眼眶纤维组织细胞瘤临床分析

目的 探讨眼眶纤维组织细胞瘤的临床诊断及治疗方法.方法 对1989年1月至2009年1月收治的21例经病理证实的眼眶纤维组织细胞瘤患者的临床特征及影像学特点进行分析.结果 21例(15例初发,6例复发)均有不同程度的眼眶占位性病变体征;16例眼球突出移位;16例有视力下降;15例有眼球运动障碍;15例可触及眶缘肿块;9例结膜充血水肿;9例出现复视;6例眼睑肿胀.B超显示占位性病变,良性者,边界清,类圆形或椭圆形,内回声少,声衰减显著;恶性者,形状不规则、边界不清,内回声中等或不均匀,声衰减显著,不可压缩.彩色多普勒超声显示肿物内有丰富或中等量血流信号,呈动脉血流频谱.CT显示眶内呈椭圆形或不规则形、边清均质的软组织密度影,或伴有骨破坏,可强化.MRI显示肿物内T1WI呈中或低信号,T2WI呈中或高信号,可强化.所有患者均行手术治疗,6例患者行眶内容剜除术;15例患者行局部肿瘤切除术,其中4例术后随访中复发再次手术.术后病理,21例患者中良性纤维组织细胞瘤10例,中间型2例,恶性者9例.结论 影像学检查只能提供定位诊断,最终仍需病理确诊.治疗以手术切除为主,常复发,可辅以放疗或化疗.

Abstract：

Objective To explore the clinical diagnosis and management approach of the orbital fibrous histiocytomas. Methods The clinical and imaging features of 21 patients from Second Hospital of Tianjin Medical University were collected from January 1989 to January 1999. They were all diagnosed for fibrous histiocytoma by histopathology. Results There were orbital occupying lesion in all 21 patients, but 16 patients demonstrated the exophthalmos and displacement, 16 patients with decreased vision, 15 patients with the ocular movement disturbance, 15 patients with the mass of orbital margin. 9 patients with the diplopia. 9 patients with the conjunctival congestion and edema and 6 patients with the eyelid swelling. Type-B ultrasound showed space occupying lesions. Benign tumors demonstrated the well-defined and nearly round mass, the moderate or few inner echo and the obvious attenuation of sound. But malignant tumors showed the ill-defined and irregular mass. Color doppler flowing image (CDFI) discovered that there was abundant or moderate blood flow, accompanied with arterial frequency spectrum. Computed tomography (CT) revealed an oval-shape or irregular, well-defined or ill-defined and homogeneous soft tissue mass in the orbital cavity, sometimes with bone destruction. The masses were enhanced. Magnetic resonance imaging (MRI) demonstrated a intermediate or low signal on T1 weight imaging, but a intermediate or high signal on T2 weight imaging in the tumor. All the patients were managed by surgery. Six patients were performed by orbital exenteration and 15 patients were performed only surgical resection. But 4 patients recurred postoperatively and underwent another surgery. There were 10 benign tumors, 2 locally aggressive tumors and 9 malignant tumors postoperatively. Conclusions Surgery is the mainstay of therapy. Imaging examination may provide the level diagnosis, but the final diagnosis is made by histopathology. The tumors often recur and adjuvant therapy is utilized.

Clinical analysis for 21 patients with orbital fibrous histiocytoma

Objective To explore the clinical diagnosis and management approach of the orbital fibrous histiocytomas. Methods The clinical and imaging features of 21 patients from Second Hospital of Tianjin Medical University were collected from January 1989 to January 1999. They were all diagnosed for fibrous histiocytoma by histopathology. Results There were orbital occupying lesion in all 21 patients, but 16 patients demonstrated the exophthalmos and displacement, 16 patients with decreased vision, 15 patients with the ocular movement disturbance, 15 patients with the mass of orbital margin. 9 patients with the diplopia. 9 patients with the conjunctival congestion and edema and 6 patients with the eyelid swelling. Type-B ultrasound showed space occupying lesions. Benign tumors demonstrated the well-defined and nearly round mass, the moderate or few inner echo and the obvious attenuation of sound. But malignant tumors showed the ill-defined and irregular mass. Color doppler flowing image (CDFI) discovered that there was abundant or moderate blood flow, accompanied with arterial frequency spectrum. Computed tomography (CT) revealed an oval-shape or irregular, well-defined or ill-defined and homogeneous soft tissue mass in the orbital cavity, sometimes with bone destruction. The masses were enhanced. Magnetic resonance imaging (MRI) demonstrated a intermediate or low signal on T1 weight imaging, but a intermediate or high signal on T2 weight imaging in the tumor. All the patients were managed by surgery. Six patients were performed by orbital exenteration and 15 patients were performed only surgical resection. But 4 patients recurred postoperatively and underwent another surgery. There were 10 benign tumors, 2 locally aggressive tumors and 9 malignant tumors postoperatively. Conclusions Surgery is the mainstay of therapy. Imaging examination may provide the level diagnosis, but the final diagnosis is made by histopathology. The tumors often recur and adjuvant therapy is utilized.