。

◎ Patients should be educated to avoid eye rubbing.