22例眼眶转移癌临床病理分析

目的探讨眼眶转移癌的临床特征和原发部位。设计回顾性病例系列。研究对象22例眼眶转移癌患者。方法分析1999～2007年武警总医院眼眶病研究所22例眼眶转移癌患者的临床、影像学和病理诊断资料。主要指标临床表现、影像学表现、病理形态学表现、原发部位。结果22例眼眶转移性肿瘤中原发肿瘤来自乳腺6例(27.3%),肺癌5例(22.7%),来源未明低分化腺癌3例(13.6%),肝癌2例(9.1%),甲状腺癌、宫颈癌、直肠类癌、下肢恶性黑色素瘤、腹膜后恶性副神经节细胞瘤及神经母细胞瘤各1例。女性13例,男性9例,平均年龄50.2岁(中位数年龄51岁,范围6～67岁)。病变位于右眼眶11例,左眼眶5例,双侧眼眶1例,同侧眼内加眶内转移2例,眶颅沟通3例。最常见的症状为视力下降、其次是眼球运动不良、眼球突出、眼痛和眼睑肿胀。10例(45.5%)眼部表现是首发症状,3例(13.6%)未找到原发灶。结论眼眶转移性肿瘤来自乳腺占第一位,其次是肺癌和来源不明的低分化腺癌。部分病例眼部症状为首发症状。(眼科,2007,16:403-406)     

眼眶病的诊断和治疗原则

眼眶病是指眶隔之后的眶骨和眶内软组织发生的疾病 ,或眶周和全身病的眼眶侵犯。眼眶病虽非常见病或多发病 ,但其种类繁多 ,与眶周及全身各系统联系密切。眼眶病的分类、临床表现、诊断及治疗均与眼球疾病有较大差异。一、眼眶病的分类[1 3 ]1.眼眶先天或发育异常 :常见为颅面骨畸形、先天性小眼球合并眼眶囊肿及脑膜 脑膨出等 ,其中以先天性小眼球合并眼眶囊肿最为多见。2 .眼眶炎性病变 :分为 3类 ,即急性炎性病变 ,如蜂窝组织炎、脓肿等 ;特发性炎性病变 ,如炎性假瘤、痛性眼肌麻痹等 ;慢性炎性病变 ,如血管炎、异物性肉芽肿及Ｗｅｇｅｎ…     

眼眶组织细胞增生症X临床分析

目的 探讨眼眶组织细胞增生症X的临床表现、影像学特征、诊断方法及治疗原则。方法 对47例(54只眼)眼眶组织细胞增生症X患者的临床症状、眼部体征、影像学检查、治疗方法及随访情况等临床资料进行分析,其中嗜酸性肉芽肿患者17例(19只眼),韩—薛—柯病患者30例(35只眼)。结果 嗜酸性肉芽肿好发于青少年,多单发于眶内。韩—薛—柯病多见于5岁以下的男性患儿,以多灶性组织细胞增生为特征,除眼眶肿瘤外,还有肝、脾、淋巴结肿大等眶外表现,典型患者具有三联征(眼球突出、尿崩症及多灶性颅骨缺失)。患者多以眼球突出、眶区发现肿块就诊。颅部X线片示颅骨多灶性缺失,B超及彩色多普勒示眶内软组织肿物,CT可同时显示眶骨缺失和软组织肿块,MRI可示眶内肿瘤及颅内受累情况。结论 特征性的影像学表现有助于组织细胞增生症X的诊断。治疗宜采用综合疗法,即在手术治疗的基础上配合局部放疗及化疗。预后与分型有关,嗜酸性肉芽肿预后最好,婴儿型组织细胞增生症预后最差。     

鼻窦源性肿瘤侵犯眼眶52例临床分析

目的 探讨侵犯眼眶的继发于鼻窦肿瘤的临床、影像学特点及治疗方法.方法回顾性分析52例侵犯眼眶的鼻窦肿瘤患者的临床表现、CT和MRI特点及治疗.结果 患者首发症状为单眼眼球突出.其中副鼻窦黏液囊肿29例,腺样囊性癌11例,鳞状上皮癌6例,其他恶性肿瘤6例.CT检查平扫25例,增强扫描5例,表现为鼻窦内形状不规则软组织肿块,眶内侧壁及眶下壁可见骨质中断,可见肿物向眶内突出,增强后肿瘤眼明显强化.MRI检查12例,均为平扫＋增强扫描,可见上颌窦或筛窦肿块与眼眶内肿块信号相等且连续.增强后肿瘤明显强化.58例全部行手术治疗.结论 鼻窦肿瘤易侵及眼眶,临床多以眼球突出为首发症状.CT、MRI检查有助诊断.多学科联合诊治,对提高鼻窦肿瘤的诊断和综合治疗水平有十分重要的临床意义.     

眼眶病常用影像学检查设备操作指南(2024)

发生于眶隔后眶骨、眶内及眶周组织的疾病或全身疾病侵犯眼眶者均属于眼眶病。眼眶病涉及的疾病类型复杂,临床表现多样,由于其病变处在眼眶及眶内而非眼球内,常规眼科光学检查对于疾病的诊断帮助有限,因此眼科影像检查技术如眼部B超、CT、MRI等成为眼眶病诊断和病情评估的最主要手段。规范眼眶病常用检查设备的操作及总结眼眶病变影像学特征,可以提高眼眶病诊疗准确性和及时性,有助于减少眼眶病的误诊和漏诊,对眼眶病的诊治具有重要意义。本指南总结了眼眶病的常用检查设备原理、操作流程及影像特征,为规范眼眶病的常用检查方法、提高基层医疗眼眶病诊断效能提供参考指南。     

11例眼眶朗格尔汉斯细胞组织细胞增多症的临床分析

目的探讨眼眶朗格尔汉斯细胞组织细胞增多症（LCH）的临床表现、影像学特征、诊断方法及治疗原则。方法对11例眼眶LCH患者的临床症状、眼部体征、影像学检查、治疗方法及随访情况等临床资料进行回顾性分析,其中嗜酸细胞肉芽肿患者7例,汉-许-克综合征患者4例。结果嗜酸细胞肉芽肿好发于青少年,多单发于眶内。汉-许-克综合征多见于5岁以下的男性患儿,以多灶性组织细胞增生为特征,典型患者具有三联征（眼球突出、尿崩症及多灶性颅骨缺失）。患者多以眼球突出、眶区发现肿块就诊。颅部x线片示颅骨多灶性缺失,B超及彩色多普勒超声检查示眶内软组织肿物,CT检查可同时显示眶骨缺失和软组织肿块,MRI检查可示眶内肿瘤及颅内受累情况。结论特征性的影像学表现有助于LCH的诊断。治疗宜采用综合疗法,即在手术治疗的基础上配合局部放疗及化疗。预后与分型有关,嗜酸细胞肉芽肿预后最好,婴儿型LCH预后最差。（中华跟科杂志．2006,42：892-895）     

眼眶肿瘤的手术治疗探讨

目的 探讨眼眶肿瘤的种类、手术进路、治疗效果及并发症.方法 对我院2004～2005年收治的眼眶肿瘤45例（45眼）的临床表现、影像检查和治疗方法进行分析.结果 45例眼眶肿瘤中囊肿12例,海绵状血管瘤10例,静脉性血管瘤6例,泪腺多形性腺瘤5例,神经鞘瘤、非霍奇金淋巴瘤各3例,泪腺腺样囊性癌2例.视神经胶质瘤、视神经鞘脑膜瘤、神经纤维瘤及眼眶骨瘤各1例.45例均进行手术摘除,其中前路开眶32例,外侧开眶9例,经筛窦内侧开眶2例,外侧结合内侧开眶1例,经颅开眶1例.术后6个月复查上睑下垂2例,瞳孔改变3例,眼球运动受限2例.结论 眼眶肿瘤的临床表现具有多样性;大多因眼球突出而就诊;影像学检查显示多种形状的占位性病变,治疗方法以手术为主,注意手术技巧和术式的选择可以防止复发和出现并发症.     

眼眶绿色瘤临床分析

目的 总结眼眶绿色瘤的临床表现、诊断方法及治疗原则。方法 回顾性系列病例研究。收集临床诊断为眼眶绿色瘤患者的病例资料17例,对其临床症状、眼部体征、影像学检查、诊断、治疗及预后进行分析。结果 眼眶绿色瘤好发于男性,多见于14岁以下青少年和儿童,多以眼球突出、眶区肿物就诊。B超检查16例,主要表现为位于眶外上和外下方的形状不规则肿物,边界清楚,呈低回声。彩色多普勒血流显像5例,主要表现为病变内丰富的红蓝血流信号。CT扫描11例,主要表现为位于外上或外下方、形状不规则、边界清楚肿物,密度均匀,少有骨破坏。实验室检查17例,多伴白细胞增高,血涂片可见大量幼稚细胞的血液系统改变。16例病例确诊后转儿科或血液科进行化疗,有随访资料者4例,其中2例3个月后死亡。结论 眼眶绿色瘤易误诊为横纹肌肉瘤等儿童时期眼眶恶性肿瘤,确诊需结合多种影像学检查及全身血液学检查,治疗以放、化疗为主。     

眼外肌内肿瘤的诊断治疗及预后分析

目的 了解眼外肌内肿瘤的种类、临床表现及诊治方法.方法 回顾性系列病例研究.收集经病理学确诊的11例眼外肌内肿瘤患者资料,分析其临床表现、影像学征象、治疗与预后情况.结果 眼外肌内肿瘤病种包括:纤维瘤病3例,肌间血管瘤和颗粒细胞瘤各2例,横纹肌肉瘤、转移性腺癌、淋巴瘤和炎性肌纤维母细胞瘤各1例.眼球运动障碍、眼球突出和移位是其常见体征.CT和MRI等影像学检查可显示肌肉形态改变,肌肉可呈梭形、球形和不规则形增粗,直径均超过1 cm.累及下直肌、内直肌、外直肌和下斜肌.根据累及肌肉的不同采用不同手术进路.病理结果是制定治疗方案的依据.结论 眼外肌内肿瘤病种多样,临床表现和影像学检查有特征性,应积极活检明确病理诊断,预后与治疗方案的选择以及肿瘤性质有关.(中华眼科杂志,2009,45:56-60)     

眼眶肿瘤眼球突出952例

目的 探讨眼眶肿瘤致眼球突出的临床特征及相关因素。方法 总结门诊住院的眼眶肿瘤致眼球突出患者952例,分析临床表现及影像学检查。结果 952例眼球突出患者中发病较多依次为血管性肿瘤、神经源性肿瘤及泪腺肿瘤等。眼球突出度较正常眼突出2－7mm者最多。突出方向以轴性突出和前下方突出为主。结论 在眼眶肿瘤中血管性肿瘤、神经源性肿瘤及泪腺肿瘤是最常见致眼突的原因。眼突度多为2－7mm ,以轴突及前下方为多,眶内肿瘤和眼腔容积的改变均影响眼球位置。     

Metastatic orbital tumors in Japan: a review of the literature

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2-3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.     

Tumors metastatic to the orbit

A review of 35 consecutive cases of tumors metastatic to the orbit revealed that the primary tumor site was breast in 18 cases (51%), prostate in 6 cases (17%), lung in 2 cases (6%), gastrointestinal tract in 2 cases (6%), kidney in 1 case (3%), cutaneous melanoma in 1 case (3%), contralateral choroidal melanoma in 1 case (3%), and unknown in 4 cases (11%). The most common presenting signs and symptoms included diplopia with noncomitant strabismus, proptosis, and a palpable mass. In nine cases (26%), the orbital metastasis was detected in patients with no prior history of cancer. The average patient survival after the diagnosis of orbital metastasis was 13 months. Orbital metastasis from lung carcinoma carried the worst prognosis, with an average survival time of only 4 months. A summary of the clinical features of these 35 cases and a review of the literature on orbital metastatic disease will be presented.     

Unklare Papillenschwellung

Orbital metastases occur in 2–5 % of cancer patients. Common primary sites that cause orbital metastases are breast, lung and prostate cancer. In up to 25 % of patients orbital metastasis is the initial sign of an unknown primary tumor. Clinical symptoms are proptosis, ocular motility disorder and visual impairment. Imaging procedures may be useful in diagnosing orbital metastases but are not specific. Treatment is palliative. Radiotherapy, chemotherapy and surgical debulkment in selected patients are treatment options.     

Metastatic tumors of the orbit and ocular adnexa

PURPOSE OF REVIEW: The management of cancer metastatic to the orbit and ocular adnexa (eyelid and periocular structures) has changed in recent decades. The purpose of this article is to review the incidence, presentation, and clinical features of metastatic tumors of the orbit and ocular adnexa and discuss their multidisciplinary care. RECENT FINDINGS: The improved survival of patients with common cancers such as breast cancer and prostate cancer, together with aging of the population has led to a higher incidence of patients living with metastatic disease in unusual sites such as the orbit and ocular adnexa. Furthermore, vigilant surveillance and advances in diagnostics have led to increased detection of orbital metastases. Treatment of metastatic lesions in the orbit and ocular adnexa is usually palliative and may include radiotherapy, chemotherapy, hormonal therapy, surgery, or a combination of these modalities. SUMMARY: Breast carcinoma continues to account for the majority of metastatic lesions of the orbit and ocular adnexa. Although the overall prognosis for patients with such lesions remains poor, the longer survival time for patients with breast carcinoma, the availability of novel targeted treatment options and new investigational agents, and advances in radiotherapy techniques may lead to better quality of life and preservation of ocular function for patients with metastatic orbital tumors.     

Metastatic breast carcinoma of the orbit

Two Caucasian females in whom an orbital mass was the first sign of metastasis from a breast carcinoma are described. Each subject had undergone a radical mastectomy to treat a primary breast carcinoma, one six years and the other eight years previously. Each presented with ipsilateral proptosis, and restricted upper eyelid action; one had altered ocular motility. In each subject an open biopsy of the orbital mass via an eyelid crease incision revealed metastatic scirrhous adenocarcinoma of the breast. The clinical features, investigations, and treatment of orbital metastases from breast carcinoma are discussed.     

Metastatic breast carcinoma of the orbit

Abstract
Two Caucasian females in whom an orbital mass was the first sign of metastasis from a breast carcinoma are described. Each subject had undergone a radical mastectomy to treat a primary breast carcinoma, one six years and the other eight years previously. Each presented with ipsilateral proptosis, and restricted upper eyelid action; one had altered ocular motility. In each subject an open biopsy of the orbital mass via an eyelid crease incision revealed metastatic scirrhous adenocarcinoma of the breast. The clinical features, investigations, and treatment of orbital metastases from breast carcinoma are discussed.     

Cutaneous malignant melanoma metastatic to the eye, lids, and orbit

The incidence of malignant cutaneous melanoma is increasing faster than any other cancer. Thus, it will become an increasingly common source of metastatic disease to the eye, lids, and orbit. Herein, we have performed a systematic review of previously published cases including patient characteristics, clinical presentation, diagnostic techniques, current treatments, and outcomes. At the time of ocular diagnosis, nearly all reported patients had a known history of cutaneous melanoma and synchronous non-ocular metastases. Several aspects help in differentiating the tumors from primary uveal melanomas such as the presence of symptoms, rapidly growing multifocal tumors, vitreous seeding, and histopathological findings. Intraocular metastases (uvea, vitreous, retina, and anterior-segment) are more common and occur in younger patients than extraocular metastases (eyelids, orbit, and extraocular muscles). Palliative radiation therapy is often used for intraocular disease. Orbital metastases from cutaneous melanoma commonly involve the extraocular muscles resulting in diplopia and exophthalmos. The mainstays of extraocular treatment are surgical resection and radiation therapy. Unfortunately, there are few good options for systemic treatment of diffusely metastatic melanoma. Therefore, patients with ocular metastasis should be managed to prevent loss of vision or loss of the eye, and to maximize their quality of life.     

65例眼眶转移性肿瘤原发病灶的回顾性分析

目的 研究眼眶转移性肿瘤的原发疾病种类、临床特征及预后。设计 回顾性病例系列。研究对象 2005-2017年解放军第三医学中心经病理学确诊的眼眶转移性肿瘤患者65例。方法 回顾分析患者的临床资料。主要指标 性别、年龄、眼别、原发肿瘤部位。结果 65例患者中，男性38例。就诊时中位数年龄46岁（0.6~83岁）。右眼26例，左眼29例，双眼10例（神经母细胞瘤3例、白血病3例、乳腺癌3例、胃肠道肿瘤1例）。肿瘤原发部位分别为乳腺12例、肺部11例、白血病10例、肾上腺8例、胃肠道6例、肝脏4例、肾脏2例、胸腺2例，膀胱、前列腺、子宫、关节、皮肤各1例，5例来源不明。成年人原发肿瘤较多的为乳腺癌、肺癌和胃肠道肿瘤。结论 本研究中眼眶转移性肿瘤患者年龄分布较广，成年人前三位原发肿瘤为乳腺癌、肺癌和胃肠道肿瘤。（眼科， 2020, 29： 396-399）     

The characteristics of the clinical picture of lymphosarcoma and of a metastatic tumor of the orbit of another origin

Clinical symptoms in patients with primary orbital lymphosarcoma, generalized lymphosarcoma involving the orbital tissues, and metastatic tumors of the orbit of another origin are analyzed. The orbital process has bee studied in 158 patients. The most frequent symptoms were ptosis and exophthalmos. Decreased visual acuity, pain, sensation of swelling in the orbit caused by rapid tumor growth were characteristic of metastases to the tumor and orbital lymphosarcoma in total system's involvement. In case of an isolated involvement of the orbit, lymphosarcoma ran a more swift course than metastases to the orbit and orbital lymphomas in systemic involvement which ran an aggressive course. These data cannot serve as differential diagnostic signs. The decisive information is provided by morphological examination of a biopsy specimen.