Non-keratinising undifferentiated nasopharyngeal-type carcinoma of the lacrimal sac

Dear Editor,We present a case of non-keratinising undifferentiated nasopharyngeal-type carcinoma(UNPC)of nasolacrimal sac and review the previously reported cases and their treatment options and prognosis.Squamous cell carcinoma with a characteristic lymphoid stroma is a type of poorly differentiated carcinoma typically occurring in the nasopharynx[1].Non-keratinising UNPC,so called lymphoepithelioma-like carcinoma(LELC),of the lacrimal

Primary malignant melanoma of lacrimal sac

Dear Sir,We write to present a case report of primary malignant melanoma of the lacrimal sac.Tumors of the lacrimal sac are rare,and most of them are benign and of epithelial origin[1].Malignant melanoma of the lacrimal sac is even rarer accounting for 5%of lacrimal sac tumors and 0.7%of ocular melanoma[2,3].To our knowledge,only 27 cases with complete clinical information have ever been reported worldwide in English literature[4-8].The disease has an insidious onset and masquerades as a chronic

Primary lacrimal sac lymphoma:a case-based retrospective study in a Chinese population

AIM:To determine the clinical characteristics,pathological types,tumor markers,treatments,and outcomes of Chinese patients with primary lacrimal sac lymphoma.METHODS:This case-based retrospective study analyzed 15 Chinese patients with primary lacrimal sac lymphoma.The clinical data collected included gender,age at diagnosis,symptoms,imaging examination results,pathologic diagnosis,pathogen identification,tumor markers,treatments,follow-up,and prognosis.Descriptive statistics were used to characterize the patients.Progression-free survival(PFS)was defined as the time from surgery to the last follow-up,first record of tumor recurrence,or death.RESULTS:There were 7 males and 8 females with unilateral primar y lacrimal sac lymphoma in the lef t eye(n=6)or right eye(n=9).The initial symptom in 13 patients was epiphora,and 2 patients had redness and swelling in the lacrimal sac area.All patients ultimately developed epiphora,and 12 had masses in the lacrimal sac area.Analysis of preoperative plasma tumor markers indicated 14 patients had elevated homocysteine,9 had elevatedβ2-microglobulin,and 2 had elevated lactate dehydrogenase(LDH);2 patients had elevations of all three markers,and 1 patient had no elevation of any marker.All patients underwent surgical resection and 12 patients received postoperative chemotherapy.The pathological types were DLBCL(n=8),MALT lymphoma(n=5),and NK/T-cell lymphoma,nasal type(n=2).The mean followup time was 25.8mo(range:4-41)and 2 patients died.Seven patients who underwent mass excision combined with dacryocystorhinostomy(DCR)had no postoperative epiphora.Eight patients who only underwent mass excision had varying degrees of postoperative epiphora.Preoperative LDH elevation and NK/T-cell lymphoma,nasal type were associated with poor prognoses.CONCLUSION:Early diagnosis and treatment can lead to a good prognosis for most patients with primary lacrimal sac lymphoma.Mass resection combined with DCR can reduce the occurrence of post-surgical epiphora.The pathology type and tumor marker status are associated with prognosis.

Pathological,immunohistochemical and microbiologicalal analysis of lacrimal sac biopsies in patients with chronic dacrocystitis

AIM:To analyze cases of obstruction of the nasolacrimal duct which creates a fertile environment for secondary bacterial Infection and can result in dacryocystitis,which is a constant threat to cornea and orbital soft tissue and a potential source of endophthalmitis following intraocular surgery.The majority of obstructions of the lacrimal excretory outflow system are acquired ones occurring in adulthood and involving the distal parts of the system.Acquired obstruction may be primary/idiopathic or secondary to a wide variety of infectious,inflammatory,traumatic,mechanical,toxic or neoplastic causes mimicking idiopathic inflammation.These cases are treated by dacryocystorhinostomy(DCR).METHODS:The present study was conducted to determine the histopathologic,immunohistochemical and current microbiologic characteristics of lacrimal sac specimens in patients undergoing external dacryocystorhinostomy.RESULTS:Non-specific lacrimal sac pathology was present in all 33 cases and 81.8%of the cases showed moderate chronic inflammation with a chronic inflammatory score(CIS)ranging between 4 and 6,whereas 12.12%showed severe inflammatory changes with a CIS of 7.Mild degree of inflammation was seen in6.06%with a CIS of 3.The total prevalence of grampositive,gram-negative,and culture-negative samples were 59.4%,37.5%,and 3%respectively.CONCLUSION:Non-specific chronic inflammation withfibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens.

Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Transcatheter arterial infusion chemotherapy and embolization for primary lacrimal sac squamous cell carcinoma: A case report

BACKGROUND Although tumors of the lacrimal sac are rare,they represent a potentially lifethreatening situation that can easily be overlooked since patients present with features consistent with chronic dacryocystitis.Lacrimal sac squamous cell carcinoma is the most common lacrimal sac malignancy,but no definitive treatment is currently available.CASE SUMMARY We describe a 34-year-old unmarried male who presented with a red and swollen right lower eyelid,which gradually developed into a mass of the lower eyelid that obstructed vision in his right eye.He was treated with transcatheter arterial infusion chemotherapy and interventional embolization based on the tumor characteristics,and we also administered intensity-modulated radiotherapy and targeted therapy after tumor shrinkage.The tumor treatment demonstrated good efficacy,and the patient’s condition was stable after 10 mo of follow-up.CONCLUSION To our knowledge,this is the first report of lacrimal sac squamous cell carcinoma treated with transcatheter arterial infusion chemotherapy and interventional embolization,which might expand clinical treatment options for lacrimal sac carcinoma.

Lacrimal sac lymphoma: a case series and literature review

AIM: To study the clinical and pathological characteristics of the lacrimal sac lymphoma, which is rare but it is the major type of non-epithelial malignant tumor in the lacrimal sac region. METHODS: Sixty-four cases of malignant lacrimal sac tumors in our hospital from 1986 to 2020 were retrospectively reviewed. Eight cases of lacrimal sac lymphoma were carefully reviewed. RESULTS: There were five mucosal-associated lymphoid tissue(MALT) lymphomas, one diffused large B-cell lymphoma, one NK/T cell lymphoma, and one mantle cell lymphoma. All eight patients represented symptoms of epiphora with swelling in the lacrimal sac for a certain period of time and showed no signs of systemic involvement at the first time of clinical visits. They had received either chemotherapy or radiotherapy after surgery. Long-term follow-up(from 11 to 220 mo) showed that, except one patient with MALT lymphoma died for unknown reasons at 104 mo after surgery, the other 7 patients were all alive with no signs of local recurrence, neither in other organs. CONCLUSION: Non-epithelial malignant tumors of the lacrimal sac are rare and lymphoma is the major subtype.

Imaging and histopathological findings of lacrimal sac lymphoma

Background Lymphoma of the lacrimal sac is rare,often misdiagnosed clinically.This study aimed to investigate the imaging features of these tumors and provide suggestions to aid the diagnosis.Methods In this retrospective study,five cases were assessed according to magnetic resonance imaging （MRI）,computed tomography （CT）,and pathological findings.All five patients underwent MRI and contrast-enhanced T1-weighted imaging （CE-T1WI）,of which four patients underwent dynamic contrast-enhanced （DCE） MRI and three patients underwent CT.Results Four cases and one case had a lymphoma in left and right medial canthus,respectively.Soft tissue surrounding the eyelids,subcutaneous tissue in the nasal dorsum,and involvement of the entire nasolacrimal canal were demonstrated in all five lesions.In two cases,the mass invaded the extraconal space.In one case,the mass invaded the adjacent medial rectus muscle and nasal area.Well-defined margins were observed in three cases and ill-defined margins in two cases.All cases showed homogeneous isointense lesions on T1Wl.Four cases showed homogeneous isointensity and one case demonstrated heterogeneous isointensity on T2Wl.After contrast injection,the lesion showed slight homogeneous isointensity and moderate enhancement in four cases and heterogeneous isointensity and moderate enhancement in one case.In the four patients who underwent DCE-MRI,a plateau pattern was revealed in three cases and washout pattern in one case.In the three cases who underwent CT,two cases had isointense and one case had hyperintense lesions.The lacrimal duct was remodeled and the surrounding bone compressed.Conclusions Tumors of the lacrimal sac showed homogeneous and isointense patterns on T1WI and T2WI with mildto-moderate enhancement and a plateau pattern on DCE-MRI.CT showed remodeling of the lacrimal duct with bone compression.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system:A case report

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint,and it may derive from amyloidosis in rare cases.There are a few reports about localized amyloidosis,and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year.Physical examination touched a firm lump in the left lacrimal sac.Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus.Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct.During an endoscopic exploration and excision,a large number of dacryoliths were exposed.Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction.In clinical practice,we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

正常泪囊在计算机断层扫描图像中的形态观察

目的探讨正常泪囊在计算机断层扫描图像中的形态及变化的原因。方法回顾性分析2020年9月至2021年1月安徽医科大学第一附属医院放射科提供的50例(100眼)来检人员头颅CT扫描图像资料,分别在软组织窗和肺窗观察其计算机断层扫描图像中泪囊的影像,根据泪囊类型和形态分为4组:泪囊空气充盈组(31眼)、泪囊空气半充盈组(20眼)、泪囊半封闭组(16眼)、泪囊全封闭组(33眼),比较各组泪囊形态的变化。结果泪囊空气充盈组软组织窗冠状位泪囊为空气密度影,肺窗轴位泪囊腔形状为椭圆形。泪囊空气半充盈组软组织窗冠状位泪囊为空气密度影,轴位上部泪囊形状为椭圆形,下部为弧形;肺窗轴位上部泪囊腔形状为椭圆形,下部为裂隙形。泪囊半封闭组软组织窗冠状位上部泪囊为空气密度影,下部为软组织密度影;肺窗轴位上部泪囊腔形状为椭圆形,下部泪囊腔消失。泪囊全封闭组软组织窗为软组织密度影,肺窗轴位泪囊腔消失。下部泪囊腔横截面由椭圆形变为裂隙形或消失可能原因是下部泪囊外侧壁向鼻侧移位;泪囊软组织密度影范围扩大,而空气密度影范围减少或消失可能原因是眶内软组织向鼻侧移位,正常泪囊CT图像中软组织密度影的来源是眶内软组织。结论正常泪囊的形态可能不是固定不变,而是在不停变化的过程中;眶内软组织压力可向鼻侧推动,进而改变下部泪囊形态。

Endoscopic dacryocystorhinostomy in acute dacryocystitis:a multicenter study in China

AIM:To repor t the clinical profile,endoscopic dacryocystorhinostomy(En-DCR)management,and acute dacryocystitis(AD)outcomes in China.METHODS:Clinical data of 554 adult AD patients(554 eyes)who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed.Clinical profile,En-DCR management,and outcomes of all cases were recorded.The anatomical and functional success were evaluated for 12mo post-operation.RESULTS:The analysis included 149 males and 368 females with a median age of 55.2y(range:18-84y).There were 459 eyes with a history of epiphora or purulent secretion.The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540(66.1±58.2)mo.Fifty-nine eyes had a history of the previous acute attack.Seventy-four eyes developed a cutaneous fistula,while 11 eyes had post septal cellulitis pre-operation.En-DCR with an anatomical success of 91.7%and functional success of 90.1%.The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates.CONCLUSION:En-DCR can be performed during an acute episode in AD with a success rate of over 90%.

获得性泪囊黏液囊肿的临床特征、影像学表现和内镜手术治疗效果

目的探讨获得性泪囊黏液囊肿(ALSM)的临床特征、影像学表现和内镜下泪囊鼻腔吻合术(En-DCR)的治疗效果。方法回顾性分析2016年1月-2021年3月于温州医科大学附属眼视光医院就诊并接受En-DCR联合双管人工泪管植入术治疗的63例(63眼)ALSM患者的术前和术后12个月随访资料,记录并分析纳入患者的临床特征、影像学表现和内镜下手术治疗效果。最终纳入57例患者(男21例,女36例),年龄25~71岁,平均(52.89±11.66)岁,右眼30眼,左眼27眼。所有患者均有溢泪和溢脓的泪道阻塞病史。结果CT检查发现泪囊扩大,相邻骨质没有破坏。MRI检查显示泪囊扩大,囊内的液体被扩大的泪囊壁与周边组织分隔。内眦部泪囊区肿块在手术切开泪囊时明显缩小,其皮肤面的轻度肿胀在术后1周内完全消失。术后随访12个月,En-DCR的解剖成功率为92.98%(53/57),功能成功率为89.47%(51/57),未出现囊肿复发、视力下降和感染等并发症。结论ALSM患者均有泪道阻塞病史。影像学检查对ALSM的诊断有参考价值。En-DCR联合人工泪管植入治疗ALSM,安全有效,值得临床推广。

鼻内窥镜下鼻腔泪囊吻合置管治疗慢性泪囊炎合并鼻泪管阻塞

目的:探讨鼻内窥镜下鼻腔泪囊吻合置管治疗慢性泪囊炎合并鼻泪管阻塞的疗效。方法:选取2011-12/2014-12我院收治的慢性泪囊炎合并鼻泪管阻塞患者70例70眼,随机分为对照组与研究组,对照组患者行鼻内窥镜下鼻腔泪囊吻合术治疗,研究组患者行鼻内窥镜下鼻腔泪囊吻合置管术治疗,对比两组患者术后1、6、12mo时治疗总有效率及瘘口面积。结果:术后1mo,对照组患者治疗总有效率97%与研究组100%,差异无统计学意义(P>0.05);术后6mo,研究组患者总有效率97%与对照组77%,差异有统计学意义(P<0.05);术后12mo,研究组总有效率94%明显高于对照组71%,差异有统计学意义(P<0.05)。两组患者术后1mo瘘口面积对比无统计学意义(P>0.05),研究组患者术后6、12mo瘘口面积大于对照组,差异有统计学意义(P<0.05)。结论:慢性泪囊炎合并鼻泪管阻塞患者行鼻内窥镜下鼻腔泪囊吻合置管治疗的效果显著。

鼻内镜下去除鼻黏膜瓣泪囊鼻腔吻合术治疗慢性泪囊炎的疗效观察

目的比较鼻内镜泪囊鼻腔吻合术(EN-DCR)中去除和保留鼻黏膜瓣治疗慢性泪囊炎的临床效果。方法采用随机对照试验方法将2017年1~12月我院收治的49例(52只眼)慢性泪囊炎患者随机分为保留鼻黏膜组(A组)和去除鼻黏膜组(B组),A组24例(26只眼),B组25例(26只眼)。A组采用传统保留鼻黏膜的EN-DCR手术方法,B组采用EN-DCR术中去除吻合口处鼻黏膜的手术方法。术后随访6个月,比较两组术后手术成功率、吻合口瘢痕组织形成以及吻合口周围肉芽组织增生情况。结果所有患者随访至6个月时,A组患者行EN-DCR术后成功率为96.15%(25/26),B组患者行EN-DCR术后成功率为92.31%(24/26),差异无统计学意义(P>0.05)。A组患者吻合口肉芽组织形成率15.38%(3/26),B组患者吻合口肉芽组织形成率42.31%(11/26),差异有统计学意义(P<0.05)。A组患者吻合口瘢痕组织形成率19.23%(4/26),B组患者吻合口瘢痕组织形成率46.15%(12/26),差异有统计学意义(P<0.05)。结论鼻内镜下鼻腔泪囊吻合术治疗慢性泪囊炎创伤小、恢复快且成功率高;术中保留鼻黏膜可以减少肉芽组织及瘢痕组织的形成。

泪囊窝与毗邻结构解剖关系的CT影像学研究

目的研究泪囊窝与毗邻结构的解剖学关系。方法收集79例泪道阻塞患者的鼻窦CT,在中鼻甲前端鼻腔外侧壁附着处最低点水平位,测量泪囊窝泪前后嵴的距离,测量泪囊窝内侧壁上颌骨额突的厚度,观察泪囊窝上颌骨额突的走形。在中鼻甲前端鼻腔外侧壁附着处以下平面,观察钩突与泪囊窝鼻腔外侧壁投影的关系。结果发现泪囊窝泪前后脊距离为3.5~13.1 mm[(7.84±1.78)mm],泪囊窝内侧壁上额骨额突厚度为0.4~8.8 mm[(2.57±1.30)mm],上颂骨额突向内型占49.48%,向外型占50.52%。中鼻甲前端鼻腔外侧壁附着以下平面,钩突附着处位于泪囊窝鼻腔外侧壁投影后方者占6.98%;位于泪囊窝鼻腔外侧壁投影之中者占89.53%;前方者3例占3.49%。结论术前通过鼻窦CT可以准确定位泪囊在鼻腔的投影,选择合适的鼻黏膜切口位置,判断手术难易,减少并发症。

泪囊按摩治疗新生儿泪囊炎

目的:观察<4月龄的新生儿泪囊炎首诊患者,泪囊按摩的疗效。方法:年龄15天龄～4月龄新生儿泪囊炎患者26例26眼,泪囊按摩治疗2mo,观察发生的并发症,患者家属的依从性及治愈率。结果:我们观察到3例患者出现并发症,所有患者均有较好的依从性,16例患者治愈,治愈率61.5%。结论:泪囊按摩可作为4月龄内新生儿泪囊炎患者治疗的首选。

泪囊黏液囊肿的鼻泪管支架植入治疗观察

目的 评价鼻泪管支架植入术在治疗泪囊黏液囊肿中的应用价值。方法 对 2 1例 ( 2 1眼 )泪囊黏液囊肿患者行鼻泪管支架植入术 ,逆行扩张鼻泪道后植入特制的鼻泪管支架 ,术前术后行数字减影泪道造影检查 ,分析其疗效。结果 2 1眼均成功植入鼻泪管支架 ,手术成功率为 10 0 %。术后随访 12～ 43个月 ,有效率为 10 0 %。无严重并发症的发生。结论 鼻泪管支架植入术治疗泪囊黏液囊肿操作简便 ,具有良好的临床效果 ,值得推广。

鼻内镜下泪总管开放术治疗泪囊吻合口闭锁的临床分析

目的：探讨鼻内镜下泪总管开放术治疗泪囊吻合口闭锁的有效性和安全性,指导临床应用。方法：回顾性临床研究。选取泪囊吻合口闭锁患者66例70眼作为研究对象,施行鼻内镜下泪总管开放术。术后随访3~24mo,通过临床资料收集、门诊随访和电话随访相结合的方法,记录患者术后主观感受,观察手术效果和并发症情况,以及处理并发症后的效果,对数据结果进行分析,评价鼻内镜下泪总管开放术的临床意义。结果：溢泪症状完全缓解或显著改善68眼（97%）,泪道冲洗通畅且无返流。术后并发症包括：内眦部异物不适感51眼（73%）,鼻腔内偶伴异物不适感22眼（31%）,泪总管开口周围肉芽组织增生4眼（6%）,球结膜局限性充血16眼（23%）,泪道引流管脱出3眼（4%）。结论：鼻内镜下泪总管开放术可有效治疗泪囊吻合口闭锁。该手术方法成功率高、并发症少、安全有效、值得临床推广。

产前超声诊断胎儿泪囊囊肿

目的探讨产前超声诊断胎儿泪囊囊肿的价值。方法回顾性分析12胎产前超声诊断为胎儿泪囊囊肿的声像图特征,并追踪其妊娠结局。结果产前超声检出12胎胎儿泪囊囊肿,孕周为26～36周,其中双侧3胎,单侧9胎。泪囊囊肿典型超声声像图表现为眼眶内下方见囊性无回声。6胎囊肿产前自行消失;1胎经终止妊娠后确定存在泪囊囊肿;2胎分娩后囊肿自行消失;1胎分娩后因新生儿呼吸窘迫而接受外科手术治疗;2胎失访。结论胎儿泪囊囊肿有其特征性超声表现,正确诊断有利于指导临床工作。

泪囊切开逆向插管治疗复杂性泪小管断裂伤

目的:探讨经泪囊切开逆向插管法治疗复杂性泪小管断裂的手术效果。方法:外伤性泪小管断裂患者45例,采用经泪囊切开逆向置硬膜外麻醉导管吻合泪小管断裂。结果:45例经6mo～1a随访观察,获得解剖复位,自觉不流泪,冲洗通畅者40例(89%);自觉轻微流泪,冲洗泪道通而不畅者3例(7%);冲洗泪道不通者2例(4%)。结论:经泪囊切开逆向插管法是一种治疗复杂性泪小管断裂的有效方法。