泪腺区占位性病变65例临床分析

目的探讨近10年来住院治疗的泪腺区占位性病变的类型、临床特点和治疗方法。方法对65例（74眼）泪腺区占位性病变进行回顾分析。结果65例（74眼）中男29例（32眼）,女36例（42眼）。年龄13～76岁,平均39岁。右眼31例,左眼25例,双眼9例。所有患眼泪腺区均可触及占位性病变,均经CT或B超检查证实。除2例（4眼）双眼泪腺炎型炎性假瘤患者接受药物治疗治疗外,余均经手术治疗。其中泪腺炎型炎性假瘤28例（30眼）,泪腺多形性腺瘤27例（27眼）（其中包括1例（1眼）复发病例）,泪腺腺样囊性癌3例（3眼）,泪腺腺癌2例（2眼）,泪腺恶性多形性腺瘤2例（2眼）,泪腺导管囊肿1例（1眼）。经眉弓外侧切口手术60例（62眼）,结膜切口1例（1眼）,眶内容摘除2例（2眼）。所有手术患眼术后均经病理检查结果证实诊断。结论因泪腺区占位性病变入院治疗者以泪腺炎型炎性假瘤及泪腺多形性腺瘤多见。泪腺区占位性病变绝大多数手术切口选取经眉弓外侧切口。     

回顾191例泪腺占位性病变临床分析及术后随访观察

目的：探讨191例泪腺占位性病变的临床特点及术后随访情况。

方法：选取2011-01/2015-08我科收治的191例221眼泪腺占位患者,总结其临床特征,并结合病史、影像、病理资料、地域特色进行分析。所有患者行泪腺肿瘤摘除,术后随访1a。

结果：患者191例221眼中,男44例49眼,女147例172眼。炎症性病变171眼,依次是IgG₄硬化性泪腺炎66眼、慢性泪腺炎27眼、泪腺脱垂伴炎性肿大54眼、Grave''s病24眼。淋巴组织增生性病变16眼,依次是恶性淋巴瘤6眼、良性淋巴组织增生10眼。上皮性病变34眼,依次是多形性腺瘤26眼、多形性腺癌2眼、腺样囊性癌3眼、腺癌3眼。泪腺占位性病变以IgG₄硬化性泪腺炎、泪腺脱垂伴炎性肿大多见,其中汉族159眼、维族36眼、哈萨克族16眼、蒙古族10眼。手术后主要表现为眼部干涩,哭时无泪,以双侧泪腺摘除者明显,但局部使用人工泪液可以缓解,无严重不良反应。

结论：病史及影像特点对泪腺占位性病变的诊断和鉴别诊断有很大的帮助,新疆地区泪腺占位,以非上皮性病变最为常见,其次是上皮性病变,多发生于汉族、维族患者,而其它民族少有发生,手术后眼部干涩及哭时无泪为主要症状。对病程短且有干眼倾向的患者需延迟摘除。     

141例泪腺占位性病变临床分析

目的：探讨141例泪腺占位性病变患者的病理类型和临床特点。方法：回顾性系列病例研究。选取2019年6月至2021年10月在吉林大学第二医院眼科中心诊治的141例泪腺区占位病变患者的临床资料,包括患者性别、年龄、临床表现、影像学特点及组织病理结果。依据病理诊断分类,探讨泪腺占位性病变的临床和影像学特点。组间比较采用独立样本t检验或非参数秩和检验;分类变量以例数、百分比表示,组间比较采用卡方检验和（或）Fisher确切概率法。结果：纳入患者中,男50例,女91例。按病变性质分类,良性病变117例（83.0%）,最常见的是IgG4相关泪腺炎55例（39.0%）;恶性肿瘤24例（17.0%）,最常见的是淋巴瘤10例。良性病变患者年龄（[ 45.8±15.7）岁]小于恶性肿瘤（[ 56.3±16.2） 岁],差异有统计学意义（Z=-3.23, P=0.001）。按病变类型依次为炎性病变72例（51.1%）,上皮性病变33例（23.4%）,淋巴系统病变17例（12.1%）。比较泪腺上皮性病变、炎性病变、淋巴系统病变3组患者性别构成、临床表现（眼睑肿胀、眼球突出、运动障碍、视力下降）、影像学表现（双侧泪腺受累、眶骨质改变、鼻窦炎）,差异均有统计学意义（均P<0.05）;3组在眼痛、眼外肌和三叉神经增粗,差异无统计学意义。两两相比显示,泪腺上皮性病变较泪腺炎性病变的女性患者比例少,出现眼睑肿胀、泪腺双侧受累、鼻窦炎的患者比例少（χ2=17.01,P<0.001;χ2=32.34,P<0.001;χ2=10.43,P=0.001; χ2=10.12,P=0.001）,而有眼球突出、运动障碍和视力下降、骨质破坏的患者比例较高（χ2=18.71,P<0.001;χ2=7.64,P=0.006;χ2=7.32,P=0.012）;泪腺上皮性病变患者与淋巴系统病变相比,前者出现眼睑肿胀、双侧泪腺受累的患者比例低,眼球突出的患者比例较高,差异有统计学意义（χ2=15.93,P<0.001;χ2=6.38,P=0.012;χ2=10.14,P=0.001）;泪腺炎性病变与淋巴系统病变性仅在泪腺双侧受累比例差异有统计学意义(χ2=10.43,P=0.001）;淋巴系统病变与炎性及上皮性病变相比,其余各组间临床和影像学的表现差异无统计学意义。儿童泪腺占位性病变7例中未见上皮性病变。结论：泪腺占位性病变中最常见的是炎性病变,其次是上皮性病变;良性病变平均年龄小于恶性肿瘤;儿童泪腺病变类型分布与成人不同;泪腺炎性病变与上皮性病变的临床和影像学表现差异较大,相对容易鉴别。     

CT和MRI对泪腺混合瘤的临床应用价值

目的:探讨CT,MRI对泪腺混合瘤的临床应用价值。方法:对术前行CT或MRI检查,术后经病理证实为泪腺混合瘤17例进行分析。结果:术后随访6mo～10a,14例未复发,3例复发(18%),1例为外院术前未行CT或MRI检查。结论:CT,MRI对泪腺混合瘤具有准确的定位、定性诊断价值,对手术入路选择、手术设计及术前准备也有着重要指导意义,对指导初次手术中连同包膜一次性完整切除病变,减少复发率,具有重要意义。     

泪腺窝占位性病变临床分析

泪腺窝占位性病变临床分析林锦镛，李恩江我们对１９６３～１９９０年间收检的１１４例泪腺窝占位性病变，除外皮样囊肿或嗜酸性细胞肉芽肿所引起的泪腺窝骨质的继发性病变，并进行临床分析。一、泪腺上皮性病变泪腺上皮性病变７４例（６４．９％），其中泪腺导管囊肿１０...     

1492例眼眶占位性病变临床病理学分析

目的探讨北京同仁医院眼科中心眼眶占位性病变的疾病谱系和发病情况。设计回顾性病例系列。研究对象自1997年1月至2006年12月间北京同仁医院眼科中心病理室存档的1492例眼眶占位性病变。方法分析1492例眼眶占位性病变的临床病理资料,基本情况包括患者的年龄、性别及肿物的病理诊断。主要指标眼眶占位性病变的疾病谱系和发病情况。结果眼眶占位性病变依据组织来源主要分为15大类:囊肿性病变、脉管性病变、周围神经病变、视神经和脑膜病变、纤维组织病变、骨和软骨病变、脂肪组织病变、肌组织病变、泪腺病变、炎性病变、色素性病变、转移性肿瘤、淋巴增生性病变、继发性肿瘤、白血病和组织细胞系统病变、其它病变。其中良性病变1318例(88.3%),恶性病变174例(11.7%)。位于良性病变前5位的分别是皮样囊肿及表皮样囊肿、海绵状血管瘤、淋巴管瘤、泪腺混合瘤、慢性炎症和炎性假瘤;位于恶性肿瘤前5位的分别是淋巴瘤、泪腺囊腺癌、横纹肌肉瘤、黑色素瘤、皮脂腺腺癌。结论眼眶占位性病变涉及不同组织来源的病变。横纹肌肉瘤是儿童最常见的眶内恶性肿瘤,淋巴瘤是老年人最常见的眶内恶性肿瘤。(眼科,2007,16:398-402)     

超声、CT、MRI对泪腺腺样囊性癌诊断价值比较

目的：探讨泪腺腺样囊性癌X线、超声、CT及MRI的影像学特征,以及各种检查方法对疾病诊断价值的比较。方法：回顾性分析1977－1999年经病理组织学确诊的泪腺腺样囊性癌46例,对X线（8例）、B超（39例）、CDI（7例）、CT（37例）、MRI（4例）的特征进行比较。结果：X线可以发现眼眶密度增高及眶骨破坏;B超可以发现眶内占位病变,且对病变内部的钙斑、液化腔等组织结构的显示良好;CDI可以提供肿瘤内部血液供应情况;CT可以揭示病变范围、生长方式、肿物与眶内正常结构的关系、眶骨及眶周结构的改变;MRI对于显示肿瘤颅内和颞凹蔓延,优于以上检查方法。结论：联合应用多种影像学检查方法,可以提高术前诊断率。     

睑板内异位泪腺组织的弥散增生性病变

据我们了解，双侧睑板内泪腺组织的弥散性异位以前未见报道。对该异常的研究源自取材于1例患有非肉芽肿性结膜炎及浅层点状角膜病变的中年女性患者。除此之外该患者还患有微核性肌病、高血压病及严重的糖尿病。临床检查显示睑板表面不规则，形态学研究证实睑板内满布大的异位腺体。     

233例眼眶占位性病变的组织病理学分析

目的 分析眼眶占位性病变的组织病理学分类.方法 对河南省眼科研究所2001年1月～2007年9月眼科病理室存档的233例眼眶占位性病变手术切除标本进行组织病理学分类.结果 良性病变191例(81.97%),其中前3位依次为海绵状血管瘤60例(25.75%),炎症22例(9.44%),皮样囊肿13例(5.58%).恶性病变42例(18.03%),其中原发性恶性肿瘤20例(8.97%),包括淋巴瘤10例(4.29%),泪腺上皮性恶性肿瘤4例(1.72%).横纹肌肉瘤3例(1.29%),纤维肉瘤1例(0.43%),其他2例(0.86%);继发性恶性肿瘤22例(9.87%),分别为眼睑皮脂腺癌眼眶蔓延9例(3.86%),眼睑鳞状细胞癌眼眶蔓延6例(2.58%),眼睑黑色素瘤眼眶蔓延3例(1.29%),视网膜母细胞瘤眶内蔓延3例(1.29%),眼睑基底细胞癌眼眶蔓延1例(0.43%).结论 眼眶占位性病变中脉管源性肿瘤最常见,其中最多见的是海绵状血管瘤,恶性病变中最多见的是淋巴瘤.     

Magnetic resonance imaging of unilateral lacrimal gland lesions

Purpose To report the findings on magnetic resonance imaging (MRI) of various benign and malignant unilateral lacrimal gland lesions.Methods This is a retrospective noncomparative interventional case series. Thirty-one consecutive patients with a unilateral lacrimal gland lesion were analyzed. The preoperative MRI findings were correlated with the pathology results. The main outcome measures were anatomic extent, configuration, margins, angulation, internal features on T1- and T2-weighted images (with respect to extraocular muscles and cerebral gray matter), contrast enhancement of the lesion and adjacent bone change on MRI.Results Of the 31 patients, 21 had chronic dacryoadenitis, 3 had lymphoid tumors, and 7 had epithelial tumors including pleomorphic adenoma (3), adenoid cystic carcinoma (3), and pleomorphic adenocarcinoma (1). The results of the patients with chronic dacryoadenitis demonstrated involvement of the orbital lobe alone in 13 patients (62%), involvement of both orbital and palpebral lobes in 8 (38%), a molded configuration with ill-defined margins, sharp angles in 13 (62%), round angles in 8 (38%), lack of bone change, an isointense internal signal on T1-weighted images, a hypointense signal on T2-weighted images, and moderate contrast enhancement. The patients with lymphoid tumors demonstrated involvement of the orbital lobe, a molded configuration with ill-defined margins and sharp angles, lack of bone change, an isointense internal signal on T1-weighted images, an isointense signal on T2-weighted images, and moderate contrast enhancement. Those with epithelial tumors showed involvement of the orbital lobe, a well-circumscribed oval configuration, and round angles. Pleomorphic adenoma demonstrated smooth margins, bone expansion in two patients , and no bone change in one. Adenoid cystic carcinoma and pleomorphic adenocarcinoma showed irregular margins and bone destruction. All epithelial tumors demonstrated an isointense internal signal on T1-weighted images, a hyperintense signal on T2-weighted images, and moderate contrast enhancement.Conclusions It is difficult to uniformly correlate the MRI features and histopathologic findings in lacrimal gland lesions. However, MRI seems to be useful in determining the etiology of a unilateral lacrimal gland lesion. Internal tissue features on T1- and T2-weighted images of MRI are most helpful in categorizing these lesions. Although the number of patients is small, our findings suggest that there are differences in orbital MRI findings of inflammatory lesions and lymphoid tumors as compared to benign and malignant epithelial tumors in the lacrimal gland fossa.Presented in part as a free paper at the 10th International Congress of Ocular Oncology, Amsterdam, the Netherlands, 17–21 June 2001An erratum to this article can be found at     

眼眶泪腺上皮性腫瘤的影像學診斷

目的分析34例泪腺上皮性腫瘤的影像學特徵.方法對20例泪腺良性多形性腺瘤(復發性7例),11例腺樣囊性癌(復發性9例),惡性多形性腺瘤2例(均爲復發性)和1例粘液表皮癌的超聲,CT和MRI進行分析.結果良性多形性腺瘤呈圓形,邊界清楚,骨窩形成.腺樣囊性癌體積較大,形狀不規則,骨破壞明顯.結論根據腫瘤的位置,形狀,邊界和繼發性改變(泪腺窩擴大,骨破壞,鈣化,病變向周圍結構蔓延)等影像學表現可作出較準確的術前定性診斷.     

普羅卡因泪腺封闭治疗泪液分泌过多症

目的 利用普羅卡因封闭泪腺治療泪液分泌过多症。方法 在眼眶上缘中、外1/3交界处经皮膚刺入,向上、外、后泪腺方向注入0.25—2％普羅卡因溶液2ml。结果 列皋4個病例,其中3例嚴重者经本法治愈。结论 本法適用于中樞性、反射性或泪腺本身泪液分泌过多引起的流泪。方法简单、易行、有效。     

甲状腺相关性眼病泪腺病变发病机制及其诊断的研究进展

甲状腺相关性眼病(TAO)是一种与自身免疫性甲状腺疾病相关的器官特异性自身免疫疾病.此病变主要累及眼眶脂肪、眼外肌及泪腺组织.大部分TAO患者都有干眼症状,如视力下降、眼干涩、畏光、流泪和异物感等.眼表损伤导致的干眼症是TAO患者眼部不适的最常见原因.有研究证实,与TAO相关的泪腺病变可能直接参与了TAO眼表损伤的发生.本文中笔者将从TAO患者眼表改变、泪腺病变的机制及泪腺影像学等角度对TAO相关泪腺病变的研究进展进行综述,以期为进一步研究及临床治疗提供参考.     

特发性睑皮松驰伴泪腺脱垂的诊断和手术治疗

目的　通过26 例睑皮松驰伴泪腺脱垂的病例分析,探讨此疾病的部分成因,以及合理的手术方法。方法　用手术的方法使脱垂的泪腺复位至泪腺窝,同时对眶隔进行加固来减轻眶隔的松驰造成的眼睑膨隆,并对上睑松驰的皮肤进行充分的切除和正确的缝合,来彻底改善病人的外观。结果　26 例52 只眼术后睑皮肤松驰得到矫正,皮肤弹性得到一定恢复,外观有很大的改善。48 只眼的眼睑膨隆得到改善,4 只眼于上睑颞侧穹隆部可见重又脱垂的泪腺。结论　通过对这些病例的分析和手术矫治,使我们对此种疾病的病因、诊断及手术关键有了很好的认识     

Epithelial lacrimal gland tumors: A comprehensive clinicopathologic review of 26 lesions with radiologic correlation

Aim

To study the prevalence, clinicopathological and radiological correlations of epithelial lacrimal gland tumors and compare these with similar published literature. The study was also designed to look at the natural history of benign mixed tumors (BMT) in regard to recurrence and malignant degeneration.

Methods

This was a retrospective study of all suspected epithelial tumors of the lacrimal gland surgically excised at King Khaled Eye Specialist Hospital (KKESH) for the period: 1983–2008. Exclusion criteria included structural lesions (dacryops) and inflammatory lesions. We included 26 cases of epithelial lacrimal gland tumors (from 24 patients). The histopathologic slides and the radiologic findings were reviewed. The corresponding demographic and clinical data were obtained by chart review using a data sheet.

Results

BMT accounted for 12/26 of the lesions while malignant lesions including adenoid cystic carcinoma (ACC) were more common (14/26). The mean age was 44.27 years (range 12–75). Commonest clinical presentation was proptosis. Median duration of symptoms in the BMT cases was 30 months and 7 months in the ACC group. The 12 BMT cases were primary in 9 and recurrent in 3 patients. The 11 ACC cases showed mostly cribriform pattern and low histopathologic grade. We had 2 cases of malignant mixed tumor (MMT) one of which arising in a recurrent tumor. One case of primary mucoepidermoid carcinoma with histopathologic grade 2 was noted. Radiologically, a well-defined appearance with bone remodeling was observed in BMT in contrast to invasive appearance with destruction in malignant lesions.

Conclusion

Our series information indicated a different distribution of benign and malignant epithelial lesions with a slightly higher rate of malignancy. BMT was the commonest benign tumor where recurrence was a squeal of incomplete surgical excision. ACC was the commonest malignant tumor with shorter duration of symptoms and radiologic evidence of invasiveness that correlated with the histopathologic features.     

Update on lacrimal gland neoplasms: Molecular pathology of interest

Lacrimal gland neoplasms are rare and much of our knowledge of the behavior and molecular pathogenesis of these tumors comes from study of the similar, but more numerous salivary gland neoplasms. After briefly discussing the classification of lacrimal gland neoplasms, I review three areas of emerging knowledge in the pathogenesis of these neoplasms: (1) the concept of adenoid cystic carcinoma with high-grade transformation and the associated cytogenetic changes; (2) recent analysis of the MYB-NFIB gene fusion in adenoid cystic carcinoma, and; (3) overexpression of HER2 in malignant salivary and lacrimal neoplasms.     

泪腺上皮性肿瘤彩色多普勒超声特征分析

目的 分析泪腺上皮性肿瘤的彩色多普勒超声声像特征,证实其临床应用价值.方法 对28例经病理证实为泪腺上皮性肿瘤的彩色多普勒超声声像图进行回顾性分析.结果 泪腺多形性腺瘤多表现为边界清楚,形态规则,均匀中等内回声或不均匀内回声,不可压缩,彩色多普勒血流分级为I～Ⅱ级;腺样囊性癌多表现为边界清楚,形态不规则,不均匀内回声,不可压缩,彩色多普勒血流分级为Ⅲ～Ⅵ级,其中原发性泪腺腺样囊性癌收缩期峰值血流速度明显升高,与原发性泪腺多形性腺瘤间差异有统计学意义(P<0.05 ).结论 彩色多普勒超声对泪腺上皮性肿瘤的诊断及区别泪腺肿瘤良、恶性有重要临床应用价值.