泪腺上皮性肿瘤DNA含量及P^53基因产物表达的定量分析

目的探讨ＤＮＡ含量和Ｐ５３基因产物表达的定量分析在泪腺上皮性肿瘤病理诊断中的意义。方法应用流式细胞计量术和免疫荧光染色技术，对３９例泪腺上皮性肿瘤细胞的ＤＮＡ含量及Ｐ５３基因产物表达进行定量测定。结果多形性腺瘤具有正常泪腺细胞的ＤＮＡ二倍体含量，而恶性泪腺肿瘤以ＤＮＡ异倍体为特征；Ｐ５３基因产物在两种组织中的表达量，差异有显著性（Ｐ＜０．００１）；ＤＮＡ含量与Ｐ５３基因产物表达量成正相关，均随肿瘤组织分化程度的降低而增高。结论上述两参数的定量测定为泪腺上皮性肿瘤的病理学诊断提供了客观指标。     

泪腺多形性腺瘤表皮生长因子受体表达与DNA含量的关系

目的观察表皮生长因子受体的表达是否与肿瘤细胞的增殖活性有关。方法采用免疫组化ＡＢＣ法和计算机图象分析技术测定３２例泪腺多形性腺瘤表皮生长因子受体表达和细胞核ＤＮＡ含量，分析两者之间的关系。结果３２例肿瘤中，１０例表皮生长因子受体染色阳性。１４例肿瘤ＤＮＡ含量增加，其倍体分布类型呈双峰及多峰型分布。表皮生长因子受体表达与肿瘤细胞ＤＮＡ含量倍体分布类型明显相关，在表皮生长因子受体染色阳性的肿瘤，ＤＮＡ含量倍体分布类型主要为双峰及多峰型，经精确概率χ２检验，差异有显著性，Ｐ＜０．０１。结论泪腺多形性腺瘤表皮生长因子受体表达与肿瘤细胞的增殖活性有关。     

泪腺多形性腺瘤细胞核形态及DNA含量的测定

应用计算机图像分析技术对３２例泪腺多形性腺瘤（其中１０例恶性变）进行了细胞核形态及ＤＮＡ含量的测定，结果在细胞核形态的七项指标中，仅最大径和最小径在良性及恶性变肿瘤之间相差显著，而ＤＮＡ含量，恶变肿瘤明显高于良性肿瘤，ＤＮＡ含量倍体分布类型在恶变肿瘤以双峰和多峰为多，提示在泪腺多形性腺瘤ＤＮＡ含量增加，并呈双峰和多峰分布是肿瘤生物学特性发生改变的重要时期。     

泪腺上皮性肿瘤α-1抗胰蛋白酶的免疫组化研究

应用α－１抗胰蛋白酶多克隆抗体对１０例多形性腺瘤和１０例腺样囊腺癌进行原位免疫标记研究。结果表明，１０例多形性腺瘤均呈阳性反应；１０例腺样囊腺癌中，７例呈阴性反应，３例阳性反应。但腺样囊腺癌的阳性反应程度明显低于多形性腺瘤。说明泪腺腺样囊腺癌的蛋白酶抑制物活性明显降低是该肿瘤具有较强的组织浸润力的原因之一。而且，α－１抗胰蛋白酶的免疫组化测定有助于泪腺上皮性肿瘤的良、恶性判断。     

泪腺良性多形性腺瘤术后随访观察

目的探讨泪腺良性多形性腺瘤术后易复发和恶性变的原因。方法对４２例泪腺良性多形性腺瘤进行随访，随访时间０．５～１７．０年。结果３４例术后无复发或恶性变；８例复发者中，有７例为多次手术者，均因术中对肿瘤组织切除不完全，导致术后复发。结论认为手术成功的关键在于初次手术时要摘除连同包膜在内的整个瘤体；并避免术前行穿刺或切开活检，以减少复发。     

眼眶占位性病变36例手术分析

目的探讨眼眶占位性病变的临床诊断，手术治疗及其组织病理学分类。方法对2004年1月～2006年5月手术治疗的36例（36眼）眼眶占位性病变的性别、年龄、眼别及病理检查结果进行分析。结果恶性肿瘤3例，良性病变33例。组织病理学检查：恶性肿瘤3例均为非何杰金氏淋巴瘤；良性者中海绵状血管瘤9例，泪腺多形性腺瘤8例，静脉性血管瘤3例，炎性假瘤3例，囊肿3例，皮脂腺囊肿2例，淋巴管瘤、视神经胶质瘤、神经纤维瘤、骨瘤及颗粒细胞瘤各1例。在泪腺多形性腺瘤中浸润性生长3例，恶变1例。结论眼眶占位性病变种类繁多，良性肿瘤中以海绵状血管瘤多见，可采用前路开眶或外侧壁开眶顺利摘除肿瘤，次为泪腺多形性腺瘤，并且容易因手术切除不彻底或术中肿瘤破碎残留肿瘤细胞而改变生长方式，甚至于恶变。炎性假瘤手术完整切除较难，多要进一步作术后治疗。神经源性肿瘤早期就对视力损伤较大。     

泪腺肿瘤组织中GPX3基因mRNA和蛋白的表达及其相关性

目的　探讨ＧＰＸ３基因ｍＲＮＡ和蛋白在泪腺上皮性肿瘤中的表达及其临床意义。方法　采用逆转录-多聚酶链反应（ＲＴ-ＰＣＲ）和Ｗｅｓｔｅｒｎ-ｂｌｏｔ技术,检测３２例泪腺多形性腺瘤、２８例泪腺腺样囊性癌及９例正常泪腺组织中的ＧＰＸ３基因ｍＲＮＡ及蛋白的表达。结果　ＲＴ-ＰＣＲ结果显示,ＧＰＸ３ｍＲＮＡ在正常泪腺组织、泪腺多形性腺瘤及泪腺腺样囊性癌中的表达量分别为:０．９０±０．０１、０．４８±０．０３、０．２１±０．０１,三组间差异有统计学意义（Ｐ＜０．０５）。Ｗｅｓｔｅｒｎ-ｂｌｏｔ结果显示,ＧＰＸ３蛋白在正常泪腺组织、泪腺多形性腺瘤及泪腺腺样囊性癌中的表达分别为１９８５．００±１２１．６３、７６８．０１±１２１．３２、０,逐渐降低,三组间差异有统计学意义（Ｐ＜０．０５）。结论　ＧＰＸ３可能参与了泪腺肿瘤的发生、发展,可作为鉴别泪腺良、恶性疾病的一种辅助分子标记物。     

视网膜母细胞瘤p53基因存在状态的研究

目的 探讨Ｐ５３基因突变与视网膜母细胞瘤的发病或病主煌关系。方法 应用单链构象多态性分析和ＤＮＡ序列测定技术,检测５２例Ｒｂ肿瘤患者ＤＮＡＰ５３基因的整个编码区、ｍＲＮＡ剪接位点及其附近的内含子含序是否存在变异,并与正常对照的ＤＮＡ序列比较,确定其变异的性质。结果 ５２例Ｒｂ肿瘤中除可见多态性、同义突变及内含子序列的变异外,未检出Ｐ５３基因有真正的点突变。结论Ｐ５３基因不是通过其结构的突变参与Ｒｂ     

泪腺多形性腺瘤ras癌基因产物表达与DNA含量的关系

目的:泪腺多形性腺瘤是常见的泪腺肿瘤,约占上皮性肿瘤的50％。手术后常有复发,恶性变也不少见。以往的研究表明,肿瘤的发生发展与癌基因产物的异常表达有关。本研究的目的是观察泪腺多形性腺瘤是否存在有P~(21ras)的异常表达。方法:研究采用免疫组化ABC法测定5例正常泪腺组织及32例多形性腺瘤P~(21ras)的表达,抗体选用单克隆抗体F—132—62。肿瘤细胞核DNA含量测定采用计算机图像分析技术。结果:正常泪腺组织均染色阴性,12例肿瘤染色阳性。14例肿瘤细胞核DNA含量增加,其倍体分布类型呈双峰及多峰型。P~(21ras)表达与肿瘤细胞DNA含量倍体分布类型明显相关,在P~(21ras)染色阳性的肿瘤,DNA含量倍体分布类型主要为双峰及多峰型,经精确概率x~2检验,差异有显著性,P<0.05。结论:本研究的结果提示,泪腺多形性腺瘤有P~(21ras)的增强表达,P~(21ras)的异常表达与肿瘤的发展有关。眼科学报 1996;12;54—57。     

泪腺多形性腺瘤转铁蛋白受体表达的研究

泪腺多形性腺瘤转铁蛋白受体表达的研究上海第二军医大长海医院眼科郑磊，何淑芳，韩传贵沈阳军区总医院眼科范忠义铁在细胞生长和生存中是必不可少的川，参与细胞内的多种代谢，包括氧比磷酸化和ＲＮＡ、ＤＮＡ的合成“’，细胞对铁的摄取依赖于血浆中的转铁蛋白和细胞表...     

Carcinosarcoma of the lacrimal gland arising from a pleomorphic adenoma

PURPOSE: To report a case of the lacrimal gland tumor diagnosed as carcinosarcoma (true mixed tumor) arising from a pleomorphic adenoma. DESIGN: Interventional case report. METHODS: An 80-year-old Japanese woman was referred with a well-circumscribed tumor in the lacrimal fossa. RESULTS: The tumor was excised, but the deepest portion remained because of heavy bleeding. Histopathologically, the tumor consisted of osteosarcomatous cells. No epithelial or myoepithelial component was identified by immunohistochemistry. Two months later, the tumor progressed further and was excised completely with lateral orbitotomy. The tumor consisted primarily of osteosarcomatous component but also had epithelial components including carcinoma and pleomorphic adenoma. Examinations did not detect local recurrence and metastasis at 10 post-operative months. CONCLUSION: The tumor was diagnosed as true carcinosarcoma of the lacrimal gland arising from a pleomorphic adenoma. When lacrimal gland tumors containing sarcomatous components are encountered, carcinosarcoma should be included in the differential diagnosis.     

Mucoepidermoid carcinoma ex pleomorphic adenoma of the lacrimal gland: A rare presentation

Carcinoma ex pleomorphic adenoma in lacrimal gland is a rare entity unlike its salivary gland counterpart. This rare tumor poses a diagnostic challenge to clinicians as pre-operative diagnosis is difficult and diagnosis is only by careful pathological assessment. We report this uncommon lesion in a 62-year-old lady, wherein the malignant component was mucoepidermoid carcinoma. The elderly patient remained clinically and radiologically free of the tumor for two years after complete excision of the tumor but computed tomography at the end of two and a half years showed a recurrent lesion in the region of the lacrimal gland. This makes long term follow up of patients with these rare lacrimal tumors imperative with a minimum period of at least five years.     

Unusual presentations of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland

Purpose: To report two atypical cases of pleomorphic adenoma and adenoid cystic tumours of the lacrimal gland. Methods: Two case reports are presented. The first is of a 65-year-old female with a long history of right hypoglobus with sudden recent worsening. Computed tomography (CT) showed a round, well-defined lesion in the fossa for the lacrimal gland with an anterior hypodense exten- sion suggestive of possible malignancy in a pleomorphic adenoma. The tumour in the second case, a 35-year-old male, was diagnosed after presentation following a relatively minor periorbital injury. The smooth rounded mass on CT scan was suggestive of a benign lacrimal gland tumour. Results: The lesion in case 1 was excised with a diagnosis of haemorrhage within a pleomorphic adenoma. The lesion in case 2 was excised with a diagnosis of adenoid cystic carcinoma of the lacrimal gland with pseudocapsule. Conclusions: Haemorrhagic cyst developing beneath the pseudocapsule of a pleomorphic adenoma should be considered in the differential diagnosis of secondary development of malignancy in a pleomorphic adenoma. Adenoid cystic tumours of the lacrimal gland can present with a pseudocapsule.     

Immunohistochemical study of pleomorphic adenoma of the lacrimal gland

We performed immunohistochemical examinations in 1 hypertrophy and 3 pleomorphic adenomas of the lacrimal glands with monoclonal antibodies to S-100 protein and GFAP (glial fibrillary acidic protein). It was thought that hypertrophy of the lacrimal gland would be cytological equivalent to normal lacrimal gland tissue because of the lack of cytological atypia except when accompanied by lymphoid infiltration. In hypertrophy of lacrimal gland, S-100 protein was identified in myoepithelial cells and parts of the ductal epithelia, but GFAP was not identified in any part. In pleomorphic adenomas of lacrimal glands, asteroid cells of myxoid and/or chondroid areas were strongly stained with both antibodies to S-100 protein and GFAP. In solid areas of pleomorphic adenomas, S-100 protein-positive fusiform or round cells and GFAP-positive round cells were observed. It was thought that S-100 protein-positive cells could have originated from myoepithelial cells and GFAP could be a tumor-associated antigen. The results coincided with recent immunohistochemical findings of pleomorphic adenoma of the salivary gland. It was suspected that pleomorphic adenoma of lacrimal gland could develop from mesenchymal metaplasia of myoepithelial cells as in the case of pleomorphic adenoma of salivary gland.     

Unusual presentations of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland.

PURPOSE: To report two atypical cases of pleomorphic adenoma and adenoid cystic tumours of the lacrimal gland. METHODS: Two case reports are presented. The first is of a 65-year-old female with a long history of right hypoglobus with sudden recent worsening. Computed tomography (CT) showed a round, well-defined lesion in the fossa for the lacrimal gland with an anterior hypodense extension suggestive of possible malignancy in a pleomorphic adenoma. The tumour in the second case, a 35-year-old male, was diagnosed after presentation following a relatively minor periorbital injury. The smooth rounded mass on CT scan was suggestive of a benign lacrimal gland tumour. RESULTS: The lesion in case 1 was excised with a diagnosis of haemorrhage within a pleomorphic adenoma. The lesion in case 2 was excised with a diagnosis of adenoid cystic carcinoma of the lacrimal gland with pseudocapsule. CONCLUSIONS: Haemorrhagic cyst developing beneath the pseudocapsule of a pleomorphic adenoma should be considered in the differential diagnosis of secondary development of malignancy in a pleomorphic adenoma. Adenoid cystic tumours of the lacrimal gland can present with a pseudocapsule.     

Immunohistochemical features of carcinoma ex pleomorphic adenoma and pleomorphic adenoma in the lacrimal gland

AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma (Ca-ex-PA) and pleomorphic adenoma (PA) in the lacrimal gland in order to find some clues in the differential diagnosis between them. METHODS: We reviewed microscopic slides and clinical records of 64 cases of PA and 15 cases of Ca-ex-PA in the lacrimal gland. Immunohistochemical antibodies for C-myc, Ki-67, pan-cytokeratin, and vimentin were employed. RESULTS: Median age of PA was 43.2y (from 21 to 75). The 35 patients (54.7%) were male and 29 patients (45.3%) were female. For the PAs, the average positivity of C-myc was 4.6%; the average proliferation index of Ki-67 was 3.2%; pan-cytokeratin was positive in ductal cells, and vimentin was positive in myoepithelial cells. Median age of Ca-ex-PA was 54.3y (from 26 to 76). There were 7 male patients (46.7%) and 8 female patients (53.3%). Among 15 Ca-ex-PAs, there were 6 myoepithelial carcinomas, 4 adenocarcinomas, 3 epithelial-myoepithelial carcinomas, and 2 squamous cell carcinomas. For the Ca-ex-PAs, the average positivity of C-myc was 36.4%; the average proliferation index of Ki-67 was 29.2%; pan-cytokeratin was positive in all cases, and vimentin was positive in myoepithelial carcinomas. CONCLUSION: PA has a lower positivity of C-myc and Ki-67, while Ca-ex-PA had a higher positivity of these two biomarkers. These four biomarkers as a set could provide valuable clues in the differential diagnosis between Ca-ex-PA and PA. Our results indicate that the activation of C-myc could play an important role in the pathogenesis of Ca-ex-PA and PA.     

Slow-growing large pleomorphic adenoma of ectopic lacrimal gland tissue in the upper eyelid

A few cases of pleomorphic adenoma of an ectopic lacrimal gland involving the deep orbit and lateral canthus have been previously reported. A 75-year-old female with a slow-growing, large pleomorphic adenoma arising from ectopic lacrimal gland tissue in the left upper eyelid is described in the present case report.     

泪腺上皮性肿瘤113例临床病理学分析

目的 探讨泪腺上皮性肿瘤组织病理学类型和临床特征.方法 回顾性病例研究重新复习天津眼科医院病理科自1980年至2009年间收检的113例泪腺上皮性肿瘤的临床和病理学资料,参照WHO关于唾液腺肿瘤的分类和诊断标准,分析泪腺上皮性肿瘤的类型和临床病理学特点.结果 113例泪腺上皮性肿瘤中,多形性腺瘤73例(64.6%),腺样囊性癌23例(20.4%),癌在多形性腺瘤中9例(8.0%),其他类型的上皮性肿瘤均为恶性,共8例(7.0%).结论 泪腺上皮性肿瘤有不同的病理类型,其临床特点、治疗和预后有很大区别,正确和详细的病理诊断可对临床治疗起到指导意义.     

泪腺多形性腺瘤表皮生长因子受体表达的研究

应用免疫组化的方法观察３２例泪腺多形性腺瘤表皮生长因子受体的表达，结果１０例染色阳性，而正常泪腺组织染色阴性，阳性染色限于索条样、腺管排列及鳞状化生的肿瘤细胞，实验结果提示泪腺多形性腺瘤表皮生长因子受体的表达水平明显高于正常泪腺组织，表皮生长因子受体可能主要表达于导管起源的肿瘤细胞。