眼睑肿物术中快速冰冻切片的病理诊断

Intraoperative Frozen Section Diagnosis in Eyelid Tumors

目的:分析眼睑肿物改良Mohs法术中冰冻切片检查的病理诊断。方法:回顾性研究。收集2014年9月至2018年5月在青岛眼科医院就诊并因眼睑肿物行改良Mohs法术中快速冰冻切片的患者44例。术中送检切除的眼睑肿物,术中报告肿物性质及切缘肿瘤细胞残留情况,并决定进一步手术方案。结果:手术切除44例眼睑肿物,其中43例眼睑肿物经术中快速冰冻切片确定诊断。确诊为恶性肿瘤的31例(70%),其中基底细胞癌22例(50%),睑板腺癌5例(11%),鳞状细胞癌2例(5%),原位癌2例(5%)。确诊为良性病变12例,其中内翻性毛囊角化病5例,脂溢性角化病3例,慢性炎症2例,眼睑脓肿和淀粉样变性各1例。1例眼睑肿物术中无法确诊,经石蜡切片确诊为转移性肾细胞癌。在术中发现3例切缘存在可疑肿瘤细胞,扩大切除并行冰冻切片检查,直至切缘未见肿瘤细胞。术后随访均未发现眼睑肿物复发。结论:改良Mohs法术中冰冻切片检查可快速诊断眼睑肿物的性质,确定手术切缘是否残存肿瘤细胞,帮助临床手术医师选择手术切除范围,对于眼睑肿物的精准手术治疗具有指导性作用。

Objective:To analyze the intraoperative frozen section diagnosis of eyelid tumors with modified Mohs surgery.Methods:This was a retrospective case study.Forty-four patients who had surgical treatment for eyelid tumors with an intraoperative frozen section technique from September 2014 to May 2018 in Qingdao Eye Hospital were included in the study.The eyelid tumors and the margin of the tumors were sectioned for frozen section diagnosis.Results:In 44 cases of eyelid tumors,43 had a confirmed diagnosis, and 31(70%) had malignant tumors,including basal cell carcinoma in 22 cases (50%),meibomian gland carcinoma in 5 cases (11%),squamous cell carcinoma in 2 cases (5%) and in situ carcinoma in 2 cases (5%). Twelve cases were diagnosed with benign lesions,including 5 cases of varus follicular keratosis,3 cases of seborrheic keratosis,2 cases of chronic inflammation,and 1 case of eyelid abscess and 1 case of amyloidosis. Only one case could not be confirmed during surgery,and metastatic renal cell carcinoma was confirmed by paraffin section.In malignant tumors,the suspected tumor cells in the margin of the resection were found in 3 cases,and extended resections were performed until no tumor cells could be found. Postoperative follow-up showed there was no recurrence of eyelid tumors in any patients.Conclusions: Intraoperative frozen section with surgical treatment can rapidly evaluate the malignancy of eyelid tumors and the margin of resection,which can help clinical surgeons choose the scope of surgical resection for precision surgery.