医学教育

基于眼科住院医师规范化培训学员视角的睑板腺囊肿诊疗培训效果调查

Training effectiveness survey of diagnosis and treatment for chalazion from ophthalmology trainees’ perspective in resident standardized training

:913-920
 
目的:探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题,以期改进培训方式。方法:以2020年4月在中山大学中山眼科中心培训的154名学员为对象,进行问卷调查,采用SPSS 20.0统计学软件进行数据分析。结果:共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%;住培则显著高于前者,分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断,90.8%的专硕选择了临床诊断(P=0.007),94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001);而住培仅为去除囊壁(P<0.001)。结论:睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高,并根据各类型学员的临床能力和认知差异,进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
论著

VX120多功能眼检查仪与TopconKR800全自动验光仪的客观验光结果的一致性分析

Consistency analysis of differences between VX120 multi-diagnostic unit and TopconKR800 automatic optometer

:787-791
 
目的:比较VX120多功能眼检查仪与Topcon KR 800全自动验光仪的客观验光结果的一致性。方法:收集2019年1 1月至2019年1 2月在我院就诊拟行角膜屈光手术的患者2 4例(24只眼),所有患者均取右眼。采用Topcon KR 800全自动验光仪和VX120多功能眼检查仪分别对2 4例患者进
行客观验光检查,分别得到球镜光度(S)、柱镜光度(C)、等效球镜光度(M)、水平和垂直方向的柱镜光度(J0)及45°柱镜光度( J45)。采用配对T检验对两种设备的测量值进行组间比较,并采用Bland-Altman 95%一致性界限法衡量其一致性。结果:VX120多功能眼检查仪在明视模式下所测S为(-3.90±3.06) D;M为(-4.41±3.24) D;J0为(0.34±0.58) D;J45为(?0.04±0.26) D;TopconKR800全自动验光仪所测S为(-3.77±2.88) D;M为(-4.15±3.07) D;J0为(0.25±0.47) D;J45为(-0.01±0.18) D。VX120多功能眼检查仪在明视模式与TopconKR800全自动验光仪所测得的S、M、J45差异无统计学意义,而J0两者之间差异有统计学意义(t=-2.24,P=0.04)。Bland-Altman95%一致性分析显示,两种仪器参数数据点多分布在95%可信区间内,一致性较好。结论:VX120多功能眼检查仪明视模式下与TopconKR800全自动验光仪的客观验光结果一致性较好,在屈光度检查上可以相互替代。
Objective: The aim of this study was to compare the consistency of objective optometry results between VX120 multi-diagnostic unit and TopconKR800 automatic optometer. Methods: A total of 24 patients (24 right eyes) admitted to our hospital from November 2019 to December 2019 for corneal refractive surgery were collected. Optometry was performed on 24 patients with TopconKR800 automatic optometer and VX120 multi-diagnostic unit, and got the results following: spherical mirror photometry (S), cylindrical lens luminosity (C), mean spherical equivalent (M), horizontal and vertical cylindrical lens luminosity ( J0) and 45° cylindrical lens luminosity ( J45). Compared T-test analysis was used to compare the parameters of the two devices, and the Bland-Altman 95% limits of agreement were performed. Results: The S measured by the VX120 multi-diagnostic unit with bright mode was (-3.90±3.06) D; M was (-4.41±3.24) D; J0 was (0.34±0.58) D;J45 was (-0.04±0.26) D. The S measured by TopconKR800 automatic optometer was (-3.77±2.88) D; M was (-4.15±3.07) D; J0 was (0.25±0.47) D; J45 was (-0.01±0.18) D. There was no statistically significant difference in S, M, and J45 measured by VX120 multi-diagnostic unit and TopconKR800 automatic optometer in bright mode, while there was statistically significant difference in J0 between VX120 multi-diagnostic unit and TopconKR800 automatic optometer (t=-2.24, P=0.04). Bland-Altman 95% consistency analysis showed that the data points of the two instruments were mostly distributed within the 95% confidence interval, indicating that the parameters measured by these two devices were in accord with each other. Conclusion: The objective optometry results of VX120 multi-diagnostic unit and TopconKR800 automatic optometer were consistent and can be substituted for each other in the refraction examination.
论著

激光光凝及抗VEGF治疗早产儿视网膜病变阈值前病变1型的疗效对比

Comparison of the efficacy of laser photocoagulation and anti-VEGF in the treatment of type 1 prethreshold retinopathy of prematurity

:776-780
 
目的:观察视网膜激光光凝术(laser photocoagulation,LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab,IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效。方法:收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症,分析不同手术方式的效果。结果:LP组20例(37只眼)行视网膜激光光凝治疗,术后未出现复发,首次治愈率100%;术后(3.42±1.57)周病情控制,术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗,39只眼行单次手术后病情控制,首次治愈率88.6%,5眼术后病情未控制。术后(2.95±2.58)周病情控制,术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论:视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效,IVR复发率较高,手术方式的选择需慎重。
Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.
综述

眼睑皮脂腺癌近5年研究进展和展望

Progress and prospect of eyelid sebaceous carcinoma in recent five years

:762-765
 
近5年来眼睑皮脂腺癌研究取得一系列成果。临床研究方面,明确了眼睑皮脂腺癌冰冻切缘控制显微手术的意义,提出了患者预后指标;在基础研究方面,描述了基因突变谱,揭示了3种相互独立的发病模式,以及提出了免疫及靶向治疗相关研究;我国眼肿瘤工作者也在眼睑皮脂腺癌研究方面树立了国际地位。本文对近5年国内外眼睑皮脂腺癌相关研究方面的主要成果进行总结分析,并展望治疗前景,为临床提供有益参考。
In recent 5 years, a series of studies have been made in the mechanism of onset of eyelid sebaceous carcinoma worldwide. In clinical research, the prognosis has made in predicting progression of patients with eyelid sebaceous carcinoma, and the significancy of frozen margin control in microsurgery was clarified. In field of basic research,from elucidation of mutational landscape to revelation of three independent pathogenesis patterns, from researches on immunotherapy to targeted therapy, efforts have been made to reveal the pathological mechanism to both aspect of its morbidity and development. This paper summarizes, analyzes and reviews the main achievements in recent 5 years on eyelid sebaceous carcinoma.
综述

眼睑皮脂腺癌发病机制研究进展

Research progress of the pathogenesis of eyelid sebaceous gland carcinoma

:755-761
 
眼睑皮脂腺癌是起源于眼睑部位皮脂腺体的恶性上皮性肿瘤,易复发、转移,主要治疗方式仍以手术切除为主,但患者整体预后并不理想,早期正确诊断和靶向治疗是改善患者预后和改进治疗的关键。眼睑皮脂腺癌临床表现复杂,早期容易误诊或漏诊进而延误治疗,病理检查是其诊断的金标准。此外,目前关于眼睑皮脂腺癌发病机制未完全阐明,癌发生发展的分子生物学过程尚未明确。因此,多方面了解眼睑皮脂腺癌发病机制为靶向治疗提供理论基础是十分必要的。本文主要从眼睑皮脂腺癌发病机制包括遗传因素、表观遗传、外源病毒感染、免疫逃逸、端粒酶学说等方面对眼睑皮脂腺癌作一综述。
Eyelid sebaceous gland carcinoma is a malignant epithelial tumor originating from eyelid sebaceous glands, which is prone to relapse and metastasis. The treatment mainly depends on surgical excision, but the overall prognosis of patients is not ideal. Early diagnosis and targeted therapy are the keys to improve the prognosis of patients.Due to its complex clinical manifestations, early misdiagnosis or missed diagnosis is easy to delay treatment, and pathological examination is still the gold standard for its diagnosis. In addition, the pathogenesis of eyelid sebaceous gland carcinoma is still unclear, and the molecular biological process of the occurrence and development is less understood. Therefore, it is very necessary to understand the pathogenesis of eyelid sebaceous gland carcinoma in various aspects to provide a theoretical basis for targeted therapy. In this paper, the pathogenesis of eyelid sebaceous gland carcinoma was reviewed from the aspects of gene , epigenetic, viral infection, immune escape, , telomerase theory and so on.
病例报告

眼睑Merkel细胞癌2例

Eyelid Merkel cell carcinoma: 2 case reports

:744-749
 
Merkel细胞癌(Merkel cell carcinoma,MCC)是一种少见的高度恶性的皮肤原发性神经内分泌癌,发生于眼睑的MCC更加罕见。本文对2例眼睑MCC患者的临床病史和治疗过程进行回顾和总结。1例初发患者经手术彻底切除,效果良好,随访7年,未再复发;1例患者在外院切除术后2个月,于眼睑原位复发,再次行手术彻底切除,2个月后同侧腮腺淋巴结及颈前淋巴结扩散,目前仍在肿瘤科进一步放化疗中。复习相关文献并结合本组病例提示,MCC诊断主要依靠病理检查,彻底切除病灶并结合术后放化疗是其治疗的主要手段,免疫治疗是目前新的发展趋势。
The Merkel cell carcinoma (MCC) is a rare highly malignant primary neuroendocrine carcinoma of the skin,especially in the eyelids. In this report, the clinical history and treatment course of 2 patients with MCC of the eyelid were reviewed and summarized. Patient 1 with primary MCC of eyelid was treated with complete surgical excision, with good results. Follow-up for 7 years had shown no recurrence. Patient 2 with the eyelid relapse in situ two months after resection in another hospital, was treated with complete surgical excision again, but the tumor metastasized to the ipsilateral lymphonodi parotidici and cervical lymph nodes two months after the surgery. The patient is now going through radiotherapy and chemotherapy in oncology department. According to the review of literatures, the diagnosis was based on the pathologic evidence. Complete removal of lesion combined with postoperative radiotherapy and chemotherapy is a major means of treatment for MCC. Immunotherapy will play a more important role in the future.
病例报告

眼眶泪腺淋巴上皮癌1例

Lymphoepithelial carcinoma of orbital lacrimal gland: a case report

:739-743
 
眼眶泪腺淋巴上皮癌是一种非常少见的恶性肿瘤。本例为一位46岁女性患者,表现为左眼睑红肿、眼球突出和视力下降,临床和影像学表现类似于泪腺炎型假瘤。手术完整切除后送检病理检查,其特征是未分化的癌巢之间有大量分化成熟的淋巴细胞、浆细胞浸润,确诊为淋巴上皮癌。术后行化学治疗和局部放射治疗,随访6.5年无复发。眼眶泪腺淋巴上皮癌的临床表现容易与泪腺炎型假瘤相混淆,应该进行病理学检查以明确其恶性表型,完整切除后辅助放化学治疗有较好的效果。
Lymphoepithelial carcinoma of the orbital lacrimal gland is a rare carcinoma. A 46-year-old female patient presented with red and swollen left eyelid, proptosis and blurred vision. The clinical and imaging manifestations were similar to inflammatory pseudotumor. Pathological examination was performed after complete resection.Pathological features showed undifferentiated carcinoma nests surrounded by obvious infiltration of non-neoplastic lymphocytes and plasma cells, which was consistent with the diagnosis of lymphoepithelial carcinoma.Chemotherapy and local radiotherapy were performed after the resection. The case did not relapse after 5 years of follow-up. The clinical manifestations of orbital lacrimal lymphoepithelial carcinoma were easily confused with inflammatory pseudotumor. Pathological examination should be performed to clarify its malignant phenotype.Adjuvant radiotherapy and chemotherapy after complete resection had a good effect.
论著

眼部转移性透明细胞肾细胞癌的临床病理分析

Ocular metastatic clear-cell renal cell carcinoma: a clinicopathologic analysis

:711-718
 
目的:探讨眼部转移性透明细胞肾细胞癌(clear-cell renal cell carcinoma,CC-RCC)的临床病理特点。方法:选取复旦大学附属眼耳鼻喉科医院2010年1月至2020年12月收治的5例并经病理学检查证实的眼部转移性CC-RCC患者的临床病理资料,包括病史、临床表现、影像学检查、病理形态学特点、免疫表型及随访结果等,并进行回顾分析。结果:5例患者中3例为脉络膜转移性CC-RCC,均为男性,年龄51~62岁,均表现为右眼前黑影伴视力下降,病程为1~6个月,术前检查视力均为眼前手动,眼底见视网膜下隆起肿块伴视网膜脱离。B超显示球内隆起肿物,中等回声,考虑脉络膜黑色素瘤。其中例2在2年前有左侧肾CC-RCC切除病史,术后1年转移至肺。3例患者均行眼球摘除加义眼座植入术。病理学形态及免疫组织化学染色结果提示为球内恶性肿瘤,考虑转移性CC-RCC,建议在肾等处寻找原发灶。术后例1腹部CT检查发现左肾占位,考虑肾癌。胸部CT检查示两下肺多个转移瘤。例3术后PET-CT发现左肾占位,手术切除后证实为左肾CC-RCC。2例为眼眶转移性CC-RCC,例4为女性,56岁,右眼红肿伴眼球突出2个月,2个月前行右肾CC-RCC切除术,PEC-CT提示右侧眼眶转移伴骨质破坏。例5为男性,65岁,左眼眉弓处肿物3年,7年前行左肾癌摘除术,后肺部转移。所有5例患者手术切除标本病理学检查均示肿瘤细胞细胞质透明或颗粒状,呈实性片状和腺样分布,间质血管丰富,免疫组织化学表达CK、VIM、CD10和PAX-8等标记提示CC-RCC转移。结论:CC-RCC可以转移至脉络膜或眼眶,病理学上需要和其他眼部具有透明细胞特征的原发和转移性肿瘤相鉴别。
Objective: To evaluate the clinicopathological features of ocular metastatic clear-cell renal cell carcinoma.Methods: Data of 5 patients (5 eyes) with ocular metastatic clear-cell renal cell carcinoma treated and diagnosed at Eye & ENT Hospital of Fudan University from January 2010 to December 2020 were retrospectively analyzed for medical history, clinical features, imaging examinations, pathomorphological features, immunophenotypes and survival outcomes. Results: There were 3 males of choroidal metastatic clear-cell renal cell carcinoma with age from 51 to 62 years old. They all presented with shadow before the eye and reduced visual acuity of the right eye for 1 to 6 months. On examination the visual acuity was hand movement in front of the affected eye. Fundus examination showed a subretinal elevated mass with retinal detachment. B-scan ultrasound demonstrated an intraocular mass with medium internal reflectivity suspected of choroidal melanoma. Case 2 reported a history of clear-cell renal cell carcinoma treated with a left nephrectomy 2 years ago and developed lung metastasis 1 year ago. Three patients all underwent enucleation and prosthesis implantation. Histopathological and immunohistochemical examinations showed intraocular malignant tumor suggestive of clear-cell renal cell carcinoma which needed further examinations to confirm the primary tumor. Postoperative computed tomography scan of the abdomen for case 1 revealed a mass of the left kidney highly suggestive of a renal cell carcinoma. The computed tomography scan of the chest revealed multiple lesions suggestive of lung metastasis. Postoperative PET-CT scan of case 3 revealed a mass of the left kidney which was confirmed to be clear-cell renal cell carcinoma histopathologically. There were 2 patients of orbital metastatic clear-cell renal cell carcinoma. One 56-year-old female patient (Case 4) presented with swelling, redness and proptosis of the right eye for 2 months. Two months ago, her right kidney was resected for the diagnosis of clear-cell renal cell carcinoma. PEC-CT revealed metastasis to the right orbit with bone destruction. Another 65-year-old male patient (Case 5) presented with palpable mass of the left eyebrow for 3 years. He had left nephrectomy for renal cell carcinoma 7 years earlier and metastasis to the lung later. Histopathology of all 5 cases demonstrated uniform cells with clear or granular cytoplasm in solid and glandular arrangement surrounded by a rich vascular network. Immunohistochemical positivity for the biomarkers CK, Vimentin, CD10 and PAX-8 confirmed the diagnosis of metastatic clear-cell renal cell carcinoma.Conclusion: Clear-cell renal cell carcinoma can metastasize to the choroid or orbit. It should be differentiated from the other ocular primary and metastatic tumors with clear-cell appearance histopathologically.
论著

双眼视网膜母细胞瘤46例的临床特点及疗效

Clinical characteristics and therapeutic effect of 46 cases of bilateral retinoblastoma

:704-710
 
目的:分析46例双眼视网膜母细胞瘤(retinoblastoma,RB)的临床特点及治疗效果。方法:回顾性分析2008年12月至2019年12月重庆市陆军军医大学陆军特色医学中心收治的46例接受静脉化疗联合经瞳孔温热疗法(transpupillary thermotherapy,TTT)或眼摘治疗的双眼RB住院患儿的临床资料,对患儿的保眼率、摘眼率、视力情况及化疗不良反应进行评估。结果:46例患儿中,男27例,女19例,初诊年龄为(13.21±11.13)个月。单纯化疗10例,化疗+TTT治疗11例,化疗+TTT+眼摘治疗17例,化疗+冷凝治疗2例,化疗+冷凝+眼摘治疗6例。46例92眼总保眼率73.1%(57/78),残留视力眼占64.1%(50/78),各期保眼率:A、B期均100.0%,C期86.7%,D期94.1%,E期35.7%。手术摘除24眼,总摘眼率26.1%(24/92),E期手术摘除21眼,占E期患眼60.0%(21/35)。平均化疗(4.1±1.9)次,化疗的骨髓抑制主要表现为白细胞减少、血小板减少及血红蛋白减少。46例患儿随访时间(35.4±23.8)个月,死亡7例,总病死率15.2%(7/46);存活39例,总存活率为84.8%(39/46),5年累积生存率为80.2%。结论:静脉化疗联合局部治疗总体疗效较好,在双眼RB患儿治疗中占据重要地位。化疗具有骨髓抑制作用,停止化疗后骨髓抑制逐渐恢复。
Objective: To analyze the clinical characteristics and therapeutic effect of 46 patients with bilateral retinoblastoma(RB). Methods: The clinical data of 46 patients with bilateral retinoblastoma who received intravenous chemotherapy combined with transpupillary thermotherapy (TTT) or enucleation from December 2008 to December 2019 in our department were analyzed retrospectively. The eye salvage rate, enucleation rate, visual acuity, and chemotherapy side effects were evaluated. Results: The 46 enrolled patients were 27 males and 19 females, at an average age of (13.21±11.13) months at the first visit. Among them, 10 received chemotherapy, 11 received chemotherapy combined with TTT, 17 received chemotherapy combined with TTT and enucleation,and 2 received chemotherapy combined with freezing, 6 received chemotherapy combined with freezing and enucleation. After treatment, 58 eyes were salvaged, with a total salvage rate of 73.1% (57/78), and the eyes that preserved vision account for 64.1% (50/78). The eye salvage rate in each stage were 100.0% for stage A and B, 86.7% for stage C, and 94.1% for stage D, 35.7% for stage E. Twenty-four eyes were enucleated, with a total enucleation rate of 26.1% (24/92), and among 35 eyes at stage E, 21 eyes were enucleated, accounting for 60.0%(21/35). The average time of chemotherapy was 4.1±1.9 and the myelosuppressive effects of chemotherapy include leucopenia, thrombocytopenia and hemoglobinopenia. During the mean follow-up time of (35.4±23.8) months, 7 (15.2%) patients died, and 39 (84.8%) cases survived. The 5-year cumulative survival rate was 80.2%. Conclusion: Intravenous chemotherapy combined with local treatment has a good overall effect and plays an important role in the treatment of bilateral retinoblastoma. Intravenous chemotherapy leads to myelosuppression, and the myelosuppression gradually recovered after stopping intravenous chemotherapy.
论著

眼眶黏膜相关淋巴组织结外边缘区B细胞淋巴瘤71例的临床病理特征

Clinicopathological features of orbital extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue: a series of 71 cases

:697-703
 
目的:探讨眼眶黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)结外边缘区B细胞淋巴瘤的临床表现、影像学特征及病理学特点,以期减少眼眶淋巴瘤的误诊,提高生存率。方法:对2020年1月至2020年12月中山大学中山眼科中心诊治的71例眼眶MALT结外边缘区B细胞淋巴瘤的临床、影像及病理学资料进行回顾性分析。结果:71例患者中,男38例,女33例;左侧眼眶31例,右侧眼眶34例,双侧眼眶6例;原发病例67例,复发病例4例;年龄23~84岁,病程为3个月~15年。最常见的临床表现是眼部肿块和不同程度的眼球活动受限;磁共振成像(magnetic resonance imaging,MRI)检查见密度均匀的软组织影,呈“铸造样”,眼球内未见侵犯;组织病理检查可见肿瘤由小至中等大小淋巴样细胞组成,瘤细胞呈弥漫或片状生长,核小到中等、不规则,核仁不明显,部分细胞呈单核样淋巴瘤细胞改变,其中9例可见浆细胞样分化,伴浆细胞分化的病例kappa与lambda的表达不对称。结论:眼眶MALT结外边缘区B细胞淋巴瘤有多种临床表现,影像学检查具有一定的特征,可辅助术前诊断。病理学检查可用于术后的准确诊断及分型,据此制定合适的治疗方案,提高疗效。
Objective: To investigate the clinical, imaging and pathological features of orbital extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT), so as to reduce misdiagnosis and improve survival rate.Methods: The clinical, imaging and histopathological data of 71 patients with orbital extranodal marginal zone B cell lymphoma of MALT who were treated in Zhongshan Ophthalmic Center, Sun Yat-sen University from Jan.2020 to Dec. 2020 were retrospectively analyzed. Results: There were 38 males and 33 females in the 71 patients.There were 31 cases located on the left orbit, 34 cases on the right orbit, and 6 cases were bilateral; there were 67 primary cases and 4 relapsed cases. The age ranged from 23 to 84 years old. The disease course ranged from 3 months to 15 years. The main clinical manifestations included ocular masses and limited eyeball movement.Magnetic resonance imaging showed a “cast-like” soft tissue shadow of uniform density, and no intraocular invasion is observed. Histopathological examination showed that the tumor was composed of small to medium sized lymphocyte-like cells. Tumor cells exhibited diffuse or lamellar growth, with small to medium-sized irregular nuclei, and the nucleoli were inconspicuous. Some of the lymphocyte-like cells showed mononuclear lymphoma cells changes, and plasmacytoid differentiation was observed in 9 cases, in which kappa and lambda expressions were asymmetric.Conclusion: The clinical manifestations of orbital extranodal marginal zone B cell lymphoma of MALT are various, and imaging examination has certain characteristics, which can assist preoperative diagnosis.Pathological examination can be used for accurate diagnosis and classification after operation, based on which appropriate treatment plan can be made and curative effect can be improved.
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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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