Skp2,p27在眼附属器黏膜相关淋巴组织结外边缘区B细胞淋巴瘤中的表达和意义

目的：探讨眼附属器黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(mucosa-associated lymphoid tissue lymphoma of ocular adnexal,MALT lymphoma of ocular adnexal)中Skp2和p27的表达及联系。

方法：收集1995～2011年青岛大学附属医院眼科切除的眼附属器MALT淋巴瘤患者及眼部反应性淋巴组织增生患者的石蜡包埋标本,用免疫组化法分别检测两组标本中Skp2和p27的表达。

结果：眼附属器 MALT淋巴瘤中Skp2 表达率与眼部反应性淋巴组织增生相比显著增高(P<0.05)。p27表达率与反应性淋巴组织增生相比显著降低(P<0.05)。Skp2和p27的表达与患者Ann Arbor病理分级无关。在眼附属器MALT淋巴瘤中Skp2与p27成负相关(r=-0.129,χ²=15.39,P<0.05)。

结论：综合分析眼附属器MALT淋巴瘤中P27及SKP2的表达对本病的预后有一定意义。两者的表达彼此相关。     

眼附属器黏膜相关淋巴组织淋巴瘤形态及免疫表型研究

目的：探讨眼附属器黏膜相关淋巴组织淋巴瘤（ mucosa－associated lymphoid tissue,MALT）形态及免疫表型特点。方法：采用光镜观察和免疫组织化学分析MALT的形态学、细胞学、免疫表型的特点。结果：眼附属器MALT患者29例33眼中,Ⅰ期23例24眼,Ⅱ期6例9眼。29例33眼均以小淋巴细胞样瘤细胞为主,瘤细胞弥漫分布,体积小,大小较均一,细胞核略呈圆形,染色深,细胞质少,染色淡;29例CD20及CD79 a均（＋）,CD5（＋）2例, CD43（＋）3例;所有患者 CD45 RO、CyclinD1、CD10、CD23均为（－）。结论：眼附属器MALT主要以小淋巴细胞样瘤细胞浸润为主,散在分布中心细胞样细胞及单核样细胞,部分可见浆细胞及Russel、Dutcher小体。眼附属器MALT典型的免疫表型CD20（＋）、CD10（－）、CD5（－）、CD23（－）、CyclinD1（－）,少数患者CD5（＋）, CD5（＋）可能是眼附属器MALT预后不好的一个信号。     

眼附属器黏膜相关淋巴组织淋巴瘤的研究进展

黏膜相关淋巴组织（MALT）淋巴瘤是非霍奇金淋巴瘤中结外边缘带淋巴瘤（MZL）的一种特殊类型。眼附属器MALT淋巴瘤是眼眶恶性肿瘤中较常见的一种，可发生在结膜、泪腺、眼睑和眼眶。近年来，国外许多学者在MALT淋巴瘤的临床特点、病理形态学、免疫表型、分子遗传学及分子生物学方面对它的发生机制在基因水平有了新的认识。就国外对眼附属器MALT淋巴瘤的分子遗传学异常在肿瘤细胞内部信号转导通路中作用的研究做一综述。     

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.     

眼附属器MALT淋巴瘤的临床分析

目的 探讨眼附属器包括眼睑、结膜，眼眶和泪腺等部位MALT淋巴瘤的临床诊断要点，影像学检查特征与治疗和预后。方法 回顾性分析1994年至2005年在第二军医大学长征医院眼科确诊的45例眼附属器MALT淋巴瘤的临床表现、影像学检查、手术治疗及病理结果与预后情况。结果 眼附属器MALT淋巴瘤23例发生于眼眶，10例发生于眼睑，8例发生于泪腺，4例发生于结膜。B超、CT、MRI均能进行定位、定性诊断，B超能较好地显示病变内部结构和形态；CT对眶骨结构和肿瘤侵犯范围与周围组织的关系显示良好，具有定性诊断价值；MRI对软组织的分辨力强，成像参数根据不同的信号强度可提示病变的内部结构。45例均行手术治疗；其中22例辅以放疗，10例结合化疗。42例随访4～135个月，1例于手术切除后25个月转移至肺死亡，其余均存活。结论 眼附属器MALT淋巴瘤好发于眼眶上方及眼睑，影像学检查对MALT淋巴瘤的诊断及鉴别诊断有帮助。手术切除肿瘤，结合病理诊断和临床分期判断能提示较准确的病情估计，病变可长期局限，预后较好，一般不会出现全身转移和向弥漫性大细胞高度恶性淋巴瘤转化。     

Resolution of siderotic glaucoma correlated with decreased pigmentation in the anterior chamber angle after removal of a retained ferrous foreign body

AIM: To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease (IgG4-MALT lymphoma), a rare but clinically important complication of ocular adnexal IgG4-related disease. METHODS: We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three tertiary and one secondary referral centers, between February 2003 and December 2016. Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified. CT and MR images were analyzed by consensus of two experienced head and neck radiologists. RESULTS: Lacrimal glands were the main site of involvement in all seven patients. The lesions typically showed well-demarcated margins, iso- to hyperattenuation on precontrast CT, T2 hypo- to isointensity, T1 isointensity, and homogenous internal architecture with homogenous enhancement pattern. Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images, respectively. CONCLUSION: Unlike in typical ocular adnexal IgG4-related disease, T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases. Although the findings may be nonspecific, the possibility of accompanying MALT lymphoma may need to be considered, when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients. However, this is a case series of a very rare complication of ocular adnexal IgG4-related disease, and thus caution is warranted to generalize the conclusion.     

Clinical features and treatment outcomes of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma: a single center retrospective analysis of 64 patients in China

AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML). METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018. RESULTS: With a median follow-up of 61mo (range, 2-156mo), estimated overall survival (OS) rate and progression-free survival (PFS) rate at 10y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient (1.6%) developed transformation to diffuse large B-cell lymphoma (DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5 (8.9%) developed local and/or systemic relapse eventually. Patients ≥60y had significantly shorter PFS than younger patients (P=0.01). For patients with early stages (Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapy dose lower than 32 Gy were independently associated with shorter PFS (P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS. CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.     

A tooth lesion in the eyelid in a Chinese infant: a rare case report

AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML). METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018. RESULTS: With a median follow-up of 61mo (range, 2-156mo), estimated overall survival (OS) rate and progression-free survival (PFS) rate at 10y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly of lymphoma progression. Transformation to diffuse large B-cell lymphoma was observed in 1 patient (1.6%). Of the 56 patients who achieved complete response after first-line treatment, 5 (8.9%) eventually developed local and/or systemic relapse. Patients ≥60y had significantly shorter PFS than younger patients (P=0.01). For patients with Ann Arbor stage I and stage II, radiotherapy dose lower than 32Gy were independently associated with shorter PFS in univariate analysis (P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS. CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. POAML patients harbor a continuous risk of local and distant relapse, and transformation to aggressive lymphoma.     

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

Purpose

To elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).

Methods

Data from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed.

Results

The median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 ± 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 ± 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 ± 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy.

Conclusions

Radiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.     

The expressions of metadherin and LEF-1 in mucosa-associated lymphoid tissue lymphoma of ocular adnexal

AIM: To investigate the expressions of metadherin (astrocyte elevated gene-1, AEG-1) and lymphoid enhancer-binding factor-1 (LEF-1) in ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction (PCR) analysis. RESULTS: AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis (P<0.05). Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result (P<0.05). A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma (r=0.435, P=0.016). CONCLUSION: The over expressions of AEG-1 and LEF-1 at the level of protein and mRNA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.     

Effect of miR-184 and miR-205 on the tumorigenesis of conjunctival mucosa associated lymphoid tissue lymphoma through regulating RasL10B and TNFAIP8

AIM: To study the efficacy and safety of accelerated collagen cross-linking in keratoconus. METHODS: Medical records of keratoconic corneas underwent accelerated collagen cross-linking at King Chulalongkorn Memorial Hospital, Thailand between April 2015 and August 2018 were reviewed. Preoperative and postoperative data at 1y of visual acuity, auto-refraction, corneal topography, higher-order aberrations (HOA), topometric indices and corneal densitometry were evaluated. Age of 24-30 (mean age 23.43±7.26)y, maximum keratometric value (Kmax) of 55 D, and baseline best corrected visual acuity (BCVA) of 20/40 (or 0.3 in LogMAR unit) were used as cut-off values to highlight the cross-linking effects. The effect of age, preoperative Kmax and BCVA were analyzed. The association between the change of corneal densitometry and other factors including preoperative Kmax, Kmean, manifest refraction spherical equivalent (MRSE), visual acuity, thinnest pachymetry, the change in Kmax, and the change of those parameters were also analyzed. P<0.05 was considered statistically significant. RESULTS: One hundred and fifty-five patients (185 eyes) were included. Male to female ratio was 3:31. According to Amsler-Krumeich classification, stage 1 and 2 were dominant (37.84% and 35.14% respectively). At 1y, mean LogMAR uncorrected visual acuity (UCVA) improved by 0.1 (P<0.05). The number of eyes of which postoperative BCVA improved more than 0.2 LogMAR was higher in the worse baseline BCVA group (preoperative BCVA ≥0.3) compared to the better baseline BCVA group (preoperative BCVA <0.3) (78.26% vs 21.74%, P<0.05). Mean Kmax decreased from baseline by 2.36 diopters (D) (P<0.05). Seventy-three percent of the eyes of which Kmax reduced more than 2.0 D had preoperative Kmax ≥55 D. Q-value showed less prolate by 0.06 (P<0.05). Corneal HOA at 6 mm from corneal apex decreased by 0.40 (P<0.05). Corneal densitometry at 0-6 mm zone increased at 1mo and persisted 1y postoperatively (P<0.05). The relationship of the increase in densitometric value and the decrease of thinnest pachymetry at 1y were in linear fashion. Index of surface variance, index of vertical asymmetry, keratoconus index, index of height decentration decreased at 1y (P<0.05). Success rate at 1y was 90.24%. Postoperative corneal haze was found 11.35%, 30.27%, 15.67%, 10.27% and 2.16% at 1wk, 1, 3, 6mo and 1y respectively. No eyes developed corneal edema. There was one case of sterile keratitis. CONCLUSION: Accelerated collagen cross-linking in keratoconus was effective to flatten, reshape the cornea, improved visual acuity, HOA and topometric indices. Great Kmax reduction was found in advanced keratoconus. The magnitude of Kmax reduction is also greatest among previous reports.     

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of a Patient with Presumed Ocular Tuberculosis

Purpose: To report a case of presumed ocular tuberculosis where a fluorine-18 fluorodeoxyglucose (FDG) PET/CT scan was used to image the chest. Design: Single case report. Methods: A 35-year-old female patient with recurrent posterior uveitis was examined and investigated. Results: A complete blood study was normal. A tuberculosis quantiferon gold test was positive (5.25 IU). CT scan studies of the chest were normal. She was advised to undergo a PET/CT scan. Increased uptake of tracer was seen in right paratracheal, precarinal, and bilateral hilar nodes and in the left choroid. Conclusions: FDG-PET/CT scan may be superior to high-resolution computed tomography in detecting concomitant pulmonary pathology.     

眼附属器MALT结外边缘区B细胞淋巴瘤临床分析

目的探讨眼附属器包括眼睑、结膜、眼眶和泪腺等部位MALT淋巴瘤的临床诊断要点、影像学检查特征及治疗和预后。方法回顾性分析1994年至2005年45例病理确诊的眼附属器MALT淋巴瘤患者的影像学和免疫学检查结果、治疗经过、疗效分析及预后情况。结果B超能较好的显示痛变内部结构和形态；CT对眶骨结构、肿瘤侵犯范围、与周围组织的关系显示良好，具有定性诊断价值；MIU对软组织的分辨力强。成像参数根据不同的信号强度可提示病变的内部结构。45例均行手术治疗，其中22例辅以放疗，10例结合化疗。42例随访4～135个月，3例复发，1例于手术切除后25个月转移至肺而死亡，其余均存活，总生存率为97．7％，复发率为6．6％．结论眼附属器MALT淋巴瘤好发于眼眶上方及眼睑。影像学检查对MALT淋巴瘤的诊断和鉴别诊断有帮助；B超、CT、MRI检查能提供较好的定性、定位诊断。手术切除肿瘤，结合放疗、化疗能取得较好的疗效。病变可长期局限，预后一般较好。不会出现全身转移和向弥漫性大细胞高度恶性淋巴瘤转化。[眼科新进展2007；27（2）：116-119】     

眼附属器淋巴瘤的临床病理分析

目的：探讨眼附属器淋巴瘤(OAL)的发病情况、临床表现及病理分型,以提高临床诊治水平。

方法：选取2005-08/2013-07在华西医院眼科确诊的OAL患者147例,收集患者的一般情况、临床表现、临床检查(影像学、病理学)结果、治疗及预后情况等临床资料进行回顾性研究。

结果：本研究纳入OAL患者147例,其中男91例(61.9%),女56例(38.1%); 年龄3.5～87岁; 病程20d～10a; 发病部位以眼眶最多见(106/147); 最常见的临床表现为眼部包块、眼睑肿胀、眼球突出; 病理分型以黏膜相关淋巴组织边缘区B细胞淋巴瘤最多见(112/147),且其预后最好,而弥漫大B细胞淋巴瘤、结外NK/T细胞淋巴瘤,鼻型预后最差。

结论：OAL病理类型复杂,发病部位和临床表现多样,免疫组织化学染色是OAL鉴别诊断的重要依据,其预后与病理类型密切相关。     

眼附属器MALT淋巴瘤的治疗及转化为弥漫性大B细胞淋巴瘤的危险因素

目的 通过对眼附属器MALT淋巴瘤的不同治疗方式及影响其转化为弥漫性大B细胞淋巴瘤（DLBCL）危险因素的研究,以期能选择合适的手术方式,降低术后并发症的发生,提高生存率。设计 回顾性病例系列。研究对象 1997年1月至2010年6月上海第二军医大学附属长征医院眼科收治的79例病理确诊为IE期眼附属器MALT淋巴瘤患者。方法 回顾上述患者的临床表现、治疗方式（包括手术和放射治疗）及预后情况。手术方式包括全部切除和部分切除。预后情况主要观察患者的生存率、有无转化为弥漫性大B细胞淋巴瘤等。主要指标 临床表现、手术治疗、放射治疗、生存率、有无转化为弥漫性大B细胞淋巴瘤等。结果 所有病例均行手术治疗,其中全部切除58例,局部切除21例。所有患者均在手术后2~4周行眼局部放射治疗。5年总生存率86.0%,共有6例转化为DLBCL。放射治疗对眼附属器MALT淋巴瘤有较好的局部控制。患者双眼发病（P=0.0221）和对放射治疗的初始反应（P=0.0033）与肿瘤转化为DLBCL有相关性;而性别、年龄、发病部位、肿瘤大小及手术方式等因素对转化均无影响。结论 双眼发病和对放疗的初始反应与MALT淋巴瘤转化为DLBCL相关,而手术方式对转化无影响;根据不损伤眼部重要结构的原则来选择合适的手术方式,可降低术后并发症的发生。（眼科, 2012, 21: 352-356）     

Livin及Caspase-3在眼附属器淋巴组织增生病变中的表达

目的：探讨眼附属器淋巴组织增生性病变组织中Livin和Caspase-3的表达情况及临床意义。

方法：收集1995-06/2015-06青岛大学附属医院眼科病理室石蜡包埋标本,采用免疫组化法检测40例眼部B细胞非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)、10例反应性淋巴组织增生组织中Livin和Caspase-3的表达情况,以患者的年龄、性别、发病部位、病理类型分级作为眼附属器淋巴瘤的分类标准。

结果：Livin及Caspase-3的表达与年龄、性别及发病部位无关,而与病理分级有关,Livin在淋巴瘤中的表达率显著高于反应性淋巴组织增生组织(P<0.05),且随着病理分级恶性程度的增加其表达逐渐上升(P<0.05); Caspase-3在淋巴瘤中的表达率则显著低于反应性淋巴组织增生(P<0.05),且随病理分级的增加其表达逐渐降低(P<0.05)。在NHL中,Livin和Caspase-3两者的表达呈负相关(r=-0.491,χ²=7.519,P<0.05)。

结论：过量的Livin表达及Caspase-3的低表达可能与眼部淋巴瘤的发生有关,且在NHL中两者表现为负相关,联合检测两种蛋白对眼部B细胞淋巴瘤的临床表现及病理分型有重要意义。     

眼附属器MALT淋巴瘤的临床与病理学特征分析

目的:探讨眼附属器包括眼睑、眼眶、泪腺等部位黏膜相关淋巴组织淋巴瘤(lymphphoma of mucosa-associated lymph-oid tissue,MALT)的临床、病理学特征与治疗方法。方法:分析24例眼附属器MALT淋巴瘤的临床、病理学及免疫组化结果,以及手术后治疗与预后情况。结果:24例眼附属器MALT淋巴瘤患者经影像学检查后均行手术治疗,其中16例行放疗,2例行化疗。20例随访3mo～7a后均存活。结论:影像学检查可辅助诊断眼附属器MALT淋巴瘤、术后病理活检及免疫组化分型检查可确诊本病,眼结膜MALT淋巴瘤预后较好,伴全身淋巴瘤转移术后辅以化疗或放疗。