결막이완증의 조직병리학적 특성에 대한 연구
Histopathologic Characteristics of Conjunctivochalasis
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목적: 결막이완증 환자에서 결막 압흔세포검사와 조직검사를 통해 조직병리학적 특성과 결막림프관 확장증의 동반 여부를 알아보고자하였다. 대상과 방법: 2012년 3월에서 11월까지 결막이완증을 진단받고 결막이완증 제거술을 받은 환자 14명을 대상으로 전향적인 연구를 시행하였다. 수술 전 세극등 현미경 검사로 결막이완증 상태를 확인하고, 건성안 검사와 압흔세포검사를 시행하였으며, 조직검사로 헤마톡실린-에오신, 베르회프 반 기슨, D2-40 염색을 시행하였다. 결과: 결막이완증에서 눈물막 파괴검사와 눈물량 측정검사 수치가 감소되었고, 압흔세포검사에서 배상세포의 밀도는 감소되었으며,핵-세포질의 비율 상 핵의 크기는 감소되고 세포질의 크기는 증가되었다. 조직검사 결과 헤마톡실린-에오신 염색에서 염증세포의침윤이 증가되었고, 베르회프 반 기슨 염색에서 콜라겐섬유 밀도는 감소되고, 탄력섬유의 변성이 관찰되었다. D2-40면역조직 화학검사에서 결막림프관 확장을 확인하였다. 결론: 결막이완증 환자의 결막압흔세포검사 및 조직소견을 통해 결막이완증의 결막림프관 확장, 배상세포 수 감소 및 콜라겐 섬유 밀도감소, 탄력섬유 변성의 조직병리학적 변화를 확인하였다.
Abstract
Purpose: In this study we investigated the histopathologic characteristics of conjunctivochalasis and its association with lymphangiectasis using impression cytology and conjunctival excisional biopsy in patients with conjunctivochalasis. Methods: This prospective study included 14 outpatients diagnosed with conjunctivochalasis, and who had excisional biopsies performed between March 1, 2012 and November 30, 2012. Preoperative slit-lamp examination, dry eye diagnostic test and impression cytology were also performed. For histological analysis, conjunctival sections were stained with hematoxylin and eosin (H&E), Verhoeff-van Gieson (VVG) elastic staining, and monoclonal antibody D2-40, a lymphatic endothelial marker. Results: Tear break-up time and Schirmer’s value were decreased in patients with conjunctivochalasis. Impression cytology showed a decrease in goblet cell density and an increase in nucleoplasmic/cytoplasmic ratio. The patients’ conjunctival tissues exhibited an infiltration increase of chronic inflammatory cells on H&E stain, and a decrease in collagen density with degeneration of elastic fibers on VVG stain compared to tissues from the control subjects. D2-40 immunohistochemistry revealed the dilated subconjunctival lymphatics in patients with conjunctivochalasis. Conclusions: This study suggests that the characteristic histopathological features of conjunctivochalasis include dilated lymphatic vessels as well as decreased goblet cell and collagen densities with degeneration of elastic fibers.
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