ĐẶC ĐIỂM LÂM SÀNG VÀ MÔ BỆNH HỌC U HẮC TỐ ÁC TÍNH HẮC MẠC TẠI BỆNH VIỆN MẮT TRUNG ƯƠNG GIAI ĐOẠN 2015-2024

Abstract

Objective: To describe the clinical and histopathological characteristics of choroidal malignant melanoma at the Vietnam National Eye Hospital during the period 2015–2024. Methods: A retrospective descriptive study was conducted based on histopathological results and medical records of 85 patients treated at the Vietnam National Eye Hospital from January 1, 2015, to December 31, 2024. Results: The study included 85 patients with a mean age of 52.5 ± 15.7 years; the male-to-female ratio was 1.1:1. Before treatment, 68.2% (58/85) of eyes had visual acuity < counting fingers at 1 m, and 18.6% had elevated intraocular pressure. A history of cancer treatment was recorded in 5.9% of patients. Intraocular hemorrhage was observed in 9.4%, and retinal detachment occurred in 90.6% of eyes. The tumors were mainly located in the posterior pole (57.6%) and less commonly in the peripheral retina (8.2%). On B-scan ultrasonography, 48.2% of tumors showed a mushroom shape and 61.2% had medium-to-low echogenicity. Histopathologically, most tumors were of mixed-cell type (61.2%), followed by spindle-cell type (25.9%) and epithelioid-cell type (12.9%). The mean largest basal diameter was 12.6 ± 1.51 mm. Tumors of medium size (largest basal diameter ≤ 16 mm and height < 10 mm) accounted for 72.9%, while 18.3% were large (> 16 mm). Scleral invasion was observed in 94.1% of cases, retinal invasion in 44.7%, and less frequent invasion of the ciliary body (18.8%), blood vessels (11.8%), and optic nerve (3.5%). Conclusion: Choroidal malignant melanoma in Vietnam predominantly affects middle-aged individuals with no significant sex difference. Most patients present at an advanced stage with severe visual loss and retinal detachment. Tumors are typically located in the posterior pole, of medium size, mushroom-shaped with medium-to-low echogenicity on ultrasonography. The mixed-cell type is most common histopathologically, with frequent scleral invasion but limited involvement of the ciliary body, vasculature, and optic nerve. The clinical and histopathological features are consistent with international reports; however, the disease is often diagnosed late, when severe visual impairment, retinal detachment, and enucleation are common.