眼附属器MALT淋巴瘤的临床分析

Clinical analysis of ocular adnexal MALT lymphoma

目的探讨黏膜相关组织淋巴瘤（MALT）在眼附属器包括眼睑、眼眶、泪腺等部位的特殊临床特征与治疗方法。方法回顾性分析32例眼附属器MALT淋巴瘤患者的临床表现、B超、CT、MRI检查结果，病理组织学和免疫组织化学结果以及综合治疗疗效与预后情况。结果32例眼附属器MALT淋巴瘤患者中男22例，女10例；年龄23．0～74．0岁，平均年龄64．1岁。18例发生于结膜，占56．3％（18／32）；9例发生于眼眶，占28．1％（9／32）；5例发生于泪腺，占15．6％（5／32）。B超检查肿块多表现为内回声不均匀（84．4％，27／32）或内回声高（28．1％，9／32）；CT检查多表现为中等密度（43．8±10．7）HU，密度均匀（84．6％，22／26）；MRI检查T1WI及T2WI多呈等信号，信号均匀。影像学检查后均行手术治疗联合放疗。随访1—12年，复发率为12．5％（4／32）。结论影像学检查可辅助诊断眼附属器MALT淋巴瘤，术后病理活体检查及免疫组织化学分型检查可确诊本病，眼附属器MALT淋巴瘤若早期诊断和治疗（手术治疗联合术后放疗）则预后较好。

Objective To study the clinical characteristic features and the treatment of ocular adnexal lymphoma. Methods Between 1996 to 2008, the clinical and imaging features, histopathological and immunohistochemical aspects, prognosis and results of treatments in 32 patients with ocular adnexal mucosa-associated lymphoid tissue （MALT） lymphoma were retrospectively analyzed. Results This group included 22 males and 10 females. The ages ranged from 23 to 74 years and the average age was 64. 1 years. Number of tumors located in the conjunctiva, the orbit and the lacrimal apparatus was 18/32 （56. 3% ）; 9/32 （28. 1% ） and 5/32 （ 15.6% ）, respectively. B ultrasound examination showed hyperechoic masses （28.1%, 9/32）, and the echo was not uniformed （84. 4%, 27/32）. CT examination showed a medium （43. 8 ＋ 10. 7 ）HU and uniform density （84. 6%, 22/26）. The signal patterns in MRI tended to be isointense in T1-, T2-weighted imaging （66. 67%, 6/9 ;88. 89%, 8/9）. After image examination, all of the 32 cases underwent surgical resection combined with radiotherapy. These cases were followed up from 1 to 12 years. The relapse rate was 12. 5%. Conclusions Image examination is useful for the diagnosis of ocular adnexal lymphoma. Pathologic and immunohistochemical examinations can confirm the diagnosis of ocular adnexal lymphoma. MALT lymphoma has a good prognosis after surgical resection combined with radiotherapy.