眼附属器MALT淋巴瘤的临床特征及复发因素分析

Clinical features and recurrence causes of ocular adnexal mucosa-associated lymphoid tissue lymphoma

目的通过对眼附属器MALT淋巴瘤的临床特征和复发因素的研究，以期对本病有一个全面的认识和了解，减少临床误诊、漏诊和复发，提高早期诊断率及生存率。方法回顾性分析1997年1月至2010年6月第二军医大学附属长征医院眼科收治的79例病理确诊为IE期眼附属器MALT淋巴瘤患者的临床表现、影像学结果、治疗方式及预后情况。结果79例病例中，原发于眼眶49例，结膜14例，泪腺10例，眼睑6例。发生在眼眶内的MALT淋巴瘤多呈包绕眼环的不规则生长，无明显边界，临床表现最为常见的是眼球突出、眼球运动受限。而发生在结膜的MALT淋巴瘤多位于穹窿部结膜，表现为结膜充血、肿块呈“鲑鱼肉”样外观。治疗方法主要包括手术及放射治疗。本组病例全部行手术治疗，全部切除58例，局部切除21例。所有患者均在手术后2～4周行眼局部放射治疗。放疗半年后，有15例出现复发。患者双眼发病（P=0．0143）和对放疗的初始反应（P〈0．0001）与肿瘤的复发有相关性；而性别、年龄、发病部位、肿瘤大小及手术方式等因素对复发均无影响。结论发生在眼眶内的MALT淋巴瘤多呈包绕眼环的不规则生长，无明显边界。患者双眼发病和对放疗的初始反应与肿瘤的复发有相关性，而手术方式等因素对复发均无影响。选择合适的手术方式可降低术后并发症的发生。

Objective To improve our understanding of the characteristics of ocular adnexal mu- cosa-associated lymphoid tissue （MALT） lymphoma so as to lower the rate of misdiagnosis, missed diagnosis and recurrence, as well as to improve the survival rate of patients. Methods The clinical features, imaging features, therapy and recurrence of 79 patients with biopsy-proven ocular adnexal MALT lymphoma at Shanghai Changzheng hospital between 1997 and 2010 were retrospectively re- viewed. Results Of the 79 cases, there were 49 patients in orbit, 14 in conjunctiva, 10 in lacrimal gland and 6 in eyelid. The MALT lymphomas occurring in the orbit usually present irregular growth wrapping the eye ring without obvious boundaries. The prevalent clinical manifestations included ex- ophthalmos, restricted eye movement, eyelid edema and the like, while the MALT lymphomas aris- ing in the conjunctiva usually located in conjunctival fornix, characterized by conjunctival congestion and bumps of salmon-like appearance. Treatments of these cases mainly included surgery and radia- tion therapy. The patients receiving all and part surgical removal was 58 and 21 cases, respectively. All the patients received partial radiotherapy on the eyes after surgery. Recurrence patients were 15cases after radiation therapy at six months. Bilateral onset （P =0.0143） and the initial reaction to ra- diotherapy （P 〈0.0001） were found to be correlated with the recurrence of ocular adnexal MALT lymphoma. Nonetheless, gender, age, locations, tumor size and surgical procedures had no effects on the recurrence. Conclusions The MALT lymphomas occurring in the orbit usually present irregular growth wrapping the eye ring and without obvious boundaries. Bilateral onset and the initial reaction to radiotherapy are correlated with the recurrence of ocular adnexal MALT lymphoma. Nonetheless surgical procedures have no effects on the recurrence. However, selecting a suitable operation can re- duce the incidence of postoperative complications.