泪囊实性肿物的临床病理分析

目的探讨泪囊实性肿物的临床病理特征。方法回顾性分析2007年至2017年于我院诊治并经组织病理检查确诊的20例泪囊实性肿物患者的临床资料。结果 20例泪囊实性肿物中,男11例,女9例,发病年龄1～81岁,平均53岁。20例均为单眼发病,均可见为泪囊区肿胀隆起;伴溢泪者15例,同时伴脓性分泌物者4例,血性分泌物者3例;泪囊区及眶周红、肿、疼痛2例。病理结果显示:良性肿物8例,其中肉芽肿3例,炎性肌纤维母细胞瘤3例,鳞状上皮乳头状瘤1例,错构瘤1例;恶性肿瘤12例,其中淋巴瘤6例,恶性黑色素瘤3例,胚胎型横纹肌肉瘤1例,鳞癌2例。预后:4例患者死亡,其中2例为恶性黑色素瘤患者,2例为弥漫性大B细胞淋巴瘤患者;1例鳞癌患者5 a后出现口腔部鳞癌生长;余15例患者未见肿物复发及转移。结论泪囊肿物临床表现多样,易误诊、漏诊,需引起眼科医师重视,对可疑患者进行相关辅助检查,确诊后根据病理类型及肿物分期行手术、放疗、化疗等个体化综合治疗。

Clinicopathological analysis of tumors of the lacrimal sac

Objective　To investigate the clinicopathological features of lacrimal sac tumors.Methods　We retrospectively analyzed clinical data of 20 patients of lacrimal sac tumors confirmed by pathological examination in our hospital from 2007 to 2017.Results　Of the 20 patients of lacrimal sac tumors，11 were males and 9 were females，with a mean age of 53 years （range，1-81 years）.All 20 patients were found to be unilateral and presented with swelling and lump in the lacrimal sac region，accompanied by epiphora in 15 patients，pyoid tears in 4 patients，bloody tears in 3 patients.There were 2 patients had redness，swelling and pain in dacryocyst region.Pathological types were as follows:8 patients of benign tumor，including 3 patients of granuloma，3 patients of inflammatory myofibroblastoma，1 patient of squamous epithelial papilloma and 1 patient of hamartoma.There were 12 patients of malignant tumor，including 6 patients of lymphoma，3 patients of malignant melanoma，1 patient of embryonic rhabdomyosarcoma and 2 patients of squamous cell carcinoma.Prognosis:four patients died，including 2 patients of malignant melanoma and 2 patients of diffuse large B cell tumor.One patient of squamous cell carcinoma developed oral squamous cell carcinoma after 5 years.No recurrence or metastasis was seen in the remaining patients.Conclusion　The clinical manifestations of lacrimal sac tumor are various and easy to be misdiagnosed and missed.Ophthalmologists need to pay attention to the suspicious patients and perform related examinations.Individualized comprehensive therapy such as surgery，radiotherapy，chemotherapy，etc should be adopted based on pathological types and stage of lacrimal sac tumor.