CAJ | 학술논문

目的分析眼睑和眼眶血管平滑肌瘤的临床与病理学特点.方法回顾性系列病例研究.收集天津市眼科医院2005年1月至2014年4月收治的2例眼睑和6例眼眶血管平滑肌瘤患者的临床资料,包括患者年龄、性别、临床表现、CT检查、彩色多普勒超声检查和治疗方法等.结果 8例患者中,男性5例,女性3例,年龄32.0 ～ 65.0岁,年龄中位数为52.5岁.2例发生于眼睑内侧皮下;6例发生于眼眶内,其中3例位于眼眶肌锥内,2例位于眼眶下方,l例位于眼眶外上方.7例为单发性肿瘤,1例眼眶血管平滑肌瘤伴发同侧下眼睑海绵状血管瘤.彩色多普勒超声检查显示肿瘤边界清楚,内回声均匀,无明显血流信号.CT检查显示肿瘤呈椭圆形或不规则形状的软组织团块影,密度比较均匀,边界清楚,CT值为45～50 Hu,部分肿瘤压迫邻近组织或视神经.肿瘤大体呈圆形或不规则椭圆形,体积为0.7～2.8cm,边界清楚,6例有较完整的包膜.肿瘤实质主要由分化成熟的平滑肌细胞和厚壁血管组成,其中5例为海绵状型,2例为静脉型,1例为实体型.免疫组织化学染色显示血管壁周围和血管之间的平滑肌纤维对SMA和Desmin呈阳性表达.8例患者均施行肿物完整切除术,术中可见肿瘤边界清楚,有包膜,与周围组织有轻度粘连.结论眼睑或眼眶血管平滑肌瘤是非常少见的良性肿瘤,多发生于成年人,肿瘤有完整包膜,主要由多数厚壁血管和平滑肌组成.对边界清楚的眼眶内肿物应考虑到本瘤的可能性.病理诊断中应当注意与平滑肌瘤或海绵状血管瘤鉴别.
목적 분석안검화안광혈관평활기류적림상여병이학특점.방법 회고성계렬병례연구.수집천진시안과의원2005년1월지2014년4월수치적2례안검화6례안광혈관평활기류환자적림상자료,포괄환자년령、성별、림상표현、CT검사、채색다보륵초성검사화치료방법등.결과 8례환자중,남성5례,녀성3례,년령32.0 ～ 65.0세,년령중위수위52.5세.2례발생우안검내측피하;6례발생우안광내,기중3례위우안광기추내,2례위우안광하방,l례위우안광외상방.7례위단발성종류,1례안광혈관평활기류반발동측하안검해면상혈관류.채색다보륵초성검사현시종류변계청초,내회성균균,무명현혈류신호.CT검사현시종류정타원형혹불규칙형상적연조직단괴영,밀도비교균균,변계청초,CT치위45～50 Hu,부분종류압박린근조직혹시신경.종류대체정원형혹불규칙타원형,체적위0.7～2.8cm,변계청초,6례유교완정적포막.종류실질주요유분화성숙적평활기세포화후벽혈관조성,기중5례위해면상형,2례위정맥형,1례위실체형.면역조직화학염색현시혈관벽주위화혈관지간적평활기섬유대SMA화Desmin정양성표체.8례환자균시행종물완정절제술,술중가견종류변계청초,유포막,여주위조직유경도점련.결론 안검혹안광혈관평활기류시비상소견적량성종류,다발생우성년인,종류유완정포막,주요유다수후벽혈관화평활기조성.대변계청초적안광내종물응고필도본류적가능성.병리진단중응당주의여평활기류혹해면상혈관류감별.
Objective To analyze the clinical pathologic characteristics of angioleiomyoma of the eyelid and orbit.Methods Retrospective case series study.The clinical and pathological characteristics of 8 cases of eyelid and orbital angioleiomyoma which were treated in Tianjin Eye Hospital from January 2005 to April 2014 were reviewed and analyzed.Results In the 8 cases,5 were male and 3 were female.The median age was 52.5 years (32.0 to 65.0).Six cases of angioleiomyoma occurred in the orbit.Three of them located in the muscle cone,2 of them located in superotemporal orbit and 1 of them located in the inferior orbit.The remaining 2 cases of angioleiomyoma occurred in the medial side of the eyelid subcutanously.Five cases were male and three cases were female.Seven cases revealed a solitary eyelid or orbital mass.One case of orbital angioleiomyoma companied with a cavernous hemangioma of ipsilateral lower eyelid.The color Doppler ultrasound of the orbit showed a well-demarcated mass with homogeneous inner-echoes without obviously blood stream signal The CT showed a circumscribing rounded or irregular shaped soft mass with isotropic density and the CT value were 45 to 50 Hu.Grossly,the tumor appeared as a rounded or irregular oval ranged from 0.7 to 2.8 cm.Six cases had complete fibrous capsule.Microscopically,the tumor was mainly consisted of well-differentiated smooth muscle cells and thick-walled vessels.Five cases were cavernous type,two cases were venous type and one case was solid type according to histological classification.The smooth muscle cells surrounding the vascular walls and the intervascular muscle bundles showed a positive reaction for smooth muscle actin (SMA) and desmin by immunohistochemical staining.Eight patients underwent complete resection of mass.During the surgery,the tumor was observed with clear boundary and capsule surrounded by mild adhesive tissue.Conclusions Angioleiomyoma of the eyelids or orbit was a uncommon benign tumor which was usually occured in adults,with well-encapsulated and composed of numerous thick-walled vessels and smooth muscle components.It should be considered in differential diagnosis of a well-circumscribed orbital mass,and distinguished from leiomyoma or cavernous hemangioma in pathological diagnosis.