眼睑皮脂腺癌治疗的研究进展

眼睑皮脂腺癌是最常起源于睑板腺和睫毛皮脂腺的恶性肿瘤,居眼睑恶性肿瘤的第2位。由于其高复发率和高转移率,已经受到人们的重视。最新研究和临床经验表明,早期发现,早期诊断,以手术为主,化疗、放疗、冷冻为辅的综合性治疗是提高眼睑皮脂腺癌存活率的关键。但是,随着现代治疗手段的应用,逐渐倾向于避免眼眶内容摘除的保守性治疗方法,这些方法有望减少复发和转移的发生率。本文就眼睑皮脂腺癌的治疗新进展作一综述。     

睑板腺癌临床组织病理学特点及影响预后因素

目的：通过系统分析睑板腺癌的临床及组织病理学特点，探讨影响睑板腺癌的临床预后因素。方法：选取北京同仁医院眼科存档睑板腺癌病例55例，对患者进行临床随诊、随访；依据原始记录和随访反馈情况，对临床及组织病理学各项因素逐项进行统计（Logistic回归分析），并进行综合分析评价。结果：睑板腺癌患者年龄33－90岁，50－70岁较多，平均发病年龄63岁，女性略多于男性，发病部位以上睑为多，位于上睑的睑板腺癌占69．09％，位于下睑者占27．27％。结论：睑板腺癌临床预后系多因素多变量结果，与患者年龄，病程长短密切相关，亦与肿瘤大小，肿瘤侵犯的解剖位置以及肿瘤分化程度等多种因素有一定关联。     

Microcystic adnexal carcinoma of the orbit mimicking pagetoid sebaceous gland carcinoma

Microcystic adnexal carcinoma (MAC) is a rare malignancy of sweat glands that has been reported most often on the face in the form of a cutaneous lesion, with the potential for deeper invasion. The synonyms of MAC include sclerosing sweat duct carcinoma, syringomatous carcinoma, and malignant syringoma. Clinically, MAC in the periocular area has been misdiagnosed as basal cell carcinoma, squamous cell carcinoma, or even chalazia. We report a case of MAC presenting clinically as sebaceous gland carcinoma with pagetoid spread for the first time in literature.     

354例眼睑皮脂腺癌预后因素分析

目的 分析眼睑皮脂腺癌患者的预后相关因素。设计 回顾性病例系列。研究对象 2006-2020年北京同仁医院手术治疗的354例眼睑皮脂腺癌患者。方法 回顾患者的临床诊疗信息及随访资料,根据第八版美国抗癌联合会(AJCC)分期标准对肿瘤进行分期。用Logistic回归分析复发相关因素,用Kaplan-Meier法绘制生存曲线并用log-rank法进行检验。主要指标 患者性别、年龄、居住地区、发病部位、肿瘤大小及分期、病程、是否复发或转移。结果 354例患者入组时平均年龄(61.68±11.55)岁,女性212例(59.89%)。214例(60.45%)上睑发病。病程中位时长为6.00(3.00,17.00)个月。T1、T2、T3、T4期肿瘤分别为166例(46.89%)、129例(36.44%)、36例(10.17%)、23例(6.50%)。68例(19.21%)术后复发。22例肿瘤转移,其中3例因转移离世。5年、10年转移率分别为4.69%(n=10)、7.98%(n=17),总转移率为10.33%。年龄较大(P=0.035)及AJCC分期较重(P=0.012)是术后复发的危险因素。结论...     

Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma

An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.     

The effect of direct cell injury inflicted by cryotherapy on eyelid sebaceous gland carcinoma cells: An ex-vivo experimental study

Purpose:To evaluate the effect of direct cell injury of cryotherapy on eyelid sebaceous gland carcinoma cells by an ex vivo cryotherapy experiment.Methods:It was a prospective interventional case series. Six patients with biopsy-proven nodular sebaceous gland carcinoma were included. After excision of the mass, a thin slice of the mass resembling the thickness of the conjunctiva was shaved off and was oriented over the broad end of a tissue forceps. Cryotherapy was applied to both its anterior and posterior aspects by the triple freeze-thaw technique. The mass was then labeled and sent separately for histopathological evaluation by fixation and staining.Results:A total of six patients with a mean age of 58.2 ± 15.5 years were included. There were four females and two males. The mean duration of the lesion was 21.6 ± 17.51 months. All patients had involvement of the upper eyelid. The patients were clinically staged as T2b (n=2), T1a (n=2), T2c (n=1), and T3a (n=1) respectively. There was no regional lymphadenopathy or metastasis in any of the cases. The experimental cryo-tissue containing the cryo-treated lesion revealed the presence of viable tumor cells (>50%) in all six specimens.Conclusion:The direct cell injury caused by cryotherapy may not be sufficient to kill all the residual sebaceous gland carcinoma cells on the tumor bed.     

泪腺腺样囊性癌临床治疗进展

泪腺腺样囊性癌(adenoid cystic carcinoma,ACC)是最常见的泪腺恶性上皮肿瘤,单纯手术切除疗效不满意,易复发,预后差。我们总结近年来国内外报道的相关泪腺ACC的临床综合治疗手段,包括改进手术入路、采取手术前后化学治疗、放射治疗等综合治疗方案,特别还报告了青年泪腺ACC患者的治疗策略,并分析了原发于泪腺以外ACC的诊断与治疗,为眼科临床医生提供更广阔的思路。     

睑板腺癌治疗的研究进展

睑板腺癌是一种起源于睑板腺的恶性肿瘤,居眼睑恶性肿瘤的第四位。因其临床表现多样,常常被误诊为其它良性或低度恶性病变而延误诊治。肿瘤具有侵袭性,局部复发及淋巴结转移不难发现。上述各种因素为肿瘤的早期诊断、早期治疗带来了巨大的困难。虽然以手术为主、冷冻、放疗为辅的综合性治疗仍为睑板腺癌的首选,但随着手术及放疗方式的改进,睑板腺癌相关基因的发现、局部使用化疗药物成为可能以及光动力疗法的出现等都为睑板腺癌的治疗创造了无限的可能。我们就睑板腺癌治疗的新进展作一概述。     

Investigation of vasculogenic mimicry in sebaceous carcinoma of the eyelid

Purpose: Vasculogenic mimicry (VM) is a newly proposed pattern of tumour angiogenesis that has been identified in some malignancies and is associated with poor prognosis. The purpose of this study was to investigate whether sebaceous carcinomas of the eyelid exhibit VM and to determine whether these fluid‐conducting patterns are associated with clinicopathologic features, the number of microvessels and the levels of endothelial growth factor (VEGF) and matrix metalloprotease‐2 (MMP‐2) in tumours. Methods: Forty paraffin‐embedded samples of sebaceous carcinoma of the eyelid were collected, along with complete clinical and pathologic data for all the cases. Tissue sections were stained for CD34, periodic acid and Schiff (PAS), VEGF and MMP‐2. VM was identified by the presence of PAS‐positive and CD34‐negative loops lined by tumour cells. The VM status of tumour samples was compared with the clinical and pathological data using statistical tests. The levels of VEGF, MMP‐2 and the number of microvessels were compared between patients with and without VM. Results: VM was detected in 14 of 40 (35%) tumour samples. The existence of VM in tumours was associated with tumour size (p = 0.007) and recurrence (p = 0.021). The number of microvessels was lower in tumours with VM (13.03 ± 4.02 versus 22.99 ± 7.72; p < 0.0001). The staining index of MMP‐2 was higher in tumours with VM (27.43, range: 0–5.3) compared to tumours without VM (16.77, range: 0–2.7; p = 0.004). However, there was no difference in the expression of VEGF between groups with and without VM (p = 0.244). Conclusions: Vasculogenic mimicry is present in sebaceous carcinoma of the eyelid making it an unfavourable prognosis sign. MMP‐2 is associated with VM formation in sebaceous carcinoma of the eyelid.     

泪腺腺样囊性癌的分期及临床治疗进展

泪腺腺样囊性癌是泪腺最常见的恶性上皮性肿瘤,手术治疗效果不理想。近年来,随着多种放射治疗和化学治疗的应用,泪腺腺样囊性癌的治疗模式发生较大转变。一方面,临床分期逐步完善,以新的分期为基础的综合治疗得到规范化应用; 另一方面,在质子放疗、中子放疗、经动脉细胞减容化疗等新辅助治疗的支持下,保眼手术逐渐增多,局部复发率和转移率逐渐降低,无病生存期获得延长,但还需要长期观察。本文就近年来国际上泪腺腺样囊性癌相关方面的治疗进展进行综述,以提供新的参考依据。     

端粒酶RNA及其催化亚单位基因hTRT在睑板腺癌中的表达

目的 探讨端粒酶RNA(hTR)及端粒酶催化亚单位基因hTRT在睑板腺癌中的表达意义。 方法 用原位杂交法检测hTR及hTRT在55例睑板腺癌、12例霰粒肿、4例睑板腺腺瘤中的表达;用EnVision法对Ki-67进行免疫组织化学染色,其结果用计算机图像自动分析系统进行量化,把积分光密度值作为肿瘤增殖指数;用SAS统计软件包对影响睑板腺癌的危险因素(性别、年龄、病程长短、肿瘤大小、肿瘤分化程度等)进行分析,结合增殖指数,hTR、hTRT表达的半定量结果对影响睑板腺癌预后因素进行综合评估。 结果 hTR在睑板腺癌中的阳性表达率为84.45％,hTRT的阳性表达为51.8％,hTR及hTRT在睑板腺癌中的表达明显高于癌旁组织、霰粒肿、睑板腺腺瘤(P<0.01)。hTR与睑板腺癌的分化有关(r=0.455,P相似文献   

Sebaceous carcinoma of the eyelid: a clinicopathological study

BACKGROUND—Sebaceous carcinoma of the eyelid is rare. The diagnosis might be difficult because of its ability to masquerade as other periocular lesions. Prognosis is still regarded as being poor compared with most other malignant eyelid tumours with a mortality second only to malignant melanoma. The present study retrospectively analyses clinical and histopathological findings and outcome in a series of patients with sebaceous carcinoma of the eyelid in Britain.
METHODS—43 patients with histologically confirmed sebaceous carcinoma treated at Moorfields Eye Hospital between 1976 and 1992 were subjected to retrospective analysis. Clinical data of all patients were reviewed from the charts; all surviving patients except four cases lost for follow up were re-examined. Histological specimens were reviewed in 41 cases.
RESULTS—23 females and 20 males, mean age 63 years (range 37-79), were treated. Primary therapy was surgery in 37 and radiotherapy in six cases. After a median follow up of 40 months (range 1-148) 30 patients were alive without recurrences, four patients had died from the tumour, and one was alive with local recurrence and distant metastases. Four patients had died of non-tumour related causes. Histologically, unfavourable outcome was correlated with poor tumour differentiation and extensive invasion.
CONCLUSION—Early diagnosis and consequent surgical therapy of sebaceous carcinoma of the eyelid leads to a better outcome and higher survival rates than generally assumed. Even local recurrences can be treated successfully. However, sebaceous carcinoma remains a threatening disease, which leads to death in 9% and to mutilating exenteration in 23% of our patients.

Keywords: sebaceous carcinoma; adenocarcinoma; meibomian gland carcinoma; malignant tumour; eyelid     

Sebaceous carcinoma of the ocular adnexa

Sebaceous carcinoma accounts for 1–5.5% of all eyelid malignancies. This lesion, traditionally considered among the most lethal of all tumors of the ocular adnexa, occurs more commonly in women and in the elderly and has a predilection for the upper lid. Both clinically and histologically, sebaceous carcinoma may masquerade as benign or less invasive conditions such as chalazion, blepharitis, conjunctivitis, meibomitis, superior limbic keratoconjunctivitis, basal cell carcinoma and carcinoma in situ, resulting in delayed diagnosis and treatment. In this review the incidence, clinical presentation, and prognostic factors (both clinical and histopathologic), and treatment modalities are discussed.     

Bilateral choroidal metastasis from carcinoma of the submandibular gland

Metastatic tumor is the most common uveal malignancy. However, choroidal metastasis from a salivary gland neoplasm is extremely rare. We report a case of bilateral, multifocal choroidal metastasis from carcinoma of the submandibular gland.     

睑板腺癌术后眼睑缺损的整复

目的探讨睑板腺癌术后眼睑缺损的整复方法。方法睑板腺癌6例。1例上睑肿物切除后上睑缺损小于1/4,创缘直接分层缝合;1例上睑肿物切除后上睑缺损大于1/2,但未侵及睑板上缘,残留睑板结膜瓣向下滑行修复缺损;2例肿物侵及睑板上缘,切除后缺损分别大于1/2和3/4,下睑板结膜滑行修复上睑缘,上睑提肌瓣向下滑行和滑行睑板吻合;1例下睑肿物切除后缺损大于3/4,鼻颊部皮瓣转移修复;1例部分眶内容摘除植皮修复。结果术后随访观察12～19个月,1例眶内容摘除眶内皮片成活良好,其余5例眼睑外形及功能均恢复,眼睑闭合好,活动自如。结论睑板腺癌切除术后根据眼睑缺损的部位和大小选择不同的修复方案,均取得了良好的效果。     

Sebaceous carcinoma of the ocular region: a review

Sebaceous carcinoma of the ocular region is a malignant neoplasm that is being recognized more frequently and managed by innovative techniques of local resection, cryotherapy, topical chemotherapy, and radiotherapy, resulting in improved visual and systemic prognosis.