114例眼附属器淋巴增生性病变的病理分析

目的：探讨眼附属器淋巴增生性病变的组织病理学分类。方法：对114例患者局部切除的眼附属淋巴增生性病变标本进行回顾性分析。结果：反应性淋巴样增生27例,非典型性增生7例,恶性淋巴瘤80例。80例恶性淋巴瘤包括76例原发性肿瘤和6例继发性肿瘤。粘膜相关组织细胞来源的恶性淋巴瘤有66例（89.19％）。结论：眼附属器原发性恶性淋巴瘤多数为粘膜相关组织细胞来源的恶性淋巴瘤。     

眼附属器黏膜相关淋巴组织型淋巴瘤和反应性淋巴组织增生的鉴别诊断研究

目的　探讨诊断和鉴别诊断眼附属器黏膜相关淋巴组织 (MALT)型淋巴瘤和淋巴组织反应性增生的方法。方法　对 2 9例眼附属器MALT淋巴瘤和 8例淋巴组织反应性增生进行临床、形态学、免疫组化和分子生物学的研究。结果　 2 9例眼附属器MALT淋巴瘤和 8例淋巴组织反应性增生的临床表现相似 ,差异无显著意义。在病理学的诊断中 ,2 9例眼附属器MALT淋巴瘤全部表达B细胞标记 ,不表达T细胞标记 ;免疫球蛋白轻链κ或λ限制 1 1例 ;PCR检测单克隆增生 1 5例 ,无特异表达 1 4例。 8例淋巴组织反应性增生中 ,7例同时表达B细胞标记和T细胞标记 ,且T细胞标记 >30 %;κ和λ阴性 ;PCR检测呈多克隆增生。结论　在眼附属器MALT型淋巴瘤和淋巴组织反应性增生的鉴别诊断中 ,免疫组化和分子生物学技术有助于进一步明确诊断。     

眼附属器淋巴组织增生性病变的临床与病理

眼附属器淋巴组织增生性病变包括反应性淋巴组织增生、非典型淋巴组织增生、淋巴瘤，三临床上没有明确的区分标准，组织学形态学区分亦有难度，免疫组织化学和分子生物学技术为明确诊断提供了一定的依据。按照最新的WHO分类，眼附属器淋巴瘤多为B细胞淋巴瘤，其中结外边缘区B细胞淋巴瘤最为多见，呈惰性发展过程，低度恶性，局部放疗效果好；该分类对于眼附属器淋巴瘤各型的治疗和预后判断有较强的指导意义。本着重从病理学分类角度描述各型特点，更好地为临床诊断、治疗及预后判断服务。     

眼附属器淋巴组织增生性病变增殖细胞核抗原的表达及其与组织学分型的关系

应用增殖细胞核抗原单克隆抗体（ＰＣ１０）对眼附属器淋巴组织增生性病变３４例（炎性假瘤５例，淋巴组织反应性增生９例，不典型淋巴组织增生９例，恶性淋巴瘤１１例）标本石腊切片进行免疫组化（ＡＢＣ法）染色。结果显示炎性假瘤与反应性淋巴组织增生ＰＣＮＡ计数相差不显著（Ｐ＞０．０５），反应性增生与后二者ＰＣＮＡ计数之间均有显著的差异（Ｐ＜０．０５，Ｐ＜０．００１），不典型淋巴组织增生与恶性淋巴瘤之间阳性细胞均值差异显著（Ｐ＜０．０５）。认为ＰＣＮＡ计数有助于区别眼附属器淋巴组织增生性病变的良、恶性，本技术用于研究眼附属器淋巴组织增生性病变尚未见报道。     

眼附属器恶性淋巴瘤172例临床病理分析

目的初步探讨眼附属器恶性淋巴瘤的临床特点及病理学分类。方法 对172例187眼经组织病理学确诊的眼附属器恶性淋巴瘤患者的临床及病理资料进行回顾性分析。结果 患者年龄12～85岁,平均63岁,病程13d～25a,平均75个月。其中眼眶恶性淋巴瘤最多见,共98眼(52.33%),其次为结膜48眼(25.00%)及眼睑37眼(20.35%)、泪囊4眼(2.33%)。免疫组织化学染色146例159眼(84.88%)均为非霍奇金淋巴瘤,其中86例95眼(58.90%)确诊为低度恶性黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)。眼附属器恶性淋巴瘤以眼睑色块和结膜新生物128眼(69.77%)或眼球突出48眼(25.00%)为主要就诊原因。结论 眼附属器恶性淋巴瘤多为黏膜相关性淋巴组织淋巴瘤,免疫组织化学检测有助于诊断。准确的肿瘤病理学分类不仅能指导临床治疗,还能反映患者预后。     

眼附属器淋巴组织增生性病变的临床与病理

眼附属器淋巴组织增生性病变包括反应性淋巴组织增生、非典型淋巴组织增生、淋巴瘤,三者临床上没有明确的区分标准,组织学形态学区分亦有难度,免疫组织化学和分子生物学技术为明确诊断提供了一定的依据。按照最新的WHO分类,眼附属器淋巴瘤多为B细胞淋巴瘤,其中结外边缘区B细胞淋巴瘤最为多见,呈惰性发展过程,低度恶性,局部放疗效果好;该分类对于眼附属器淋巴瘤各型的治疗和预后判断有较强的指导意义。本文着重从病理学分类角度描述各型特点,更好地为临床诊断、治疗及预后判断服务。     

眼部淋巴增生病AgNORs的定量及免疫表型研究

目的探讨眼附属器淋巴组织增生性病变的增殖活性与组织学分型的关系．方法用银染色技术对眼部淋巴增生病34例（良性淋巴组织增生14例，不典型淋巴组织增生9例，恶性淋巴瘤11例）进行银染核仁组织区（AgNORS）定量观察。结果发现良性淋巴组织增生与后二者AgNORS颗粒数量间均有极显著性的差异（P＜0．01，P＜0．001），不典型淋巴组织增生与恶性淋巴瘤之间AgNORs颗粒数量相差不显著。结论二种技术对眼附属器淋巴组织增生性病变组织学分型有一定意义。     

眼附属器淋巴瘤组织病理学及免疫表型研究

目的 探讨眼附属器淋巴瘤的临床特点，组织学分型及免疫表型。方法 收集眼附属器淋巴瘤病例33例。采用HE染色常规观察形态学特点。采用多种抗体标记B淋巴细胞，行T细胞鉴别，检测细胞增殖活性及探讨B细胞起源，进行免疫组织化学染色诊断和鉴别诊断，判定免疫表型，细胞分化及增殖状态。结果 29例（87.9%)瘤细胞B细胞标记物CD20，CD79a阳性，并出现k或λ的克隆性增生，诊断为结外边缘区B细胞淋巴瘤，黏膜相关淋巴组织型（MZL-MALT）。2例（6.1%)诊断为弥漫性大B细胞淋巴瘤。1例（3%）为组织学典型的浆细胞瘤分化，1例（3%）为此部位极为罕见的T细胞淋巴瘤，免疫表型为T细胞分化。结论 MZL-MALT型淋巴瘤是眼附属器淋巴瘤中最常见的一类，免疫组化抗体标记在诊断和鉴别诊断中起重要作用，其他类型的淋巴瘤较少见。     

眼附属器黏膜相关淋巴组织淋巴瘤的Bcl-10基因突变研究

目的探讨Bcl-10基因在我国人群眼附属器黏膜相关淋巴组织（MALT）淋巴瘤、不典型淋巴组织增生和淋巴组织反应性增生中的表达和新突变。方法收集第二军医大学附属长征医院眼科患者新鲜冰冻组织标本31例,其中眼附属器MALT淋巴瘤23例,不典型淋巴组织增生4例,淋巴组织反应性增生4例。采用分子生物学方法获得Bcl-10基因,以双脱氧Sanger法行DNA测序,Blast比对分析后,得到突变碱基。同时行免疫组织化学检测和免疫荧光定位,用激光共焦显微镜检测Bcl-10和NF—κB的共定位情况。结果31例中,检出14例眼附属器MALT淋巴瘤有Bcl-10基因表达,其中10例发现新的基因突变。4例不典型淋巴组织增生和4例淋巴组织反应性增生中,各有1例发生新突变。免疫组织化学检测发现异常的Bcl-10基因在14例MALT淋巴瘤中均有表达（60．8％）,其中中等强度核表达为6例,弱到中等强度胞质表达为8例。2例不典型增生标本胞质中有异常Bcl-10表达,1例反应性增生标本胞质中亦见异常Bcl-10表达。免疫荧光定位发现NF—κB的反应因子Iκα在20例胞质中弥漫性表达,其中Bcl-10和Iκα共表达有14例。结论Bcl-10基因在我国人群眼附属器MALT淋巴瘤中有新的突变形式,检测到的基因突变分布与病理诊断一致。基因检测的灵敏度高于病理诊断,在尚无形态学改变及其他可供鉴别的指标下,能判断出病变阶段和性质改变,可作为早期诊断的灵敏指标之一。（中华眼科杂志,2007,43：1010—1016）     

眼科首诊的黏膜相关淋巴组织淋巴瘤一例

黏膜相关淋巴组织（mucosa associated lymphoid tissue,MALT）淋巴瘤是一种淋巴结外淋巴瘤,常见部位包括胃肠道、肺、甲状腺、涎腺、眼眶等,眼附属器MALT淋巴瘤是眼附属器最常见的淋巴瘤,     

Lymphoid tumours of the ocular adnexa: a morphologic and genotypic study of 15 cases

PURPOSE: To examine all lymphoproliferative lesions of the ocular adnexa diagnosed in Iceland during 1983-2000 and to determine whether polymerase chain reaction (PCR) methods to determine clonality are helpful in characterizing these lesions. METHODS: All patients diagnosed with lymphoproliferative lesions in the ocular adnexa in the years 1983-2000 were included in the study. Polymerase chain reaction studies for clonality were performed on these lesions. RESULTS: Fifteen cases were identified. Seven were classified as inflammatory pseudotumour, one as lymphoid hyperplasia, four as atypical lymphoid hyperplasia and three as lymphoma. Of 12 cases examined by PCR, three were monoclonal for B-cells (one lymphoma, one inflammatory pseudotumour and one atypical lymphoid hyperplasia) while the remaining lesions (including two lymphomas) appeared polyclonal. CONCLUSION: The results of this study suggest that analysis of clonality by PCR methods may be of limited use in classifying lymphoproliferative lesions of the ocular adnexa as benign or malignant. These results underscore the importance of using several techniques when determining clonality.     

眼附属器MALT淋巴瘤的临床分析

目的 探讨黏膜相关组织淋巴瘤(MALT)在眼附属器包括眼睑、眼眶、泪腺等部位的特殊临床特征与治疗方法.方法 回顾性分析32例眼附属器MALT淋巴瘤患者的临床表现、B超、CT、MRI检查结果,病理组织学和免疫组织化学结果以及综合治疗疗效与预后情况.结果 32例眼附属器MALT淋巴瘤患者中男22例,女10例;年龄23.0～74.0岁,平均年龄64.1岁.18例发生于结膜,占56.3%(18/32);9例发生于眼眶,占28.1%(9/32);5例发生于泪腺,占15.6%(5/32).B超检查肿块多表现为内回声不均匀(84.4%,27/32)或内回声高(28.1%,9/32);CT检查多表现为中等密度(43.8±10.7)HU,密度均匀(84.6%,22/26);MRI检查T1WI及T2WI多呈等信号,信号均匀.影像学检查后均行手术治疗联合放疗.随访1～12年,复发率为12.5%(4/32).结论 影像学检查可辅助诊断眼附属器MALT淋巴瘤,术后病理活体检查及免疫组织化学分型检查可确诊本病,眼附属器MALT淋巴瘤若早期诊断和治疗(手术治疗联合术后放疗)则预后较好.     

Ocular adnexal lymphoproliferative disease: a series of 73 cases

Background : This study involved 73 patients with lymphoproliferative lesions of the ocular adnexa. The lesions were categorized using the Revised European American Lymphoma classification of lymphoid tissues and analysed to determine the frequency and prognostic impact of tumour type, location, stage and patient's age and sex. Methods : The clinical, histopathological, immunohistochemical and phenotypic analysis by flow cytometry and follow‐up data were studied. Results : The ocular adnexal lymphoproliferative lesions included 70 lymphomas and six reactive lymphoid hyperplasia. Seventy‐nine per cent had stage IE disease, 4% stage II, 1.5% stage III and 15.5% stage IV. Five patients (7%) had a past history of systemic lymphoma. Major histological types were extranodal marginal zone lymphoma (MZL) in 44 (63%), follicular (FL) in 12 (17%), diffuse large B‐cell (DLBCL) in eight (11%), mantle cell (MCL) in two (3%), B‐cell chronic lymphocytic leukaemia (CLL)/small lymphocytic lymphoma in two (3%), peripheral T‐cell lymphoma (PTCL) one (1.5%) and natural killer cell lymphoma (NKCL) in one (1.5%). Longest survival was seen in those with low‐grade lymphomas (MZL and FL) and worst in PTCL and NKCL. Lymphoma‐related mortality was 2% for MZL, 33% for FL, 38% for DLBCL, and 100% for MCL, PTCL and NKCL. Systemic lymphoma was present prior to, at presentation or at subsequent follow up in 26/68 (39%) of all lymphoma patients, 17% for MZL, 38% for DLBCL, 83% for FL, and 100% for MCL, CLL, PTCL and NKCL. Conclusion : The majority of ocular adnexal lymphomas were low‐grade B‐cell lymphomas (MZL). Multivariate analysis showed that the only significant independent predictors of all causes of mortality were the histological type of lymphoma and the stage of disease at presentation.     

聚合酶链反应扩增IgH CDR-Ⅲ序列对眼部淋巴样增生病的诊断研究

目的从分子生物学角度探讨眼部淋巴样增生病的诊断、分类及肿瘤细胞的起源。方法应用聚合酶链反应（ｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ,ＰＣＲ）对２９例（３１只眼）眼部淋巴样增生病的石蜡切片进行免疫球蛋白重链基因第三互补决定区（ＩｇＨＣＤＲ－Ⅲ）重排检测,并结合形态学及免疫表型进行分析检查。结果１７只眼恶性淋巴瘤、５只眼反应性增生均呈ＩｇＨ基因克隆性重排,电泳产物可见一明显的扩增窄带（１００～１２０ｂｐ）,其中２例双眼恶性淋巴瘤的两侧病变扩增带一致,１只眼恶性淋巴瘤、８只眼反应性增生均呈ＩｇＨ基因多克隆性重排。结论采用ＰＣＲ扩增ＩｇＨＣＤＲ－Ⅲ序列能确定此类疾病的克隆性质,并能发现免疫组化及形态学不能识别的小克隆Ｂ细胞病变,为诊断眼部淋巴样增生病提供了一个较为客观、敏感而又实用的手段。     

B-Cells in ocular adnexal lymphoproliferative lesions express B-cell attracting chemokine 1 (CXCL13)

PURPOSE: The homeostatic chemokine, B cell attracting chemokine 1 (CXCL13), has been implicated in the pathogenesis of lymphocyte-mediated diseases. We investigated the cellular expression of this chemokine in the spectrum of ocular adnexal lymphoproliferative lesions. DESIGN: Laboratory investigation. METHODS: CXCL13 expression in paraffin-embedded adnexal biopsy specimens was determined by indirect immunohistochemistry with antigen retrieval. RESULTS: In 15 of 16 biopsy specimens, including reactive lymphoid hyperplasia (n = 7), atypical lymphoid hyperplasia (n = 3), and B cell lymphoma (n = 6), CXCL13 was detected. CD20-positive B-cells, as well as dendritic cells and endothelial cells, expressed the chemokine. CONCLUSIONS: B-cells in ocular adnexal lymphoproliferative lesions demonstrate expression of CXCL13, a chemokine that may participate in tumor pathogenesis and is a potential target for novel therapies.     

眼部淋巴组织增生性病变PCNA和AgNORs的观察

目的：探讨眼部淋巴组织增生性病变的增殖活性与组织学分型的关系。方法：应用抗增殖细胞核抗原的单克隆抗体ＰＣ１０和ＡｇＮＯＲｓ技术，对３４例眼附属器淋巴组织增生性病变（包括良性淋巴组织增生１４例，不典型增生９例，恶性淋巴瘤１１例）的石腊切片进行检测。结果：良性淋巴组织增生与后二者ＰＣＮＡ及ＡｇＮＯＲｓ计数之间均有非常显著的差异（ＰＣＮＡ Ｐ〈０．００１，ＡｇＮＯＲｓＰ〈０．０１及Ｐ〈０．００１），不典     

Prognostic value of cell-cycle markers in ocular adnexal lymphoma: an assessment of 230 cases

Background To determine the prognostic value of cell-cycle associated markers in ocular adnexal lymphoma (OAL).Methods Two hundred sixty-one consecutive cases of ocular adnexal lymphoproliferative lesions were subdivided into reactive lymphoid hyperplasia (RLH), atypical lymphoid hyperplasia (ALH) and OAL. The latter were sub-typed according to the new WHO Lymphoma Classification. All lesions were investigated applying standard immunohistochemical methods with antibodies specific for pRB, p53, p16, p21, BCL-6 and for multiple myeloma oncogene-1-protein (MUM1, also known as IRF4). The main endpoints included the development of a local recurrence, of systemic disease and of lymphoma-related death. The association of prognostic variables with endpoints was assessed by multiple logistic and Cox regression models, respectively.Results The ocular adnexal lymphoproliferative lesions were categorised as OAL (n=230; 88%), RLH (n=29; 11%), and ALH (n=2; 1%). The major lymphoma subtypes included 136 extranodal marginal zone B-cell lymphoma (EMZL), 31 diffuse large cell B-cell lymphomas, 27 follicular lymphomas, 9 plasmacytomas, 9 lymphoplasmocytic lymphoma/immunocytomas and 8 mantle cell lymphomas. The median follow-up time was 44.5 months. Most OAL patients had Stage IE disease and were treated with radiotherapy. Thirty-seven (25%) Stage IE patients had tumour relapses: these were significantly associated with an increased BCL6 blast percentage. Sixty-two (42%) Stage IE patients developed systemic disease: they had non-EMZL with large growth fractions and increased blast percentages for BCL6. Fifty-seven (25%) OAL patients died because of their lymphoma; lymphoma-related death was significantly associated on multivariable analysis with advanced clinical stage, an age >60 years and large tumour growth fractions.Conclusion Subtyping of OAL according to the new WHO Lymphoma Classification, the stage of disease and tumour cell growth fraction aided the prediction of (1) tumour relapse, (2) the development of systemic disease and (3) lymphoma-related death in OAL.     

眼眶及眼附属器淋巴瘤的彩色多普勒超声显像特征分析

目的 探讨眼眶及眼附属器淋巴瘤的彩色多普勒超声显像(CDI)特征.方法 回顾性研究30例经病理证实为眼眶及眼附属器淋巴瘤的CDI,结合临床表现和好发部位分析其特征.结果 淋巴瘤发生部位有眼眶、结膜、泪腺和泪囊;瘤体大多数长径在1cm以上,形态不规则,边界不清,内回声不均匀,以低回声为主,但多可见高回声分隔;14例声衰减中等,16例声衰减不明显;多数肿瘤有轻度可压缩性;可见较明显占位效应.彩色多普勒血流显像(CDFI)显示多数肿瘤内部可见Ⅲ级或Ⅳ级血流信号,均为动脉频谱,峰值流速和阻力指数较高;部分瘤体周围可见血流信号.结论 眼眶及眼附属器淋巴瘤的CDI具有一定特征,结合好发部位及临床表现有助于临床判断.