常见泪腺上皮性肿瘤中EGFL7的表达及其与血管生成和细胞增殖活性的相关性研究

目的：检测常见泪腺上皮性肿瘤中类表皮生长因子结构域 7(EGFL7)、微血管密度(MVD)、Ki67的表达,探究EGFL7与MVD、Ki67之间的相互关系。

方法：应用免疫组化法,对10例正常泪腺组织(取自因炎性假瘤、Mikulicz病等良性泪腺肿瘤切除后,标本中的部分正常泪腺组织)、20例泪腺多形性腺瘤、12例多形性腺癌、14例腺样囊性癌组织中的EGFL7蛋白、Ki67进行检测,并应用CD34标记计数MVD。

结果：EGFL7主要在泪腺多形性腺癌、腺样囊性癌的肿瘤细胞的细胞浆中表达,免疫组化染色结果显示,在正常泪腺组织中EGFL7无阳性表达,泪腺多形性腺瘤组织中EGFL7的阳性率为5%(1/20),泪腺多形性腺癌中EGFL7的阳性表达率83%(10/12),泪腺腺样囊性癌中EGFL7的阳性表达率为86%(12/14),两种恶性肿瘤中的表达率明显高于多形性腺瘤和正常泪腺组织(P<0.001)。CD34可使肿瘤微血管染色呈棕黄色的单个或成簇细胞群。在泪腺多形性腺癌(32.58±14.46)及腺样囊性癌(43.43±4.60)中CD34的表达明显高于多形性腺瘤(4.20±1.19)(P<0.001); Ki67在具有增殖活性的细胞核呈棕褐色着色,在泪腺多形性腺癌(44.83±13.68)及腺样囊性癌(26.29±8.44)中Ki67的表达明显高于多形性腺瘤(2.80±3.14)及正常组织(0.40±0.70)(P<0.001)。在两种恶性肿瘤中EGFL7的表达分别与MVD、Ki67呈明显正相关(r_s=0.897,P<0.001; r_s=0.837,P<0.001)。

结论：EGFL7在泪腺上皮性肿瘤中的表达与MVD、Ki67呈正相关性,提示EGFL7不仅在泪腺上皮性肿瘤血管生成中起重要作用,而且参与泪腺上皮性肿瘤的增殖。     

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。     

眼眶占位性病变36例手术分析

目的探讨眼眶占位性病变的临床诊断，手术治疗及其组织病理学分类。方法对2004年1月～2006年5月手术治疗的36例（36眼）眼眶占位性病变的性别、年龄、眼别及病理检查结果进行分析。结果恶性肿瘤3例，良性病变33例。组织病理学检查：恶性肿瘤3例均为非何杰金氏淋巴瘤；良性者中海绵状血管瘤9例，泪腺多形性腺瘤8例，静脉性血管瘤3例，炎性假瘤3例，囊肿3例，皮脂腺囊肿2例，淋巴管瘤、视神经胶质瘤、神经纤维瘤、骨瘤及颗粒细胞瘤各1例。在泪腺多形性腺瘤中浸润性生长3例，恶变1例。结论眼眶占位性病变种类繁多，良性肿瘤中以海绵状血管瘤多见，可采用前路开眶或外侧壁开眶顺利摘除肿瘤，次为泪腺多形性腺瘤，并且容易因手术切除不彻底或术中肿瘤破碎残留肿瘤细胞而改变生长方式，甚至于恶变。炎性假瘤手术完整切除较难，多要进一步作术后治疗。神经源性肿瘤早期就对视力损伤较大。     

Pleomorphic adenoma of the lacrimal gland: A review with updates on malignant transformation and molecular genetics

Pleomorphic adenoma (benign mixed tumor) is the most common epithelial neoplasm of the lacrimal gland. It is usually a slow growing, well-circumscribed, mass that is identical to its salivary gland counterpart. Patients generally have an excellent prognosis for vision and long-term survival after complete surgical excision. There is a tendency to reoccur, especially if there is an incomplete excision, and rarely, malignant transformation to carcinoma ex pleomorphic adenoma can occur, which has a much poorer prognosis. The molecular genetics of lacrimal gland pleomorphic adenomas have only recently been studies, but appear to display similar genetic aberration found in the salivary gland counterparts.     

Carcinosarcoma of the lacrimal gland arising from a pleomorphic adenoma

PURPOSE: To report a case of the lacrimal gland tumor diagnosed as carcinosarcoma (true mixed tumor) arising from a pleomorphic adenoma. DESIGN: Interventional case report. METHODS: An 80-year-old Japanese woman was referred with a well-circumscribed tumor in the lacrimal fossa. RESULTS: The tumor was excised, but the deepest portion remained because of heavy bleeding. Histopathologically, the tumor consisted of osteosarcomatous cells. No epithelial or myoepithelial component was identified by immunohistochemistry. Two months later, the tumor progressed further and was excised completely with lateral orbitotomy. The tumor consisted primarily of osteosarcomatous component but also had epithelial components including carcinoma and pleomorphic adenoma. Examinations did not detect local recurrence and metastasis at 10 post-operative months. CONCLUSION: The tumor was diagnosed as true carcinosarcoma of the lacrimal gland arising from a pleomorphic adenoma. When lacrimal gland tumors containing sarcomatous components are encountered, carcinosarcoma should be included in the differential diagnosis.     

Epithelial lacrimal gland tumors: A comprehensive clinicopathologic review of 26 lesions with radiologic correlation

Aim

To study the prevalence, clinicopathological and radiological correlations of epithelial lacrimal gland tumors and compare these with similar published literature. The study was also designed to look at the natural history of benign mixed tumors (BMT) in regard to recurrence and malignant degeneration.

Methods

This was a retrospective study of all suspected epithelial tumors of the lacrimal gland surgically excised at King Khaled Eye Specialist Hospital (KKESH) for the period: 1983–2008. Exclusion criteria included structural lesions (dacryops) and inflammatory lesions. We included 26 cases of epithelial lacrimal gland tumors (from 24 patients). The histopathologic slides and the radiologic findings were reviewed. The corresponding demographic and clinical data were obtained by chart review using a data sheet.

Results

BMT accounted for 12/26 of the lesions while malignant lesions including adenoid cystic carcinoma (ACC) were more common (14/26). The mean age was 44.27 years (range 12–75). Commonest clinical presentation was proptosis. Median duration of symptoms in the BMT cases was 30 months and 7 months in the ACC group. The 12 BMT cases were primary in 9 and recurrent in 3 patients. The 11 ACC cases showed mostly cribriform pattern and low histopathologic grade. We had 2 cases of malignant mixed tumor (MMT) one of which arising in a recurrent tumor. One case of primary mucoepidermoid carcinoma with histopathologic grade 2 was noted. Radiologically, a well-defined appearance with bone remodeling was observed in BMT in contrast to invasive appearance with destruction in malignant lesions.

Conclusion

Our series information indicated a different distribution of benign and malignant epithelial lesions with a slightly higher rate of malignancy. BMT was the commonest benign tumor where recurrence was a squeal of incomplete surgical excision. ACC was the commonest malignant tumor with shorter duration of symptoms and radiologic evidence of invasiveness that correlated with the histopathologic features.     

1921例眼眶肿瘤的组织病理分类

对本院收检的１９２１例眼眶肿瘤进行组织病理分类，对有代表性的肿瘤，容易误诊的肿瘤及眼眶的罕见肿瘤进行讨论。对本文包括的所有病例及病理切片进行复查，疑难及争议病例进行讨论，并采用特殊染色，免疫组化等手段加以证实。恶性肿瘤的前５位：泪腺恶性肿瘤１３８例（３２％），泪囊恶性肿瘤１１２例（２６％），横纹肌肉瘤６５例（１５％），淋巴肉瘤５６例（１３％），血管外皮肉瘤３１例（７％），良性肿瘤前５位为：窦性血管     

Pleomorphic adenomas of the lacrimal gland: a clinicopathological analysis

PURPOSE: To analyse retrospectively 32 cases of pleomorphic adenoma of the lacrimal gland diagnosed over a 10-year period in a tertiary referral eye centre from North India. METHODS: The clinical features of 32 cases of pleomorphic adenomas diagnosed between 1991 and 2000 were analysed and the histopathological features reviewed light microscopically. RESULTS: Among the clinical features, a marked male predominance with younger age of presentation and left-sided dominance was noted. The duration of symptoms was less than 10 months in 28% cases. Histopathologically, the features included presence of cystic degeneration (15.6%) and squamous metaplasia (18.7%). Calcification, osteoid formation and malignant transformation (3.1% each) were occasionally observed. CONCLUSIONS: Pleomorphic adenomas of the lacrimal gland may present with duration of symptoms of less than 10 months. Cystic degeneration, squamous metaplasia, calcification or ossification may be observed in lacrimal gland pleomorphic adenomas, as has been described in pleomorphic adenomas of salivary glands. However, the presence of calcification and bone erosion radiologically in a lacrimal gland tumour does not necessarily indicate malignancy.     

1492例眼眶占位性病变临床病理学分析

目的探讨北京同仁医院眼科中心眼眶占位性病变的疾病谱系和发病情况。设计回顾性病例系列。研究对象自1997年1月至2006年12月间北京同仁医院眼科中心病理室存档的1492例眼眶占位性病变。方法分析1492例眼眶占位性病变的临床病理资料,基本情况包括患者的年龄、性别及肿物的病理诊断。主要指标眼眶占位性病变的疾病谱系和发病情况。结果眼眶占位性病变依据组织来源主要分为15大类:囊肿性病变、脉管性病变、周围神经病变、视神经和脑膜病变、纤维组织病变、骨和软骨病变、脂肪组织病变、肌组织病变、泪腺病变、炎性病变、色素性病变、转移性肿瘤、淋巴增生性病变、继发性肿瘤、白血病和组织细胞系统病变、其它病变。其中良性病变1318例(88.3%),恶性病变174例(11.7%)。位于良性病变前5位的分别是皮样囊肿及表皮样囊肿、海绵状血管瘤、淋巴管瘤、泪腺混合瘤、慢性炎症和炎性假瘤;位于恶性肿瘤前5位的分别是淋巴瘤、泪腺囊腺癌、横纹肌肉瘤、黑色素瘤、皮脂腺腺癌。结论眼眶占位性病变涉及不同组织来源的病变。横纹肌肉瘤是儿童最常见的眶内恶性肿瘤,淋巴瘤是老年人最常见的眶内恶性肿瘤。(眼科,2007,16:398-402)     

泪腺腺样囊性癌临床治疗进展

泪腺腺样囊性癌(adenoid cystic carcinoma,ACC)是最常见的泪腺恶性上皮肿瘤,单纯手术切除疗效不满意,易复发,预后差。我们总结近年来国内外报道的相关泪腺ACC的临床综合治疗手段,包括改进手术入路、采取手术前后化学治疗、放射治疗等综合治疗方案,特别还报告了青年泪腺ACC患者的治疗策略,并分析了原发于泪腺以外ACC的诊断与治疗,为眼科临床医生提供更广阔的思路。     

泪腺上皮性肿瘤113例临床病理学分析

目的 探讨泪腺上皮性肿瘤组织病理学类型和临床特征.方法 回顾性病例研究重新复习天津眼科医院病理科自1980年至2009年间收检的113例泪腺上皮性肿瘤的临床和病理学资料,参照WHO关于唾液腺肿瘤的分类和诊断标准,分析泪腺上皮性肿瘤的类型和临床病理学特点.结果 113例泪腺上皮性肿瘤中,多形性腺瘤73例(64.6%),腺样囊性癌23例(20.4%),癌在多形性腺瘤中9例(8.0%),其他类型的上皮性肿瘤均为恶性,共8例(7.0%).结论 泪腺上皮性肿瘤有不同的病理类型,其临床特点、治疗和预后有很大区别,正确和详细的病理诊断可对临床治疗起到指导意义.     

回顾191例泪腺占位性病变临床分析及术后随访观察

目的：探讨191例泪腺占位性病变的临床特点及术后随访情况。

方法：选取2011-01/2015-08我科收治的191例221眼泪腺占位患者,总结其临床特征,并结合病史、影像、病理资料、地域特色进行分析。所有患者行泪腺肿瘤摘除,术后随访1a。

结果：患者191例221眼中,男44例49眼,女147例172眼。炎症性病变171眼,依次是IgG₄硬化性泪腺炎66眼、慢性泪腺炎27眼、泪腺脱垂伴炎性肿大54眼、Grave''s病24眼。淋巴组织增生性病变16眼,依次是恶性淋巴瘤6眼、良性淋巴组织增生10眼。上皮性病变34眼,依次是多形性腺瘤26眼、多形性腺癌2眼、腺样囊性癌3眼、腺癌3眼。泪腺占位性病变以IgG₄硬化性泪腺炎、泪腺脱垂伴炎性肿大多见,其中汉族159眼、维族36眼、哈萨克族16眼、蒙古族10眼。手术后主要表现为眼部干涩,哭时无泪,以双侧泪腺摘除者明显,但局部使用人工泪液可以缓解,无严重不良反应。

结论：病史及影像特点对泪腺占位性病变的诊断和鉴别诊断有很大的帮助,新疆地区泪腺占位,以非上皮性病变最为常见,其次是上皮性病变,多发生于汉族、维族患者,而其它民族少有发生,手术后眼部干涩及哭时无泪为主要症状。对病程短且有干眼倾向的患者需延迟摘除。     

原发性泪腺上皮性肿瘤患者97例诊治分析

目的　探讨泪腺上皮性肿瘤的临床表现、影像学特征、诊断方法及治疗原则。方法　对２００３年１月至２０１４年１０月在河南省眼科研究所就诊的９７例泪腺上皮性肿瘤的临床表现、影像学检查、治疗方法、术后视力、及随访情况等临床资料进行回顾性分析。采用前路开眶１１例,常规外侧开眶１９例,改良“Ｓ”形皮肤切口并外侧开眶６７例。结果　９７例泪腺上皮性肿瘤中,泪腺多行性腺瘤６５例（６７．０１％）,腺样囊性癌１６例（１６．４９％）,多形性腺癌１２例（１２．３７％）,腺癌２例（２．０６％）,黏液表皮样癌１例（１．０３％）,肌上皮瘤１例（１．０３％）。术后视力提高３７例,无变化５４例,下降６例。１３例出现眼球内陷,早期上睑下垂１１例,４例出现外展运动受限、水平复视。术后６个月随访:上睑下垂４例;１例出现永久性外展不足、水平复视。结论　泪腺上皮性肿瘤具有典型的临床表现和特征性的影像学改变,术前通过准确的定位来选择适宜的手术进路,可顺利并完整地切除肿瘤,避免肿瘤复发和出现严重并发症。     

泪腺肿瘤38例临床分析

目的：分析泪腺肿瘤的临床特点和治疗结果。方法：回顾性研究38例45眼泪腺肿瘤。结果38例45眼中，男17例17眼，女21例28眼；年龄5～63岁，平均40．6岁；其中泪腺癌5眼，腺样囊性癌5眼。恶性泪腺混合瘤5眼，良性泪腺混合瘤14眼，炎性假瘤13眼，慢性泪腺炎2眼，泪腺潴留性囊肿1眼。42眼行前路或侧壁开眶肿瘤摘除术，恶性肿瘤中4眼行眶内容物剜除。恶性肿瘤患者全部于术后1个月接受放疗。术后随访观察3个月～8年。术后症状完全缓解35眼，好转5眼，复发5眼。结论：泪腺肿瘤为眼眶常见肿瘤，结合病史，临床表现和影像学检查。绝大部分可以作出术前定性诊断，良性泪腺混合瘤预后较好，但易复发。恶性泪腺混合瘤及腺样囊性癌复发率、死亡率较高，应联合眶内容物剜除，放疗及化疗。     

Lacrimal gland pleomorphic adenomas with low-density zones resembling cystic change on computed tomography

We report 2 cases of pleomorphic adenoma with unusual radiologic findings. CT showed lacrimal gland masses dominated by low-density areas resembling cysts. Pathology revealed the lesions to be pleomorphic adenomas with myxomatous and/or cartilaginous features.     

125 I粒子治疗泪腺恶性和复发多形性腺瘤

目的：观察 125 I粒子植入治疗泪腺恶性肿瘤和复发的多形性腺瘤的临床效果和并发症。方法：回顾性系列病例研究。收集2008年7月至2016年2月于郑州大学第一附属医院眼科收入院治疗并保留完整病历资料的泪腺上皮性肿瘤16例,其中泪腺腺样囊性癌8例,黏液表皮样癌1例,癌在多形性腺瘤中2例,复发的多形性腺瘤5例。所有患者均经过手术和病理检查确诊,恶性肿瘤和复发的多形性腺瘤在术后1个月行 125 I粒子植入治疗。临床和影像学检查随访项目包括肿瘤局部控制情况和并发症。 结果： ①肿瘤控制情况：11例1次 125 I粒子植入有效控制病变;3例2次植入有效控制病变;1例3次、1例4次植入有效控制病变。②并发症情况：16例均未见眼球、视神经和颅脑穿刺损伤;13例在3个月内出现眼表刺激征,其中1例眼睑浅部植入粒子出现重度刺激征;8例出现干眼症表现;6例出现轻度的结膜充血、睑缘肥厚、睫毛或眉毛脱落、角膜水肿、角膜上皮脱失;4例出现皮肤表面红肿和色素沉着。并发症多在3个月后逐渐缓解和恢复正常。结论：泪腺恶性肿瘤和复发的多形性腺瘤,术后给予 125 I粒子植入内照射治疗,肿瘤局部控制效果好,且并发症较少,被认为是治疗易复发的泪腺上皮性肿瘤的有效方法。     

Atypical presentations of pleomorphic adenoma of the lacrimal gland

PURPOSE: To report 3 cases of pleomorphic adenoma of the lacrimal gland with atypical features. METHODS: The medical records, radiographic imaging, operative reports, and tumor histopathology of 3 patients with unusual presentations of pleomorphic adenoma of the lacrimal gland were reviewed. RESULTS: All 3 patients were females ranging in age from 18 to 64 years. The first patient presented with abrupt orbital inflammation mimicking orbital cellulitis. The second patient presented with a painful subcutaneous nodule. The last patient demonstrated calcification with bony erosion on orbital imaging. Orbitotomy was performed in all cases. Histopathologic evaluation of all specimens with light microscopy was consistent with pleomorphic adenoma of the lacrimal gland. CONCLUSIONS: Pleomorphic adenoma is the most common epithelial tumor of the lacrimal gland. A higher degree of suspicion must be present to make the correct diagnosis in cases with atypical features. Pleomorphic adenoma may present abruptly with orbital inflammation mimicking orbital cellulitis, as a painful subcutaneous nodule, or demonstrate calcification with bony erosion on orbital imaging. Complete surgical excision of the lesion within its pseudocapsule is recommended to prevent local recurrences and, although less likely, the possibility of malignant transformation.     

泪腺多形性腺瘤表皮生长因子受体表达的研究

应用免疫组化的方法观察３２例泪腺多形性腺瘤表皮生长因子受体的表达，结果１０例染色阳性，而正常泪腺组织染色阴性，阳性染色限于索条样、腺管排列及鳞状化生的肿瘤细胞，实验结果提示泪腺多形性腺瘤表皮生长因子受体的表达水平明显高于正常泪腺组织，表皮生长因子受体可能主要表达于导管起源的肿瘤细胞。     

泪腺上皮性肿瘤261例的临床和组织病理学特点分析

目的研究泪腺上皮性肿瘤的病理类型和临床特征。方法收集261例经病理诊断为泪腺上皮性肿瘤患者的273份石蜡切片标本,结合患者的组织病理学和临床相关资料进行归纳分析,探讨不同类型泪腺上皮性肿瘤的病理学特点及临床表现。结果泪腺上皮性肿瘤中各种类型所占比例由高向低排列依次为多形性腺瘤(混合瘤)(62．3％)、泪腺囊腺癌(22．3％)、多形性腺癌(8．8％)及泪腺腺癌(4．0％)等。术后复发12例,总复发率为4．6％;死亡4例,死亡率为1．5％。结论泪腺上皮性肿瘤死亡率较低,但复发率较高。应根据临床资料和病理诊断决定治疗用药和术后处理,而以手术治疗为主。     

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。