摘要
目的 探讨眼眶炎性假瘤影像学与组织病理学改变的关系 ,以期在治疗前通过影像学检查结果推断其病理类型 ,选择不同的治疗方案并评估其预后。方法 回顾我院经病理学检查证实为眼眶炎性假瘤的患者 5 6例 ( 5 8只眼 ) ,分析临床特点 ,观察影像学和组织病理学改变及二者之间的关系 ,并对治疗及预后进行分析。结果 不同类型眼眶炎性假瘤发病年龄比较 ,差异无显著意义 (方差分析 ,P =0 44 )。不同类型眼眶炎性假瘤病程比较差异有显著意义 (秩和检验 ,P =0 0 0 6 )。弥漫性淋巴细胞浸润型炎性假瘤病理上表现为组织内大量炎性细胞浸润 ,仅有少许纤维结缔组织增生 ,故B超检查为无回声或低回声实性暗区 ,后界显示清晰 ,MRI上T1WI低信号或等信号 ,T2 WI高信号 ,明显强化。硬化型炎性假瘤组织内大量纤维结缔组织增生 ,炎性细胞浸润较少 ,故B超仅能探及肿物的前部 ,后界不显示 ,MRI上T1WI低信号或等信号 ,T2 WI低信号 ,且不被强化或仅轻度强化。混合型炎性假瘤表现为炎性细胞浸润和增生的纤维结缔组织混杂 ,故影像表现介于上述二者之间。 42例淋巴细胞浸润型和混合型炎性假瘤患者经全身及局部应用糖皮质激素治疗后 ,病情不能控制或停药后复发 ,最终采取手术治疗。 12例硬化型炎性假瘤患者保守治疗无效 。
ObjectiveTo investigate the relationship between the histopathology and the imaging analysis of orbital pseudotumor to judge the histopathological types of these tumors before treatment according to imaging analysis, in order to search for different therapeutic approaches for different pathologic types and to predicate prognosis. MethodsFifty-six cases (58 eyes) of orbital pseudotumor that had been operated in Tongren hospital were studied. The clinical manifestations of these patients were reviewed. Changes in the imaging analysis and histopathologic examination were observed and their relationship was studied. Methods of treatment and their prognosis were also analyzed. ResultsHistorically, the lymphocytic infiltrated type of orbital pseudotumor composed of large amounts of chronic inflammatory cells, only a small amount of collagen was found, so the imaging features of the lymphocytic infiltrated type presented as low or none reflecting areas with a clear posterior demarcation on B scan, and the signals were low or equal on T 1WI and high on T 2WI, which could be enhanced by contrast. Oppositely, the fibrotic type was composed of large amounts of fibrotic tissue, and few chronic inflammatory cells were found, so that only the anterior border of the lesion could be identified and the posterior demarcation was blur on the B scan, and the signals were low or equal on T 1WI and low on T 2WI, which could not be enhanced or could be enhanced only slightly by changing the contrast. The mixed type presented as an admixture of chronic inflammatory cells and fibric hyperplasia, and the imaging of the mixed type was midway between the lymphocytic infiltrated type and the fibrotic type. Forty-two patients of lymphocytic and mixed types which were identified by histopathology and imaging analysis received a local and systemic corticosteroid therapy. The effect was unstable, and recurrence occurred easily. Therefore, operations were performed on these patients, thirteen of them were treated with low-dose radiotherapy (2 000-3 000 cGy) two weeks after operation. Fifteen cases recurred after the operation and 4 cases recurred after the radiotherapy. The fibrotic type of orbitalpseudotumor was identified in 12 cases in which no effect could be observed after conservative therapy andoperations were performed subsequently. Two cases recurred and were operated again. Exenteration was performed in 2 cases of 56 cases. The cure rate of the composite treatment in the present series was 68.5%. ConclusionsDifferent types of orbital pseudotumor present different imaging exhibition, and imaging features are closely related with histopathological changes. Lesions can be localized by CT scan, and also can be localized by B scan and MRI. While it is difficult to obtain a cure result in the orbital pseudotumor, the cure rate can be improved by composite treatment.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2003年第2期81-86,共6页
Chinese Journal of Ophthalmology
关键词
眼眶炎性假瘤
病理
治疗
诊断
Granuloma, plasma cell, orbital
Pathology, clinical
