泪腺上皮性肿瘤中CUL-1蛋白和Ki-67蛋白表达的意义

目的 研究 cullin-1（CUL-1）蛋白和Ki-67蛋白在泪腺上皮性肿瘤中的表达及其临床意义.方法 选取手术切取的泪腺上皮性肿瘤31例（多形性腺瘤11例、腺样囊性癌12例和腺癌8例）,其中男19例,女12例,年龄34～68岁,平均（42.5±4.7）岁,单眼发病.另取5例正常泪腺组织作为对照.采用免疫组化SP法检测CUL-1蛋白和Ki-67蛋白在泪腺正常组织及良、恶性上皮性肿瘤中的表达.在200倍视野下,辨别阳性细胞和阴性细胞并计数,计算出CUL-1蛋白和Ki-67蛋白在不同组织的阳性表达率.对各组的阳性表达率作卡方检验.结果 ①CUL-1蛋白的阳性细胞经免疫组化染色后呈棕黄色,分布于细胞核和细胞质,在3种肿瘤中均呈高表达.在多形性腺瘤、腺样囊性癌和腺癌中,CUL-1蛋白的阳性表达率分别为43.10%、46.63%和43.88%;在正常组织呈低表达,阳性表达率为1.43%.经卡方检验,CUL-1蛋白在多形性腺瘤、腺样囊性癌和腺癌组织中的阳性表达率明显高于正常组织（x2=492.821、550.069、504.907,P均＜0.01）,而在良、恶性肿瘤组织中的表达差异则无统计学意义（P＞0.05）.②Ki-67蛋白的阳性细胞经免疫组化染色后呈棕黄色,分布于细胞核.在腺样囊性癌和腺癌中呈高表达,阳性表达率高达48.59%和53.88%;在多形性腺瘤和正常组织中呈低表达,阳性表达率分别为6.06%和4.32%.经卡方检验,Ki-67蛋白在腺样囊性癌和腺癌中的表达明显高于多形性腺瘤（x2=454.522、544.010,P均＜0.01）.结论 CUL-1蛋白在泪腺上皮性肿瘤中表达增高,是导致泪腺上皮细胞异常增生的分子机制之一.Ki-67蛋白在泪腺恶性上皮肿瘤中呈高表达,可作为判断泪腺上皮性肿瘤生物学行为及预后的指标.     

泪腺多形性低度恶性腺癌一例

泪腺多形性低度恶性腺癌一例夏瑞南，罗清礼，张贤良，袁季高，曾晓燕泪腺肿瘤占眼眶肿瘤的第５位￣［１］，大多数文献报道泪腺上皮性肿瘤占５０％左右￣［２，３］，上皮性良性肿瘤以混合瘤（多形性腺瘤）最为多见，恶性肿瘤以腺样囊性癌占首位￣［４］。我们报告１例极...     

E-cadherin和β-catenin在泪腺多形性腺瘤和腺样囊性癌中的表达

目的研究E-cadherin及β-catenin在泪腺多形性腺瘤和腺样囊性癌中的表达。方法选取经病理检查确诊为泪腺多形性腺瘤的患者11例11眼和腺样囊性癌的患者6例6眼,分别行E-cadherin和β-catenin免疫组织化学染色。选取泪腺脱垂患者的泪腺组织6例作为正常对照组。结果正常泪腺组织中E-cadherin呈强阳性表达,主要位于细胞膜;而在泪腺多形性腺瘤中E-cadherin呈弱阳性表达,主要位于细胞质。E-cadherin在腺样囊性癌中未见表达。3组中E-cadherin阳性表达的样本数差异有统计学意义（H=16.492,P=0.000）;正常泪腺组E-cadherin阳性表达的样本数明显高于多形性腺瘤组和腺样囊性癌组,差异均有统计学意义（U=-3.561,P=0.000;U=-3.108,P=0.002）,多形性腺瘤组中E-cadherin阳性表达的样本数明显高于腺样囊性癌组,差异有统计学意义（U=-2.147,P=0.032）。正常泪腺β-catenin细胞膜呈中度或强阳性表达,多形性腺瘤和腺样囊性癌中β-catenin的表达较正常泪腺组织表达阳性程度差异无统计学意义（P〉0.05）,腺样囊性癌组中β-catenin细胞核阳性的比例（33.3%,2/6）较多形性腺瘤组（72.7%,7/11）低。结论 E-cadherin表达的下降是参与泪腺上皮性肿瘤发生及癌变的重要因素,而E-cadherin的进一步下降甚至缺失,以及β-catenin的核转位可能是参与泪腺多形性腺瘤恶性转化的因素之一。     

10年原发性眼眶肿瘤回顾性分析

目的分析原发性眼眶肿瘤的组织学来源和流行病学特征,为原发性眼眶肿瘤的诊断提供一定的指导。方法回顾性分析十年手术切除的原发性眼眶肿瘤病理标本。结果原发性眼眶肿瘤共701例,女性360例,男性341例;平均年龄(35.1±2.3)岁;左侧357例,右侧341例,双侧3例;良性498例(71.0%),恶性203例(29.0%)。血管源性326例(46.5%),泪腺源性146例(20.8%),神经源性101例(14.4%),淋巴源性92例(13.1%),其他36例(5.1%)。居前十位的依次为:海绵状血管瘤、淋巴瘤、泪腺多形性腺瘤、静脉性血管瘤、神经鞘瘤、淋巴管瘤、脑膜瘤、泪腺腺样囊性癌、泪腺多形性腺癌和横纹肌肉瘤。结论海绵状血管瘤和淋巴瘤仍然是最常见的良性和恶性原发性眼眶肿瘤。     

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.     

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。     

泪腺上皮性肿瘤临床病理及复发机理的探讨

目的对泪腺上皮性肿瘤的临床病理特征进行总结，分析复发机理和原因。方法回顾分析经病理确诊的泪腺上皮性肿瘤125例病理，用免疫组化法检测肿瘤组织标本的CD44v6蛋白的表达。结果在泪腺上皮性肿瘤中，以多形性腺瘤、腺样囊腺癌、多形性腺癌和腺癌较为多见。复发是泪腺上皮性肿瘤的重要生物学特征之一，复发的原因主要与肿瘤的组织类型、包膜的浸润、残留或破裂、手术操作、CD44v6蛋白的过表达有关。结论临床病理特点与免疫组织化学紧密结合，有助于阐明对泪腺上皮性肿瘤生物学行为的了解及复发原因，CD44v6在泪腺上皮性肿瘤的进展过程和复发中发挥重要作用。     

PCNA、Ki-67、CyclinD1、P53在泪腺上皮性肿瘤的表达及临床相关性研究

目的探讨PCNA、Ki-67、CyclinD1、P53的表达与泪腺上皮性肿瘤的发生、发展的关系及其临床病理意义。方法应用Envision法检测1985年1月至2005年10月间存档的45例泪腺良、恶性上皮性肿瘤和6例正常泪腺组织中PCNA、Ki-67、CyclinD1、P53的表达,并将检查结果结合临床进行比较。结果在正常泪腺组织组、泪腺多形性腺瘤初次手术组、泪腺多形性腺瘤复发组、泪腺多形性腺癌组、腺样囊性癌组中各免疫因子的阳性细胞比例分别为:PCNA:34.83%±12.64%、52.19%±9.42%、56.20%±9.28%、82.0%±8.46%、89.29%±5.24%、Ki-67:3.83%±4.62%、6.0%±6.51%、7.7%±8.35%、15.08%±11.41%、16.86%±12.27%、CylinD1:5.50%±5.96%、13.25%±12.69%、12.1%±10.95%、15.17%±11.92%、17.14%±11.49%;P53:7.13%±7.57%、8.5%±7.11%、26.33%±9.44%、22.29%±6.05%。经统计学分析,在泪腺良性上皮性肿瘤与恶性上皮性肿瘤之间比较均有统计学意义的有PCNA、Ki-67、P53;在正常泪腺与恶性上皮性肿瘤之间表达有统计学意义的有PCNA、P53;PCNA、Ki-67、CyclinD1、P53在初发和复发的泪腺多形性腺瘤中的表达差别无统计学意义。结论PCNA、P53可作为鉴别泪腺上皮性肿瘤良恶性的参考指标。     

泪腺腺样囊性癌生物标志物的研究进展

泪腺腺样囊性癌是泪腺最常见的恶性上皮肿瘤,具有易复发、易转移及预后差的特点,目前临床治疗方式主要有手术切除、放疗、化疗等,但其生存率仍低。因此,进一步研究泪腺腺样囊性癌的发病机制和寻找泪腺腺样囊性癌的生物标志物尤为迫切。本文将对泪腺腺样囊性癌的生物标志物的研究进展作一综述。     

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。     

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.     

泪腺上皮性肿瘤彩色多普勒超声特征分析

目的 分析泪腺上皮性肿瘤的彩色多普勒超声声像特征,证实其临床应用价值.方法 对28例经病理证实为泪腺上皮性肿瘤的彩色多普勒超声声像图进行回顾性分析.结果 泪腺多形性腺瘤多表现为边界清楚,形态规则,均匀中等内回声或不均匀内回声,不可压缩,彩色多普勒血流分级为I～Ⅱ级;腺样囊性癌多表现为边界清楚,形态不规则,不均匀内回声,不可压缩,彩色多普勒血流分级为Ⅲ～Ⅵ级,其中原发性泪腺腺样囊性癌收缩期峰值血流速度明显升高,与原发性泪腺多形性腺瘤间差异有统计学意义(P<0.05 ).结论 彩色多普勒超声对泪腺上皮性肿瘤的诊断及区别泪腺肿瘤良、恶性有重要临床应用价值.     

复发性泪腺区肿瘤25例临床病理分析

目的：探讨复发性泪腺区肿瘤的临床特征和组织病理学类型。方法：回顾性研究。收集2004-01/2014-02在我科确诊的25例复发性泪腺区肿瘤患者的临床和病理资料,对其临床表现、复发情况、组织病理学分型及预后情况进行分析。结果：所选25例患者中21例为初次复发,1例为3次复发,3例为2次复发。最后一次手术到最近一次复发间隔1mo~28a(中位数1a)。复发后在我院手术时的年龄17.5~70(平均47.9)岁。组织病理检查：多形性腺瘤4例,多形性腺瘤恶变2例,腺样囊性癌10例,上皮-肌上皮癌3例,恶性多形性腺瘤3例,腺癌1例,间叶组织肿瘤1例,黏膜相关淋巴组织淋巴瘤1例。结论：泪腺区复发性肿瘤种类繁多,以腺样囊性癌最多,其次是多形性腺瘤;恶性肿瘤复发率高;多形性腺瘤初次手术完整的切除,对预防术后复发和恶变至关重要。同时早期及长期的随访,对发现肿瘤复发,也非常重要。     

Primary malignant neoplasms of the lacrimal gland.

The clinical characteristics and outcome of 50 primary malignant neoplasms of the lacrimal gland are reviewed: 38 (76%) adenoid cystic carcinomas, six (12%) carcinomas arising in pleomorphic adenoma, and six (12%) adenocarcinomas or other types of carcinoma. Most patients presented with a short history and pain, though pain tended to occur less often and later with adenocarcinoma than with adenoid cystic carcinoma. Pain was unrelated to the duration of symptoms, invasion of bone, loss of trigeminal nerve function, or the frequency and time of tumour recurrence. The estimated disease-free survival for patients with adenoid cystic carcinoma was significantly (p less than 0.01) reduced where half or more of the biopsy specimen showed basaloid differentiation. Eleven patients underwent extended cranio-orbital resection, and the others received a combination of total dacryoadenectomy adenectomy and/or radiotherapy. Survival after adenoid cystic carcinomas appears to be significantly (p less than 0.05) greater when tumour resection is combined with radiotherapy than after radiotherapy alone. At present, however, the rate of disease-free survival after treatment of adenoid cystic carcinoma appears unaltered by cranio-orbital resection, though these latter patients form a relatively greater proportion of those surviving for more than 10 years. Further long-term follow-up is needed to see if this technique does influence survival.     

298例泪腺上皮性肿瘤临床特征及组织病理学分析

目的探讨泪腺上皮性肿瘤的临床特征与组织病理学类型之间的关系，旨在为临床提供较为可靠的诊断依据。方法回顾总结北京同仁医院眼病理室44年间（1961年～2005年1月）存档的298例泪腺上皮性肿瘤的临床及病理资料，进行统计学分析。结果298例肿瘤中，最常见的为泪腺多形性腺瘤，其它依次为腺样囊腺癌，腺癌，多形性腺癌及其它泪腺少见肿瘤。对不同类型肿瘤发病年龄、性别及眼别进行比较，差异均无显著性意义。对其发病时间进行比较，差异具有显著性意义。结论根据病史、临床表现、影像学检查，可对多数病例做出初步诊断，有助于临床医生正确选择治疗方案。     

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.     

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.