泪腺腺样囊性癌12例的放射学特征及临床病理学分析

Imaging feature and Clinical histological analysis of 12 adenoid cystic carcinoma of the lacrimal gland

目的探讨泪腺腺样囊性癌的放射学特征及临床病理学特点。方法回顾性系列病例研究。2009年9月至2011年11月天津第一中心医院眼科共收治12例泪腺腺样囊性癌患者，所有诊断均经病理检查证实。男性5例，女性7例，年龄22—63岁，平均年龄42．6岁。12例患者均行眼眶CT检查，10例行MRI检查。采用电话及门诊复查方式对患者进行随访，其中2例患者失访。结果12例肿瘤均发生在泪腺眶部。临床表现为疼痛10例，眼球突出9例，上睑下垂4例，视力下降3例，复视2例。依据第7版美国癌症联合委员会对泪腺区肿瘤TNM分级：T1NOM01例，T2NOM04例，T4NOM07例。术前CT检查发现有眶壁骨质改变的7例患者中，病理学检查结果证实6例有眶壁骨质改变；术前cT检查未发现有眶壁骨质改变的5例患者中，病理学检查结果证实1例有眶壁骨质累及。CT检查对骨质累及检查的阳性率为6／7。术前MRI检查发现有眶壁骨质改变的7例中，6例经病理检查结果证实有眶壁骨质改变；术前MRI检查未发现眶壁骨质改变的3例均经病理检查结果证实无眶壁骨质改变。MRI对骨质累及检查的阳性率为6／7。7例病理检查结果证实有眶壁骨质改变的患者中，实体型5例、混合型2例。术后复发3例。结论泪腺腺样囊性癌的CT和MRI检查结果有一定的特征性。泪腺腺样囊性癌常伴有眶壁骨质的受累，实体型肿瘤组织本身的侵袭性较强。局部肿瘤的复发与肿瘤的病理学类型及分期（眶壁骨质是否受累）有一定关联。

Objective To study the imaging and histologic features of adenoid cystic carcinoma （ACC） of the lacrimal gland. Methods It was a restrospective case series study. Twelve patients with ACC of the lacrimal gland were surgically treated in Tianjin First Center Hospital from September 2009 to November 2011. The 5 men and 7 women aged from 22 to 63 years（average 42.6 years）. The imaging and histologic features of 12 cases with ACC of the lacrimal gland pathologically confirmed were retrospectively reviewed. Twelve cases were performed with CT scan, 10 cases with MRI scan. All patients were followed up by telephone and reexamination in the outpatient service, and 2 patients were lost to follow-up. Results The lesions originated in the orbital lobe of the lacrimal gland. The most commom presenting symptom was pain; it was followed by proptosis, ptosis, decreased visual acuity and diplopia. The 7th Edition of the American Joint Committee on Cancer TNM Classification system for Lacrimal Gland Tumors stages were as follows： T1NOM0 1 patients, T2NOM0 4 patients, T4NOM0 7 patients.＇ Preoperative CT imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients; this was histologically confirmed in 6 of the 7. Preoperative CT imaging suggested no bone involvement in 5 patients, 1 of whom had bone involvement by histology. The positive rate of CT scan was 6/7. Preoperative MRI imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients; this was histologically confirmed in 6 of the 7. Preoperative MRI imaging suggested no bone involvement in 3 patients who were confirmed by histology. The positive rate of MRI scan was 6/7. Overall,7 Of 12 histologically evaluable cases had bone invasion. Five of the histologically proven 7 patients with bone involvement had a predominantly basaloid pattern, 2 mixed pattern. Three patients had local recurrence. Conclusions The imaging for ACC of the lacrimal gland is characteristic. ACC of thelacrimal gland is associated with the high rate of bone invasion. The basaloid variety has more aggressive biologic behavior. The risk of local recurrence may be associated with the histologic types and stages of lacrimal gland adenoid cystic carcinoma.