眼附属器MALT淋巴瘤的临床分析

Clinical analysis of diagnosis and treatment of ocular adnexal mucosa-associated lymphoid tissue lymphoma

目的探讨[附属器包括[睑、结膜、[眶和泪腺等部位MALT淋巴瘤的临床诊断要点,影像学检查特征与治疗和预后。方法回顾性分析1994年至2005年在第二军医大学长征医院[科确诊的45例[附属器MALT淋巴瘤的临床表现、影像学检查、手术治疗及病理结果与预后情况。结果[附属器MALT淋巴瘤23例发生于[眶,10例发生于[睑,8例发生于泪腺,4例发生于结膜。B超、CT、MRI均能进行定位、定性诊断,B超能较好地显示病变内部结构和形态;CT对眶骨结构和肿瘤侵犯范围与周围组织的关系显示良好,具有定性诊断价值;MRI对软组织的分辨力强,成像参数根据不同的信号强度可提示病变的内部结构。45例均行手术治疗;其中22例辅以放疗,10例结合化疗。42例随访4～135个月,1例于手术切除后25个月转移至肺死亡,其余均存活。结论[附属器MALT淋巴瘤好发于[眶上方及[睑,影像学检查对MALT淋巴瘤的诊断及鉴别诊断有帮助。手术切除肿瘤,结合病理诊断和临床分期判断能提示较准确的病情估计,病变可长期局限,预后较好,一般不会出现全身转移和向弥漫性大细胞高度恶性淋巴瘤转化。

Objective To study the methds of preoperative diagnosis and treatment and prognosis under the guidance of imaging examination of the mucoa-associated lymphoid tissue （MALT） lymphoma which occur in the conjunctiva, eyelids, lacrimal gland and orbit. Methods To analyze retrospectively 45 cases of ocular adnexal MALT lymphoma between clinicopathological features, image examination, therapeutic measures and survival were discussed, who were adopted to Changzheng Hospital during 1994-2005. Results ocular adnexal MALT lymphoma which occur in the orbit （23 cases）, eyelids （10 cases）, lacrimal gland （8 cases）, conjunctiva （4 cases）. Each of B-scan, CT scan and MRI can locate and show the nature of the lesion, B-scan has a better value to display internal structure and shape of the lesions. CT can discover the stucture of the os orbitale and calcification, has the value to analyze the nature of lesions. MRI has correct discrimination of the soft tissue, imaging parameter based on different signal intensity to reveal internal structure of the lesions. All 45 cases were treated by surgery, 22 cases added to radiotherapy, 10 cases added to chemotherapy. 42 cases alive after followed-up for 4 to 135 months except one case after surgery 25 months metastasis in lung and died. Conclusions the ocular adnexal MALT lymphoma is commonly localized in superior part of the fossa orbitalis and eyelids, with the guidance of imaging examination, correct diagnosis and differential diagnosis could be taken. Surgery combined clinicopathological and clinical stage could offered precise estimation. Local relpse of the tumor is common, but seldom transforms to high-grade lymphoma and distance dissemination.