眼眶软组织肿瘤455例临床病理观察

目的：探讨眼眶软组织肿瘤临床病理特征。

方法：回顾性分析我院2003-11/2018-11眼眶软组织肿瘤患者455例的病例资料,观察其临床特点、病理分类和少见肿瘤的病理学特征。

结果：眼眶软组织肿瘤患者455例中,良性肿瘤421例(92.5%),居于前5位的依次为海绵状血管瘤258例、毛细血管瘤58例、神经纤维瘤16例、纤维瘤15例和神经鞘瘤14例; 中间型27例(5.9%),其中孤立性纤维性肿瘤(SFT)23例、低度恶性纤维组织细胞瘤2例、低度恶性黏液性神经纤维瘤2例; 恶性7例(1.5%),其中眼眶恶性SFT者2例,眼眶髓系肉瘤(MS)2例,黏液样脂肪肉瘤(MLS)、梭形细胞未分化肉瘤和外周原始神经外胚叶肿瘤(PNET)各1例。对部分病例进行免疫组化和分子检测,结果发现新抗体如STAT6和分子检测技术的应用能提高诊断准确性。

结论：眼眶软组织肿瘤中,良性肿瘤占大部分,脉管肿瘤中的海绵状血管瘤居于首位,不乏眼眶部位少见软组织肿瘤病理学类型如Erdheim-Chester病(ECD)、砂粒体性骨化性纤维瘤(POF)、平滑肌瘤和黏液瘤等; 中间型和恶性肿瘤少见,眼眶部位SFT、MLS、梭形细胞未分化肉瘤和MS等少见的病理学类型常诊断困难,容易漏诊误诊,新型免疫组化抗体和分子检测技术能提高诊断的准确率。     

眼附属器孤立性纤维性肿瘤35例临床病理学分析

目的探讨眼附属器孤立性纤维性肿瘤(SFT)的临床病理学特点及预后。方法回顾性病例系列研究。收集天津市眼科医院2000年1月至2020年12月收治的35例眼附属器SFT患者的临床和组织病理学资料, 总结并分析患者的病史、影像学、组织病理学和免疫组织化学染色的特征、分型及治疗方法, 并对患者进行随访。依照2013年世界卫生组织对SFT的诊断和分类标准, 对所有患者进行病理学分类。结果 35例患者中, 男性21例(60.0%)、女性14例(40.0%);均为单眼发病, 其中右眼23例(65.7%), 左眼12例(34.3%)。年龄44(35, 54)岁, 范围为17～83岁。病程12(6, 36)个月, 范围为2个月至11年。临床表现包括眼球突出、眼球转动受限、复视及流泪等。肿瘤可发生于眼眶任何部位, 以眶上部多见(19例, 73.1%)。所有患者均手术完整切除肿物。影像学检查, 肿瘤显示边界清楚的占位性病变, 增强扫描后呈不均匀强化, 肿瘤内含有丰富的血流信号。MRI检查显示加权成像T1WI呈等或稍低信号, 加权成像T2WI信号显著增强, 呈中高混杂信号。肿瘤长径2.1(1.5, 2.6)...     

眼眶巨大血管外皮细胞瘤/孤立性纤维瘤1例

血管外皮细胞瘤(hemangiopericytoma,HPC)/孤立性纤维性肿瘤(solitaryfibroustumor,SFT)原发于眼眶者少见,其超微结构和免疫组织化学检查介于典型的HPC和SFT之间。我科遇到1例眼眶巨大HPC/SFT病例,结合文献复习,对其形态学特点、免疫组化表达及生物学行为,尤其是HPC和SFT的关系进行了研究,现报道如下。患者男73岁因右眼眶肿块伴右眼进行性突出3y余、视力丧失1y、眼球破溃6个月,于2005年6月9日因晕厥来院。血压60/40mmHg,Hb:72g/L,RBC:2.33×10.12/L,无头痛,头胀。以右眼眶巨大肿瘤,慢性失血收入院。既往在发现右眼球突出6m时于…     

眼眶孤立性纤维瘤12例临床影像学分析

目的：探讨眼眶孤立性纤维瘤(SFT)的彩色多普勒超声及磁共振成像(MRI)特点。

方法：回顾性病例研究。收集2013-04/2018-08天津医科大学眼科医院收治的12例眼眶SFT患者的临床资料,均行彩色多普勒超声和MRI平扫、增强及动态增强检查,分析其临床影像学特点。

结果：纳入的12例患者中男7例,女5例,病程3mo～20a(平均3.2±5.2a),6例为首次发病,6例为复发病例; 均为单眼发病,其中左眶8例,右眶4例。肿瘤位于眼球后肌锥间隙内5例,肌锥间隙外3例,跨肌锥间隙内、外4例; 肿瘤形状呈卵形9例,不规则形3例,边界均清晰。超声表现为低回声10例,不均匀回声2例; 12例彩色多普勒血流显像(CDFI)均可见血流信号,阻力指数(RI)平均值0.70,PW均测得动脉频谱。MRI表现在T1WI均呈等信号; T2WI呈低信号 5例,等信号3例,中高信号4例,内部信号均匀9例,不均匀3例; 增强后12例均呈显著强化,10例均匀强化,2例不均匀强化。动态增强扫描的时间-信号强度曲线(TIC)7例为速升平台型,5例为速升速降型。

结论：眼眶SFT在彩超显示低回声、富血供的实体瘤,MRI提示T1WI呈等信号,T2WI信号混杂,增强后显著强化,动态增强TIC曲线以速升型为主的特征性表现对诊断具有重要意义。     

头颈部肿瘤的术中放疗

术中放疗是治疗恶性肿瘤的方法之一.身体深部的肿瘤通过采用术中放疗,使治疗射线针对暴露的肿瘤或肿瘤床,同时牵拉开周围可动的软组织,从而保护肿瘤周围的正常组织免受照射.国内未见头颈部肿瘤术中放疗的报道,本文就近10年来头颈部肿瘤术中放疗的情况作一综述.     

头颈部肿瘤术后心功能不全的防治

目的探讨头颈部肿瘤术后心功能不全的发病原因,并提出防治措施.方法回顾总结73例头颈部肿瘤术后的病例情况.结果有6例并发心功能不全,发生率8.22%(6/73),严重者导致死亡1例.结论随着头颈部肿瘤手术的发展和增多,术后对患者的电解质、感染控制情况、心功能等各方面要引起足够的重视.     

眼眶孤立性纤维瘤1例

患者男,50岁,农民.左眼球鼻侧发红,出现肿块一年.病史回顾:发病初于当地医院就诊,诊断为"左眼翼状胬肉",未予特殊处理.     

肿瘤凋亡抑制蛋白-Survivin与头颈部肿瘤

Survivin是凋亡抑制蛋白家族的新成员,Survivin具有肿瘤特异性,只表达于肿瘤和胚胎组织,且与肿瘤细胞的分化增殖及浸润转移密切相关.并可能成为肿瘤靶相治疗的一个良好的靶基因蛋白.本文综述了Survivin的生物学特性及其与肿瘤浸润转移的关系,着重阐述了其在头颈部肿瘤中的表达及意义,并提出了目前存在的问题与展望.     

孤立性脉络膜血管瘤的临床疗效观察

目的：探讨孤立性脉络膜血管瘤的治疗疗效。方法：回顾性分析24例孤立性脉络膜血管瘤的临床资料。24例中，男17人，女7人，平均年龄43．29岁。全部患者均存在渗出性视网膜脱离，其中，6眼视网膜脱离为移动性。患者首选激光治疗，激光治疗无效并存在移动性视网膜脱离者行巩膜外冷冻治疗。患者平均随访21．17月。结果：无移动性视网膜脱离的18眼，激光治疗后视力稳定或提高者占94．5％。瘤体表面仍有少量液体残存的共有3眼(12．5％)均为黄斑中心下的血管瘤。有移动性视网膜脱离的6眼最终均行冷冻治疗，冷冻术后周边液体吸收，5例视力下降。结论：位于黄斑下的及伴有移动性视网膜下液的脉络膜血管瘤预后差。     

Correlation between Clinical Features,Imaging and Pathologic Findings in Recurrent Solitary Fibrous Tumor of the Orbit

Abstract

Purpose: To correlate clinical features, imaging and pathologic findings in recurrent Solitary Fibrous Tumor of the orbit (SFT) in order to predict long-term behavior.

Methods: Clinical features, imaging and pathologic findings of three patients with biopsy proven SFT are reported. Demographic and clinical features were recorded at presentation and at each consultation; imaging was performed as a diagnostic tool and for follow-up. A biopsy was performed at presentation and subsequently when symptoms worsened. Pathology specimens were reviewed retrospectively to corroborate diagnosis. Intraoperative and histopathologic features were recorded. A correlation was made between clinical, imaging and pathologic results to identify outcome predictors of recurrence, locally aggressive behavior and malignant transformation.

Results: All cases presented recurrent tumors with locally aggressive behavior over time. All were women in the fifth decade of life. Tumors induced proptosis, swelling of the lids and eye displacement at presentation and were diagnosed as other types of collagen-rich tumors before CD34 immunohistochemistry was available. Mean follow-up was 26.6 years (range 12–37). Relevant findings for all cases included a heterogeneous, irregular tumor containing cystoid spaces filled with mucoid material diffusely enhancing with imaging techniques. Intraoperative findings included a gelatinous matrix within the center of the tumor mass, which was not present at primary resection. Histopathology could not detect specific cellular patterns or immunological markers related to these changes.

Conclusions: Recurrence and locally aggressive behavior was better predicted by imaging and surgical findings rather than histopathological characteristics. Cystoid degeneration in recurrent tumors may suggest malignant transformation over time.     

Solitary Fibrous Tumor of the Orbit: A Case Series

Purpose: Solitary fibrous tumor (SFT) occurs rarely in the orbit. We present four such cases, representing one of the largest case series reported to date of this rare orbital tumor. Method: The four patients ranged from ages 20 to 50, all of whom presented with lid swelling or bulging in the involved eye. All four patients underwent CT scan to confirm the diagnosis of an orbital mass, which was then excised. Results: The tumors of all four specimens contained spindle-shaped cells with bland nuclei and rare mitotic figures. They all stained positively with CD34 and vimentin. Resection margins were positive in two of the four cases. One of these cases demonstrated residual tumor on follow-up CT scan, which remained unchanged at one-year follow-up. No evidence of residual tumor was found in the other three cases, despite one having malignant pathology. Conclusion: SFT is a rare and generally benign tumor of the orbit. Immunohistochemical testing with CD34 is necessary to confirm the diagnosis. Although en bloc tumor resection is the definitive treatment, residual tumor may remain stable for some time. However, this must be followed closely if complete resection is not carried out.     

Atypical Presentation of a Case of Solitary Fibrous Tumor of the Orbit

Purpose: To describe a rare case of solitary fibrous tumor of the orbit in a child, clinically misdiagnosed as arterious hemangioma. Methods: A nine-year-old child presented a hard-elastic palpable mass located in the right inferotemporal orbit. Computed tomography, orbital pulsed-wave Doppler and internal carotid artery angiography consented diagnosis of high-vascularization mass probably related to arterious hemangioma with feeder vessel arising from a branch of ophthalmic artery. The orbital mass was surgically removed. Results: The histological examination showed mesenchimal tumor, CD34 positive, related to solitary fibrous tumor of the orbit. Conclusions: Solitary fibrous tumor of the orbit should be considered in the differential diagnosis of arterious hemangioma.     

重视头颈部肿瘤气管旁及上纵隔淋巴结的处理

头颈部恶性肿瘤的颈淋巴结转移一直是临床研究的热点,影响预后的关键因素是有无局部复发和淋巴结转移,正确的颈廓清术对防止肿瘤转移,提高患者的生存率和生存质量有重要意义,不断学习和掌握有关头颈肿瘤患者颈廓清术的新观念和新技术十分必要。     

头颈外科进展

耳鼻咽喉科发展到耳鼻咽喉-头颈外科已经有50余年,现代科学技术的发展为该学科提供了新的机遇和挑战。近年来新技术和新理论的不断涌现,内镜技术的普及,微创外科的开展,三维螺旋CT、MRI及影像导航系统的应用,以及分子生物学等基础学科的发展,使耳鼻咽喉一头颈外科成为医学领域发展最为迅速的学科之一。     

深圳市头颈外伤10年住院病例回顾性调查

目的 了解深圳市头颈外伤的流行病学特点,为防控措施提供决策依据.方法 回顾性抽样调查1994年1月至2003年12月深圳市各级医院因头颈外伤住院的患者病历,采用统一的调查表,由专门培训的统计员进行填表调查.结果 共调查到7 974份住院病历,头颈外伤发生率呈逐年上升趋势,2003年的发生率(63.00/10万)是1994年发生率(37.17/10万)的1.7倍;患者中男女比例为3.9∶1;21～40岁年龄段的青壮年最多(占63﹪),其次是11～20岁年龄段的青少年(占14.79﹪);特区外发生率明显高于特区内;交通事故、治安事件及工伤是外伤的前3位原因;头颈外伤中最易受伤部位是眼及面颊部,多为软组织损伤;患者首先就诊的医院是乡镇及区级医院;3.46﹪的患者费用来自社会基本医疗保险.结论 头颈外伤给深圳市带来的公共卫生问题和社会、经济负担不容忽视,应针对重点人群、多部门合作地进行综合防控,医疗资源的配置应适应头颈外伤的流行分布特点.