鼻泪管恶性肿瘤2例临床病理观察

Nasolacrimal duct malignant tumor: a clinicopathologic analysis of two cases

目的探讨鼻泪管恶性肿瘤的临床病理特征及鉴别诊断。方法观察2例鼻泪管恶性肿瘤的临床表现、影像学特点、组织病理学特征和免疫组化,并复习相关文献。结果 2例肿瘤均累及鼻泪管及周围组织,以溢泪等功能障碍为首发症状。例1镜下肿瘤细胞以小淋巴细胞样细胞为主,弥漫分布,其间散在分布中等大小肿瘤细胞,核仁明显。CD20弥漫(+)、Ki-67阳性指数70%。病理诊断:弥漫性大B细胞淋巴瘤。例2镜下肿瘤细胞巢状分布,部分细胞巢中央可见显著坏死,部分瘤细胞可见透明胞质。EMA、AR(+),Ki-67阳性指数50%。病理诊断:高分化皮脂腺癌。结论鼻泪管肿瘤极罕见,由于特殊的解剖特点,肿瘤难以完整切除,复发可能性很大,预后不佳。

Objective To explore the clinicopathologic features and differential diagnosis of malignant tumor occurring in nasolacrimal duct. Methods The clinical manifestations, imaging, histopathological and immunohistochemical features of two cases of nasolacrimal duct malignant tumor were analysed and the relevant literatures were reviewed. Results Both tumor masses were located in the nasolacrimal duct and the neighbouring soft tissue. The first clinical symptoms were epiphora and other dysfunction. In case 1, microscopic histology showed infiltration of flake small round malignant cells among which some medium-sized atypical ceils with visible nucleoli could be seen and immunohistochemical staining showed that tumor cells were positive for CD20; Ki-67 index was about 70%. Pathologic diagnosis was diffuse large B cell lymphoma. In case 2, microscopic histology showed that the tumor cell nests with coagulative tumor necrosis were composed of atypical sebaceous germinative cells and immunohistochemical staining showed that tumor ceils were positive for EMA, AR; Ki-67 index was about 70%. Pathologic diagnosis was well-differentiated sebaceous carcinoma. Conclusion Malignant tumor occurring in nasolacrimal duct with the possibility of local recurrence potential is extremely rare and total resection of tumor tissue is very hard because of the special anatomical position. Patients have a poor prognosis.