Benigne und maligne Bindehauttumoren in Diagnostik und Therapie

Zusammenfassung

Bindehauttumoren betreffen in Diagnostik und Therapie alle Bereiche der augenärztlichen Praxis. Das beginnt mit der klinischen Kontrolle von Bindehautnävi und anderen benignen Tumoren, der Einschätzung von entzündlichen Pseudotumoren und ihrer Abgrenzung zu Präkanzerosen oder vernarbenden Erkrankungen und mündet in der hochspezialisierten und interdisziplinären Führung onkologischer Patienten mit Lymphomen, hochmalignen Melanomen oder invasiven Plattenepithelkarzinomen.

Abstract

The aim of this paper is to give an overview of different benign and malignant epibulbar tumors. Categories can be made of the age of manifestation (paediatric tumors versus tumors of adults), the originating cell types (squamous cell tumors, melanocytic tumors, lymphomas or germ cell tumors) or genesis (proliferative, infectious or degenerating tumors). Most epibulbar tumors show lesions on the conjunctiva or the cornea. These can be flesh coloured or pigmented efflorescences with leucoplakias or hyperkeratosis. Especially malignant tumors show atypical growth of blood vessels, are often prominent and can have ulcerations or bleeding. In case of tumor growth, change in pigmentations or atypical bleedings a malign tumor can be suspected. The diagnosis should be confirmed using histopathological evaluation after an incisional or excisional biopsy. Molecular pathologic techniques extend the diagnostic tools and have an implication on the therapy of metastatic tumors. Therapeutic options of the malignant tumors (apart from lymphomas) are chirurgical excision preferably with a no touch technique and afterwards an adjuvant therapy consisting of radiation or cryotherapy. A topical chemotherapy with Mitomycin C, 5-Fluorouracil or Interferon α2b can be effective to reduce persisting precancerosis and reduce recurrences. In case of a suspected malignant tumor it is advisable to refer the patient to an ophthalmo-oncologic center to plan and ensure interdisciplinary therapy.

Kernaussagen

• Benigne Bindehauttumoren kommen in allen Altersstufen vor. Der Bindehautnävus ist bei Kindern wie Erwachsenen der häufigste gutartige Tumor der Bindehaut, bei anderen Formen variiert die Altersverteilung (Hämangiome v. a. bei Kindern).

• Epibulbäre Tumoren können amelanotisch fleischfarben oder pigmentiert teils prominent auftreten.

• Malignitätskriterien sind auffällige Gefäßzeichnungen, Größenzunahme oder Änderung der Pigmentierung sowie Ulzerationen oder spontane Blutungen. Die genaue Differenzierung kann in vielen Fällen nur histopathologisch erfolgen.

• Entzündliche Prozesse und granulomatöse Erkrankungen können mit pseudotumorösen Läsionen einhergehen.

• Therapeutische Optionen richten sich nach der Histologie und bei malignen Prozessen auch nach dem Ergebnis der Staging-Untersuchungen.

• Es stehen neben der vollständigen Exzision (Ausnahme Lymphom) die Strahlentherapie, Kryotherapie oder eine adjuvante lokale Chemotherapie mit Interferon α2b oder mit Zytostatika wie Mitomycin C bzw. 5-Fluorouracil (5-FU) zur Verfügung.

• Bei Verdacht auf Malignität sollte zeitnah die Überweisung des Patienten an ein ophthalmoonkologisches Zentrum erfolgen. Hier können Diagnostik, Therapie und Nachsorge interdisziplinär geplant und durchgeführt werden.

Schlüsselwörter

Bindehaut - Tumor - Augenoberfläche - benigner Tumor

Key words

conjunctiva - tumor - ocular surface - malignancy - benign tumor

Publication History

Article published online:
10 August 2020

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