泪腺腺样囊性癌CT表现的研究

目的 分析泪腺腺样囊性癌常见的CT图像特征,从而探讨CT(computed tomography)影像对于泪腺腺样囊性癌的诊断价值.方法 病历来源为天津医科大学眼科中心及天津医科大学第二医院,经病理确诊的眼眶腺样囊腺癌39例.其中原发肿瘤20例,复发肿瘤19例,均为单眼发病,所有患者均行眼眶CT检查,获取水平及冠状扫描图像.结果 泪腺腺样囊性癌中原发肿瘤形状多为厚扁平状,贴附于眶壁增长,在体层像上呈锥形者10例、不规则形5例;复发肿瘤形状为不规则型8例、厚扁平状,贴附于眶外上壁向后增长者8例.原发与复发泪腺腺样囊腺癌的好发位置位于眶外上方分别为18例与11例.结论 CT可清晰显示肿瘤的位置,形状,范围、眶骨壁改变,对于泪腺腺样囊性癌的诊断和制定治疗方案具有重要指导意义.

Abstract：

Objective To analyze imaging characteristics of adenoid cystic carcinoma(ACC)of lachrymal gland on CT for the diagnosis of ACC in clinic. Methods Thirty-nine patients with ACC consisting of 20 cases of primary tumor and 19 cases of recurred tumors confirmed by pathology were collected from The Eye Centre of Tianjin Medical University and The Second Hospital of Tianjin Medical University. All the patients were unilateral, and examined by CT. The imaging characteristics of ACC on CT were analyzed. Results The most common shape of primary ACC included 10 cases of conical-shape, 5 cases of irregular-shape. The recurred cases contained 8 cases of irregular-shape, 8 cases of conical-shape. The primary and recurred ACC usually existed on superior-external side, with which there were 18 cases and 11 cases respectively. Conclusions CT examination can exactly reveal the shape, size, position, and ossa orbitale destruction of ACC and played an important role in the diagnosis of ACC.     

眼眶腺样囊性癌的影像学研究

目的分析眼眶腺样囊性癌(ACC)的超声、CT及MRI等影像学特征。设计回顾性病例系列。研究对象经病理诊断证实的泪腺腺样囊性癌38例和副鼻窦来源的腺样囊性癌4例。方法分析眼眶腺样囊性癌超声、CT和MRI等各种影像学检查结果,记录图像特征。主要指标标准化A/B超、CT和MRI影像。结果ACC标准化A超表现为前部高波峰,后部低波峰和不规则高低混杂波峰两种类型。B超可显示肿瘤的轮廓,对于瘤内钙化及液化坏死等病变显示优良。CT扫描显示ACC有梭形、扁平形、团块状和不规则形等四种形状,对于肿瘤的边界、空间位置,骨破坏和骨吸收等继发改变显示清晰。ACC在T_1加权像为中信号,T_2加权像有均一的等信号,等、低信号混杂和等、高信号混杂三种,多数不均匀强化。强化MRI有利于显示肿瘤的蔓延途径,泪腺ACC有多种蔓延途径。副鼻窦ACC易累及筛窦和上颌窦。结论各种影像学检查可显示眼眶ACC的不同特性。综合运用和分析各种影像学检查结果可提高诊断水平。(眼科,2007,16:391-394)     

泪腺肿瘤38例临床分析

目的：分析泪腺肿瘤的临床特点和治疗结果。方法：回顾性研究38例45眼泪腺肿瘤。结果38例45眼中，男17例17眼，女21例28眼；年龄5～63岁，平均40．6岁；其中泪腺癌5眼，腺样囊性癌5眼。恶性泪腺混合瘤5眼，良性泪腺混合瘤14眼，炎性假瘤13眼，慢性泪腺炎2眼，泪腺潴留性囊肿1眼。42眼行前路或侧壁开眶肿瘤摘除术，恶性肿瘤中4眼行眶内容物剜除。恶性肿瘤患者全部于术后1个月接受放疗。术后随访观察3个月～8年。术后症状完全缓解35眼，好转5眼，复发5眼。结论：泪腺肿瘤为眼眶常见肿瘤，结合病史，临床表现和影像学检查。绝大部分可以作出术前定性诊断，良性泪腺混合瘤预后较好，但易复发。恶性泪腺混合瘤及腺样囊性癌复发率、死亡率较高，应联合眶内容物剜除，放疗及化疗。     

泪腺腺样囊性癌

一、命名、发病率腺样囊性癌系起源于腺体组织,恶性度较高的肿瘤。通常发生在唾液腺、泪腺、也可在气管、乳腺、皮肤汗腺等处发生。眼眶部泪腺腺样囊性癌是泪腺最常见的恶性肿瘤。在泪腺癌中,腺样囊性癌的发病率是25％和35％。本病最初由Billroth在1859年命名为圆柱瘤,他描述此肿瘤原发于鼻窦,以后穿透到     

原发性眼眶肿瘤120例临床病理分析

目的:探讨原发性眼眶肿瘤的发病情况及组织学来源,为原发性眼眶肿瘤的诊断提供参考.方法:回顾性分析我院近5a来原发性眼眶肿瘤患者的病历资料,记录患者的性别、年龄、眼别、病理结果.结果:原发性眼眶肿瘤共120例,血管源性肿瘤32例(26.7%),泪腺源性肿瘤28例(23.3%),眼眶囊肿22例(18.3%),神经源性肿瘤19例(15.8%),淋巴瘤6例(5.0%),炎性假瘤5例(4.1%),肌源性肿瘤3例(2.5%),骨源性肿瘤2例(1.7%),其它未明确诊断的3例(2.5%).其中良性肿瘤93例(77.5%),依次为海绵状血管瘤、皮样囊肿、多形性腺瘤、毛细血管瘤、神经鞘瘤、脑膜瘤、炎性假瘤、表皮样囊肿、视神经胶质瘤、骨瘤、血管平滑肌瘤、淋巴管瘤、皮脂腺瘤、血囊肿、泪腺囊肿.恶性肿瘤24例(20.0%),依次为泪腺腺样囊性癌、淋巴瘤、多形性腺癌、横纹肌肉瘤、泪腺腺癌、恶性黑色素瘤.结论:眼眶肿瘤种类繁多,海绵状血管瘤和泪腺腺样囊性癌仍是最常见的良性和恶性原发性眼眶肿瘤.     

眼眶泪腺上皮性肿瘤的影像学诊断

目的 分析34例泪腺上皮性肿瘤的影像学特微,方法 对20例泪腺良性多形性腺瘤（复发性7例）,11例腺样囊性癌（复发性9例）,恶性多形性腺瘤2例（均为复发性）和1例粘液表皮癌的超声,CT和MRI进行分析。结果 良性多形性腺瘤呈圆形,帝界清楚,骨窝形成,腺样囊性癌体积较大,形状不规则,骨破坏明显。结论 根据肿瘤的位置,形状,帝界和继发性改变（泪腺窝扩大,骨破坏,钙化,病变向周围结构蔓延）等影像学表现可作出较准确的术前定性诊断。     

眼眶肿瘤的手术治疗探讨

目的 探讨眼眶肿瘤的种类、手术进路、治疗效果及并发症.方法 对我院2004～2005年收治的眼眶肿瘤45例（45眼）的临床表现、影像检查和治疗方法进行分析.结果 45例眼眶肿瘤中囊肿12例,海绵状血管瘤10例,静脉性血管瘤6例,泪腺多形性腺瘤5例,神经鞘瘤、非霍奇金淋巴瘤各3例,泪腺腺样囊性癌2例.视神经胶质瘤、视神经鞘脑膜瘤、神经纤维瘤及眼眶骨瘤各1例.45例均进行手术摘除,其中前路开眶32例,外侧开眶9例,经筛窦内侧开眶2例,外侧结合内侧开眶1例,经颅开眶1例.术后6个月复查上睑下垂2例,瞳孔改变3例,眼球运动受限2例.结论 眼眶肿瘤的临床表现具有多样性;大多因眼球突出而就诊;影像学检查显示多种形状的占位性病变,治疗方法以手术为主,注意手术技巧和术式的选择可以防止复发和出现并发症.     

10例眼眶腺样囊性癌临床病理分析

１０例眼眶腺样囊性癌临床病理分析北京天坛医院眼科石峙敏，金崇华北京天坛医院病理科俞进腺样囊性癌为一种具有特征性病理形态的恶性肿瘤．发生于泪腺部位较常见．也可发生在眼眶其它部位．本文统计眼眶腺样囊性癌１０例，均经病理确诊，其中９例起源于泪腺，ｌ例源于筛...     

鼻窦源性肿瘤侵犯眼眶52例临床分析

目的 探讨侵犯眼眶的继发于鼻窦肿瘤的临床、影像学特点及治疗方法.方法回顾性分析52例侵犯眼眶的鼻窦肿瘤患者的临床表现、CT和MRI特点及治疗.结果 患者首发症状为单眼眼球突出.其中副鼻窦黏液囊肿29例,腺样囊性癌11例,鳞状上皮癌6例,其他恶性肿瘤6例.CT检查平扫25例,增强扫描5例,表现为鼻窦内形状不规则软组织肿块,眶内侧壁及眶下壁可见骨质中断,可见肿物向眶内突出,增强后肿瘤眼明显强化.MRI检查12例,均为平扫＋增强扫描,可见上颌窦或筛窦肿块与眼眶内肿块信号相等且连续.增强后肿瘤明显强化.58例全部行手术治疗.结论 鼻窦肿瘤易侵及眼眶,临床多以眼球突出为首发症状.CT、MRI检查有助诊断.多学科联合诊治,对提高鼻窦肿瘤的诊断和综合治疗水平有十分重要的临床意义.     

272例原发性泪腺上皮性肿瘤的病理分类

本文报道原发性泪腺上皮性肿瘤272例的组织病理分类,并与涎腺肿瘤的病理分类相比拟,本组大量泪腺肿瘤代表390例泪腺窝病变的70％,占一个医院中1530例眼眶肿瘤的18％。本组泪腺肿瘤中,良性混合瘤居首位(52％)次为腺样囊性癌(25％),再次为恶性混合瘤(9％)。少见的泪腺肿瘤中,作者首先识别出3例泪腺低度恶性多型性腺癌,2例梭形细胞形肌上皮瘤,1例癌肉瘤。有关低度恶性多型性腺癌及梭形细胞型肌上皮瘤的鉴别诊断进行了一些讨论。     

原发于眼眶脑膜瘤的CT图像分析

目的分析原发于眼眶脑膜瘤的常见CT图像特征,探讨CT影像对原发于眼眶脑膜瘤的诊断价值。方法回顾性分析51例经病理确诊的原发于眼眶脑膜瘤患者的临床资料和CT图像表现。探讨CT对脑膜瘤的诊断及鉴别诊断价值。结果 51例原发于眼眶脑膜瘤患者中视神经鞘脑膜瘤43例,眶骨膜脑膜瘤8例。视神经鞘脑膜瘤43例中肿瘤形状呈管状20例,块状12例,其他形状11例;呈现车轨征16例,钙化斑6例。8例眶骨膜脑膜瘤均有蝶骨大翼和(或)小翼骨膜增厚及眶外壁骨质增生,其中视神经向内移位6例。所有病例中肿瘤蔓延者8例,双眼眶发病2例。结论 CT图像可清晰显示肿瘤的位置、形状、范围,尤其是眶骨壁改变,对于原发于眼眶脑膜瘤的诊断及治疗具有重要的临床指导意义。     

眼眶纤维组织细胞瘤临床分析

目的 探讨眼眶纤维组织细胞瘤的临床诊断及治疗方法.方法 对1989年1月至2009年1月收治的21例经病理证实的眼眶纤维组织细胞瘤患者的临床特征及影像学特点进行分析.结果 21例(15例初发,6例复发)均有不同程度的眼眶占位性病变体征;16例眼球突出移位;16例有视力下降;15例有眼球运动障碍;15例可触及眶缘肿块;9例结膜充血水肿;9例出现复视;6例眼睑肿胀.B超显示占位性病变,良性者,边界清,类圆形或椭圆形,内回声少,声衰减显著;恶性者,形状不规则、边界不清,内回声中等或不均匀,声衰减显著,不可压缩.彩色多普勒超声显示肿物内有丰富或中等量血流信号,呈动脉血流频谱.CT显示眶内呈椭圆形或不规则形、边清均质的软组织密度影,或伴有骨破坏,可强化.MRI显示肿物内T1WI呈中或低信号,T2WI呈中或高信号,可强化.所有患者均行手术治疗,6例患者行眶内容剜除术;15例患者行局部肿瘤切除术,其中4例术后随访中复发再次手术.术后病理,21例患者中良性纤维组织细胞瘤10例,中间型2例,恶性者9例.结论 影像学检查只能提供定位诊断,最终仍需病理确诊.治疗以手术切除为主,常复发,可辅以放疗或化疗.

Abstract：

Objective To explore the clinical diagnosis and management approach of the orbital fibrous histiocytomas. Methods The clinical and imaging features of 21 patients from Second Hospital of Tianjin Medical University were collected from January 1989 to January 1999. They were all diagnosed for fibrous histiocytoma by histopathology. Results There were orbital occupying lesion in all 21 patients, but 16 patients demonstrated the exophthalmos and displacement, 16 patients with decreased vision, 15 patients with the ocular movement disturbance, 15 patients with the mass of orbital margin. 9 patients with the diplopia. 9 patients with the conjunctival congestion and edema and 6 patients with the eyelid swelling. Type-B ultrasound showed space occupying lesions. Benign tumors demonstrated the well-defined and nearly round mass, the moderate or few inner echo and the obvious attenuation of sound. But malignant tumors showed the ill-defined and irregular mass. Color doppler flowing image (CDFI) discovered that there was abundant or moderate blood flow, accompanied with arterial frequency spectrum. Computed tomography (CT) revealed an oval-shape or irregular, well-defined or ill-defined and homogeneous soft tissue mass in the orbital cavity, sometimes with bone destruction. The masses were enhanced. Magnetic resonance imaging (MRI) demonstrated a intermediate or low signal on T1 weight imaging, but a intermediate or high signal on T2 weight imaging in the tumor. All the patients were managed by surgery. Six patients were performed by orbital exenteration and 15 patients were performed only surgical resection. But 4 patients recurred postoperatively and underwent another surgery. There were 10 benign tumors, 2 locally aggressive tumors and 9 malignant tumors postoperatively. Conclusions Surgery is the mainstay of therapy. Imaging examination may provide the level diagnosis, but the final diagnosis is made by histopathology. The tumors often recur and adjuvant therapy is utilized.     

泪腺腺样囊腺癌的MRI特征分析

目的 探讨泪腺腺样囊腺癌（adenoid cystic carcinoma,ACC）的MRI特征,为临床早期诊断提供依据。设计 回顾性病例系列。研究对象 北京同仁医院经手术证实ACC患者26例,术前均行MRI扫描。方法 所有ACC患者常规MRI扫描;同时对动态增强磁共振成像（DCE-MRI）及磁共振扩散加权成像（DWI）图像进行后处理获得相应量化指标。主要指标 ACC动态增强的峰值强化指数（CIpeak）、峰值强化时间（Tpeak）、最大强化指数（CImax）、强化指数曲线（I型为持续上升型,II型为平台型,III型为流出型）、肿瘤平均表观扩散系数（ADC）值。结果  26例均起自泪腺眶部,20例形态不规则,14例边界不清,12例边界清晰,6例累及颅内,9例出现骨质破坏。T1WI呈等或略低信号,其中3例内部出现高信号区;T2WI呈等或稍高信号为主,增强后仅1例强化均匀,25例呈不均匀强化,其中16例伴有内部囊变、坏死区。泪腺ACC峰值强化指数（CIpeak）为0.9±0.41,峰值强化时间（Tpeak）为（109.3±58.5）s, 最大强化指数（CImax）为0.95±0.45。22例时间强化指数曲线中2例为I型,14例为II型,6例为III型。平均ADC值为（1.25±0.30×10-3）mm2·s－1。结论 MRI可以清晰显示泪腺ACC的部位、形态、范围、边界及骨质侵犯,DCE-MRI及DWI为肿瘤的诊断及鉴别诊断提供辅助量化特征。（眼科,2013, 22： 314-319）     

高分辨弥散张量示踪用于鞍区肿瘤患者前视路的形态学研究

目的：探讨鞍区肿瘤患者前视路高分辨弥散张量纤维束示踪（DTT）的影像特点及其与视觉功能、预后的关系。方法：系列病例研究。选取2015年11月至2017年6月在福建医科大学福总临床医学院经手术切除的鞍区肿瘤患者21例，在术前1周及术后4个月行前视路高分辨弥散张量成像（DTI）扫描， 并通过DTT重建白质纤维束，观察纤维束走行及完整性情况。采用视觉功能障碍（VIS）评分进行视 觉功能的评估。采用Ｍann-Whitney U检验、Fisher精确概率法对数据进行统计学分析。结果：DTT 可清晰观察21例鞍区肿瘤患者前视路白质纤维束的中断或完整现象，稀疏或饱满情况，也可以显现 前视路白质纤维束与鞍区肿瘤之间的空间位置关系（中断型8例，连续型13例）。术前前视路白质纤 维束不同形态患者的VIS评分差异无统计学意义（Z=-0.679，P=0.497），连续型和中断型与视觉功能预后相关，前视路白质纤维束形态完整型的患者术前视觉功能状态及术后4个月时的预后均优于中断型（P=0.014）。结论：高分辨DTT能直观显示前视路白质纤维束的形态，并对鞍区肿瘤患者视觉功 能的预后判断具有参考价值。     

眼眶神经鞘瘤的影像学研究

目的 探讨眼眶神经鞘瘤的CT和MRI的影像学表现及诊断价值。方法 42例眼眶神经鞘瘤均经手术及病理证实。结果 42例中CT显示（1）球后视神经上方20例，视神经外侧9例（2例位于眶尖），视神经下方11例和内侧2例。（2）椭圆形和类圆形27例，分叶状或S形9例，哑铃形6例（其中5例经眶上裂向颅内蔓延）。（3）平扫显示肿瘤内均质高密度28例，不均质14例，其中5例肿瘤内有较大片状低密度区（囊变区）。37例MRI扫描中等T1、长T24例；等T1、短等长T2混杂信号29例；等T1等T24例。在37例MRI检查中35例行Gd-DTPA增强，3l例呈不均匀增强；4例均匀增强。显示肿瘤颅内蔓延5例。结论 CT和MRI能显示肿瘤的位置、形状和病变内部特征，可明确诊断，为手术治疗提供重要依据；而MRI在肿瘤的定性和定位诊断方面明显优于CT。     

眼眶CT视神经增粗征的临床分析

目的 探讨CT检查出现视神经增粗征的临床意义。方法 回顾1424例眼眶肿瘤CT资料，选择出现视神经增粗征的病例，将其按病因及形状分类。结果 在1424例眼眶肿瘤CT中，有111例出现视神经增粗征。按病因分为原发性和继发性；按形状分为管状、梭形或椭圆形、锥形、局部膨大、块状。结论 在眼眶CT影像中，视神经增粗征可见于多种疾病，有助于眼眶肿瘤的诊断和鉴别诊断。     

Combined positron emission tomography/computed tomography for evaluation of presumed choroidal metastases

BACKGROUND: Choroidal metastases are the most common intraocular malignancy and are the first sign of systemic malignancy in approximately one-third of patients. Of patients with no previous diagnosis of cancer, oncological evaluation fails to find the primary lesion in approximately 50% of cases. Newer imaging modalities such as combined positron emission tomography/computed tomography (PET/CT) may improve the yield of the systemic work-up. METHODS: Consecutive patients presenting with presumed choroidal metastases were evaluated with whole body combined PET/CT scanning. RESULTS: Four patients presenting to a tertiary referral hospital with choroidal metastases as the first sign of systemic malignancy were evaluated. In all four cases, PET/CT demonstrated the ocular lesion, and the primary malignancy which was confirmed by tissue biopsy. False-negative results were seen in two cases of cerebral metastases. PET/CT demonstrated lesions not visible on CT or magnetic resonance imaging in two cases. CONCLUSIONS: Combined PET/CT is a useful addition to the work-up of patients with choroidal metastases. It provides the opportunity to detect lesions not visible with other imaging modalities and the ability to image patients with contraindications to magnetic resonance imaging. It is essential to correlate PET images with clinical information and the results of other imaging modalities and tissue biopsy remains the gold standard in the diagnosis of malignancy. False positives and negatives can occur with PET/CT, and further research is needed before this promising technology becomes a routine part of the evaluation of patients with choroidal metastases.     

Space-occupying lesions of the lacrimal gland at one tertiary eye center in China: a retrospective clinical study of 95 patients

AIM: To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS: A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS: Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION: Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis.