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24例泪腺黏液表皮样癌的临床特征分析

智绪爽 吴畏 杨新吉 黑砚 吕小辉 邓爱军

智绪爽, 吴畏, 杨新吉, 黑砚, 吕小辉, 邓爱军. 24例泪腺黏液表皮样癌的临床特征分析[J]. 解放军医学院学报, 2023, 44(4): 345-349. doi: 10.3969/j.issn.2095-5227.2023.04.005
引用本文: 智绪爽, 吴畏, 杨新吉, 黑砚, 吕小辉, 邓爱军. 24例泪腺黏液表皮样癌的临床特征分析[J]. 解放军医学院学报, 2023, 44(4): 345-349. doi: 10.3969/j.issn.2095-5227.2023.04.005
ZHI Xushuang, WU Wei, YANG Xinji, HEI Yan, LYU Xiaohui, DENG Aijun. Clinical features of mucoepidermoid carcinoma of lacrimal gland: An analysis of 24 cases[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(4): 345-349. doi: 10.3969/j.issn.2095-5227.2023.04.005
Citation: ZHI Xushuang, WU Wei, YANG Xinji, HEI Yan, LYU Xiaohui, DENG Aijun. Clinical features of mucoepidermoid carcinoma of lacrimal gland: An analysis of 24 cases[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(4): 345-349. doi: 10.3969/j.issn.2095-5227.2023.04.005

24例泪腺黏液表皮样癌的临床特征分析

doi: 10.3969/j.issn.2095-5227.2023.04.005
基金项目: 山东省自然科学基金面上项目(ZR2020MH173)
详细信息
    作者简介:

    智绪爽,女,在读硕士。研究方向:眼科学。Email: zxs9622@126.com

    通讯作者:

    邓爱军,男,博士,主任医师。Email: dengaijun@hotmail.com

  • 中图分类号: R320.37

Clinical features of mucoepidermoid carcinoma of lacrimal gland: An analysis of 24 cases

More Information
  • 摘要:   背景  黏液表皮样癌(mucoepidermoid carcinoma,MEC)是常见的唾液腺肿瘤,极少数原发于泪腺,临床实践中认识有限。  目的  分析泪腺MEC的临床特征、影像表现、诊断治疗及预后。  方法  回顾性分析2010年1月 - 2021年12月解放军总医院第三医学中心连续收治的经组织病理学证实的24例泪腺MEC患者的临床、影像及病理资料。  结果  24例患者平均患病年龄为56.35岁,男女比例7∶1。临床表现:21例(87.5%)眼球突出,16例(66.7%)眶外上方可扪及肿物,3例(12.5%)眶周疼痛。初发为泪腺MEC有19例,泪腺多形性腺瘤术后恶变为MEC有5例;6例发生远处转移。10例泪腺MEC的CT图像中,7例呈不均匀软组织密度影,9例形状不规则,7例肿瘤内有钙化,7例肿瘤破坏周围骨质;8例泪腺MEC的MRI图像中,8例不均匀强化,均可见液化腔;4例形状呈不规则,3例侵犯颅内、鼻旁窦、颞窝。24例泪腺MEC均进行了手术切除。病理证实24例均为高级别泪腺MEC,其中20例(83.3%)可见肿瘤侵犯神经,肿瘤细胞坏死,4个以上的核分裂/10个高倍视野;9例(37.5%)可见侵犯骨质。随访7例患者中1例复发(随访时间为12个月),6例患者未复发(平均随访时间为24.3个月)。  结论  高级别泪腺MEC好发于中老年男性,常表现为无痛性眼球突出;影像大多表现为眶外上方中密度占位病变,形状不规则,常发生钙化,多伴有骨质破坏,可见液化腔,可侵犯邻近组织结构;治疗以手术切除为主,但需警惕术后复发和远处转移的发生。

     

  • 图  1  泪腺黏液表皮样癌的CT表现

    A:眼眶水平位CT显示,右侧泪腺区占位局限于眶外壁和外侧直肌的三角间隙中,可见“楔形征”;B:眼眶水平位骨窗显示,左眶外壁骨质破坏,呈虫蚀样;C:眼眶水平位CT显示,左侧泪腺区软组织密度影,形状不规则,可见钙化斑,破坏周围骨质

    Figure  1.  CT images of MEC of the lacrimal gland

    A: CT images in horizontal axial showed the “wedge sign” in the right lacrimal gland, which refers to a sign that the tumor was confined to the triangular space between the outer wall of orbital and the lateral rectus muscle; B: Bone window at orbital horizontal axial showed a worm-like bone destruction of the left outer wall of orbit; C: CT images showed an irregularly shaped soft tissue density shadow in the left lacrimal gland area, with visible calcified spots, which destroyed the surrounding bone

    图  2  泪腺黏液表皮样癌的MRI表现

    A:眼眶水平位MRI (T1WI)增强结合脂肪抑制扫描显示,右侧泪腺区肿块不均匀强化,侵犯右眶外直肌,内部可见液化区;B:眼眶冠状位MRI (T1WI)增强联合脂肪抑制扫描显示,病灶侵犯左眶外上壁,左侧颞肌,左侧额部脑膜,呈不均匀强化

    Figure  2.  Manifestations of MEC of the lacrimal gland on MRI

    A: Orbital axial MRI (T1WI) enhanced combined fat-suppressed scan showed that the mass in the region of right lacrimal gland was inhomogeneous enhanced, invading the right lateral rectus muscle, and liquify area was visible inside; B: Orbital coronal MRI (T1WI) enhanced combined fat suppression scan showed that the lesion invaded the left superolateral-orbital wall, left temporalis and left forehead meninges. Heterogeneous enhancement was visible in the lesion

    图  3  泪腺黏液表皮样癌的HE形态(200×)。肿瘤细胞主要由表皮样细胞和中间型细胞为主

    Figure  3.  HE of MEC of lacrimal gland (200×). HE staining showed that the tumor cells were mainly composed of epidermoid cells and intermediate cells

    表  1  24例泪腺黏液表皮样癌患者的临床和人口学特征(例,%)

    Table  1.   Clinical and demographic characteristics of the patients (n, %)

     特征泪腺黏液表皮样癌(n=24)
    性别
     女3(12.5)
     男21(87.5)
    年龄
     <20岁0
     20 ~ <40岁3(12.5)
     40 ~ 60岁10(41.7)
     >60岁11(45.8)
    临床表现
     眼球突出21(87.5)
     斜视18(75.0)
     眼球运动异常18(75.0)
     眶周疼痛3(12.5)
     眼睑水肿15(62.5)
     眼睑下垂7(29.0)
     视力下降5(21.0)
     眶周扪及肿物16(66.7)
     有压痛4(16.7)
    下载: 导出CSV

    表  2  7例随访患者的预后情况

    Table  2.   Prognosis of the 7 patients

    患者年龄/性别既往手术史治疗方式随访时间/月复发
    132岁/男完整手术切除 + 放疗68
    269岁/男完整手术切除12
    365岁/男泪腺多形性腺瘤手术史完整手术切除 + 放疗45
    439岁/男泪腺多形性腺瘤手术史完整手术切除 + 放疗8
    562岁/男完整手术切除13
    673岁/男完整手术切除 + 放疗9
    749岁/男泪腺多形性腺瘤手术史完整手术切除 + 放疗3
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-11-22
  • 网络出版日期:  2023-04-18
  • 刊出日期:  2023-04-28

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