睑板腺癌多次手术病例临床特征及组织病理学特点分析

背景 睑板腺癌是国内发病率仅次于基底细胞癌的眼睑恶性肿瘤,对放射治疗、化学疗法均不敏感,容易复发和转移,有关其复发及转移的研究少见报道.目的 探讨睑板腺癌多次手术病例的临床特征及组织病理学特点,研究采用组织学控制性肿物切除术对睑板腺癌的治疗效果.方法 回顾性分析2003年9月至2011年4月中山大学中山眼科中心收治的34例睑板腺癌多次手术病例的临床及病理资料,评价其组织学控制性肿物切除术后的疗效及复发情况.结果 本组病例中,睑板腺癌的发病左右眼概率相同;位于上睑者26例(占76.5％),位于下睑者5例(占14.7％),上下睑同时受累者3例(占8.8％);平均发病年龄为57.5岁.首诊于当地医院临床正确诊断者13例(占38.2％),误诊为睑板腺囊肿者16例(占47.1％),误诊为鳞状细胞癌2例,误诊为睑板腺炎、泪腺混合瘤、血管瘤者各1例.16例患者初次手术时采用了睑板腺囊肿刮除术,行单纯肿物切除术者16例,组织学控制性肿物切除术者2例.首次病理诊断为睑板腺癌者26例,占76.5％,曾在当地医院误诊为鳞状细胞癌者3例,占8.8％,皮脂腺腺瘤1例,另有4例术后病理资料遗失.再发或复发病例均在中山大学中山眼科中心行组织学控制性肿物切除术,病理观察58.8％有派杰样浸润.对16例睑板腺癌组织学控制性肿物切除术后患者进行5个月～8年的随访,无1例死于睑板腺癌复发转移,此外随访的16例患者与失访的18例患者之间的临床基本特征及肿瘤病理特征差异均无统计学意义(P＞0.05).结论 睑板腺癌误诊为睑板腺囊肿是导致多次手术的主要原因之一,对各种原因引起的再发病例采用组织学控制性切除术有望阻止复发转移.

A clinical and pathologic study of meibomian gland carcinoma with reduplicative operations

Background The meibomian gland carcinoma is an eyelid malignant tumor with a domestic incidence after basal cell carcinoma. Meibomian gland carcinoma is not sensitive to radiation therapy and chemotherapy, and the related factors with its recurrence and metastasis are rarely reported. Objective This study was to investigate the clinical and pathologic features of meibomian gland carcinoma with multiple operations and the effectiveness of histologically controlled excision. Methods The clinical data and the histopathologic sections of 34 cases of the meibomian gland carcinoma diagnosed by pathology were retrospectively analyzed at Zhongshan Ophthalmic Center in September 2003 to April 2011, and the treating effectiveness of histologically controlled excision was evaluated. Results In this group of cases,the appearing rate of the meibomian gland carcinoma was resemble in both lateral eyes. A higher morbidity was on the upper eyelid （26/34,76.5 % ） and then the lower eyelids （5/34, 14.7% ） and both （3/34,8.8%）. The average ages of these cases were 57.5 years old. Sixteen of 21 misdiagnosed cases were identified as chalazion at the first visit, and no histopathologieai examination was performed in 11 cases after initial operation. Twenty-six cases（76. 5% ）were identified as meibomian gland carcinoma in initial histopathologie diagnosis. Two cases had histologically controlled excision and 16 cases had simple excision while 16 cases had ehalazion enueleation in the first operation. All the patients had histologically controlled excision in Zhongshan Ophthalmic Center with 58.8% of the patients having pagetoid invasion. Sixteen cases were followed up for 5 months to 8 years after histologically controlled excision,in which none died of recurrence and metastasis of mcibomian gland carcinoma. No significant differences were found in the pathological feature between 16 lost patients and 18 followed-up patients（P 〉 0. 05 ）. Conclusions Misdiagnosis of meibomian gland as chalazion is a main cause of repeat operations of meibomian gland carcinoma. Histologically controlled excision is a feasible therapy for the recurrence and metastasis of meibomian gland carcinoma.