145例眼眶占位性病变临床病理及影像学分析

发布时间：2018-12-20 08:15

【摘要】：目的：分析145例眼眶占位性病变的组织病理学分类及分布情况,了解眶内肿瘤的影像学特点及在眼眶各区的分布,提高眼眶占位性病变术前诊断的正确率。方法：回顾性分析2003年4月-2010年6月青岛大学医学院附属医院诊断眼眶占位性病变并有病理证实的患者。将145例患者的病理诊断按照国际公认的Shields病理学分类方法进行分类,统计各种病变的病理分类以及各年龄组的常见病变构成情况,分析眼眶占位性病变的临床特点。总结常见眼眶肿瘤的影像学特征,按照四分区法对眼眶占位性病变进行分析,了解眶内病变在眼眶各区的分布情况。结果：在145例眼眶占位性病变中,原发性眼眶肿瘤141例(97.2%),继发性眼眶肿瘤3例(2.1%),转移性眼眶肿瘤1例(0.7%)。按组织来源分类排在首位的是脉管源性病变41例(28.2%),接下来分别为囊肿性病变37例(25.5%),泪腺源性(上皮来源)21例(14.4%),炎症性病变14例(9.6%),淋巴造血系统病变11例(7.6%)。本研究中良性病变121例(83.4%),其中前4位依次为海绵状血管瘤、皮样囊肿、多形性腺瘤、炎性假瘤。恶性病变24例(16.6%),前4位依次为恶性淋巴瘤,泪腺腺癌,脉络膜恶性黑色素瘤球外蔓延,腺样囊性癌。儿童组(18岁以下)患者中最常见的病变为皮样囊肿20例(13.8%),其次为表皮样囊肿4例(2.7%)和脂肪瘤4例(2.7%)；中青年组(19-59岁)患者中最常见良性肿瘤为海绵状血管瘤32例(22%),最常见的恶性肿瘤为淋巴瘤3例(3.4%)；老年组(60岁以上)患者中最常见良性肿瘤为海绵状血管瘤3例(11.5%),最常见的恶性肿瘤为淋巴瘤8例(30.7%)和泪腺腺癌3例(11.5%)。影像学检查示良性肿瘤大多呈圆形、椭圆形肿块,与周围组织边界清,无骨质破坏；恶性肿瘤大多边界不清,形状不规则,与周围组织分界不清,往往伴有骨质破坏。肌锥外区占位性病变最多(56,38.6%),眼球筋膜囊区最少(5,3.4%)。眼球筋膜囊区、骨膜外区病变均为良性(100%)。肌锥内区良性病变33例(94.3%)恶性病变2例(5.7%)；肌锥外区良性病变46例(82.1%),恶性病变10例(17.9%)混合型良性病变7例(36.8%),恶性病变12例(63.2%)。海绵状血管瘤主要分布于肌锥内区,泪腺源性病变主要分布于肌锥外区,所有淋巴瘤均累及肌锥外区, 结论：眼眶占位性病变种类较多,海绵状血管瘤和淋巴瘤分别是最常见的良性和恶性眼眶肿瘤,皮样囊肿和表皮样囊肿是儿童发生眼眶占位性病变最主要的病因。各种眶内占位性病变的影像学均有一定的特征性,眼眶良、恶性病变在肌锥内区、肌锥外区及混合型的分布有差异。结合患者的临床表现、影像学特点及肿瘤所处位置有助于明确术前诊断,制定正确的治疗方案。
[Abstract]:Objective: to analyze the histopathological classification and distribution of orbital space-occupying lesions in 145 cases, to understand the imaging features of orbital tumors and their distribution in orbital regions, and to improve the accuracy of preoperative diagnosis of orbital space-occupying lesions. Methods: from April 2003 to June 2010, the patients with orbital space occupying lesions diagnosed by the affiliated Hospital of Qingdao University Medical College were analyzed retrospectively. The pathological diagnosis of 145 patients was classified according to the internationally recognized Shields pathological classification method. The pathological classification of all kinds of lesions and the composition of common lesions in different age groups were analyzed. The clinical features of orbital space-occupying lesions were analyzed. The imaging features of common orbital tumors were summarized and the distribution of orbital lesions in orbital regions was analyzed according to the four-zone method. Results: among 145 orbital space-occupying lesions, 141 (97.2%) were primary orbital tumors, 3 (2.1%) were secondary orbital tumors, and 1 (0.7%) was metastatic orbital tumors. According to tissue origin, 41 cases (28.2%) were vascular diseases, 37 cases (25.5%) were cyst lesions, 21 cases (14.4%) were lacrimal gland origin (epithelial origin). Inflammatory lesions were found in 14 cases (9.6%) and lymphatic hematopoietic lesions in 11 cases (7.6%). In this study, 121 cases (83.4%) were benign lesions, of which the top 4 were cavernous hemangioma, dermoid cyst, pleomorphic adenoma and inflammatory pseudotumor. Malignant lesions were found in 24 cases (16.6%), the first four were malignant lymphoma, lacrimal gland adenocarcinoma, extrabulbar extension of choroidal malignant melanoma and adenoid cystic carcinoma. The most common lesions were dermoid cysts in 20 cases (13.8%), epidermoid cysts in 4 cases (2.7%) and lipomas in 4 cases (2.7%). The most common benign tumor was cavernous hemangioma (22%) and the most common malignant tumor was lymphoma (3. 4%) in the young and middle-aged group (19-59 years old). The most common benign tumor was cavernous hemangioma (11.5%), the most common malignant tumor was lymphoma in 8 cases (30.7%) and lacrimal gland adenocarcinoma in 3 cases (11.5%). Imaging examination showed that the benign tumors were mostly round, elliptical masses, clear with the surrounding tissue boundary, no bone destruction; most malignant tumors with unclear boundary, irregular shape, not clear border with surrounding tissues, often accompanied by bone destruction. The area of extrapyramidal area occupied the most (56%), and the area of fascia sac of eyeball was the least (53.4%). The lesions of fascia capsule and extraperiosteal area were all benign (100%). 33 cases (94.3%) were benign lesions in the intraconical area and 2 cases (5.7%) were malignant lesions. There were 46 cases (82.1%) of benign lesions in the extrapyramidal area, 10 cases (17.9%) of malignant lesions, 7 cases (36.8%) of mixed benign lesions and 12 cases (63.2%) of malignant lesions. Cavernous hemangioma is mainly located in the intramuscular cone, lacrimal gland is mainly located in the extrapyramidal area, and all lymphomas involve the extrapyramidal area. Conclusion: there are more types of orbital space-occupying lesions. Cavernous hemangioma and lymphoma are the most common benign and malignant orbital tumors respectively. Dermoid cysts and epidermoid cysts are the main causes of orbital space-occupying lesions in children. The imaging features of all kinds of intraorbital space-occupying lesions have certain characteristics. The distribution of benign and malignant orbital lesions in the intrapyramidal area, extrapyramidal area and mixed type is different. Combined with the clinical manifestations, imaging features and location of the tumor, it is helpful to determine the preoperative diagnosis and make the correct treatment plan.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.7

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