Treatment of lacrimal gland adenoid cystic carcinoma:a systematic review and Meta-analysis

AIM:To evaluate lacrimal gland adenoid cystic carcinoma(LGACC)of prognosis in patients who underwent different treatment regimens.METHODS:We searched PubMed,EMBASE,and the Cochrane Library for studies done on the treatment of LGACC,between January 1987 and April 2022.A Metaanalysis was conducted to pool the 5-year overall survival rate(OR),and the 5-year recurrence rate(RR)and 5-year metastasis rate(MR)were assessed.RESULTS:The 30 studies involved 585 patients were included in the Meta-analysis.The pooled 5-year OR with surgery alone was 50%,the 5-year RR was 63%,and the 5-year MR was 34%.The pooled 5-year OR with surgery and adjuvant radiotherapy combined was 67%(95%CI 61%,73%),the 5-year RR was 41%,and the 5-year MR was 35%.The pooled 5-year OR with surgery and adjuvant chemoradiotherapy combined was 72%(95%CI 59%,84%),the 5-year RR was 48%,and the 5-year MR was 36%.The pooled 5-year OR with surgery,intra-arterial cytoreductive chemotherapy,and adjuvant chemoradiotherapy combined was 78%(95%CI 68%,89%),the 5-year RR was 15%,and the 5-year MR was 27%.CONCLUSION:Comprehensive treatment is more effective than surgery alone.Surgery combined with intraarterial chemotherapy and adjuvant chemoradiotherapy seems to add value to the therapeutic effect of comprehensive treatment of LGACC but further high-quality research is required to validate this.

Dry environment on the expression of lacrimal gland S100A9,Anxa1,and Clu in rats via proteomics

●AIM:To investigate the underlying mechanism of dry environment(autumn dryness)affecting the lacrimal glands in rats.●METHODS:Twenty Sprague-Dawley rats were randomly divided into two groups.The rats were fed in specific pathogen free environment as the control group(n=10),and the rats fed in dry environment as the dryness group(n=10).After 24d,lacrimal glands were collected from the rats.The tissues morphology was observed by hematoxylineosin(HE)staining.Tandem mass tags(TMT)quantitative proteomics analysis technology was used to screen the differential expressed proteins of lacrimal glands between the two groups,then bioinformatics analysis was performed.Further,the immunohistochemical(IHC)method was used to verify the target proteins.●RESULTS:In dryness group,the lacrimal glands lobule atrophied,the glandular cavities enlarged,the sparse nuclear distribution and scattered inflammatory infiltration between the acinus were observed.The proteomics exhibited that a total of 195 up-regulated and 236 downregulated differential expressed proteins screened from the lacrimal glands of rats.It was indicated that the biological processes(BP)of differential expressed proteins mainly included cell processes and single BP.The cellular compositions of differential expressed proteins mainly located in cells,organelles.The molecular functions of differential expressed proteins mainly included binding,catalytic activity.Moreover,the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis showed that the differential expressed proteins mainly involved lysosome,complement and coagulation cascade,and ribosome pathway.The IHC result verified that the up-regulated expression proteins of Protein S100A9(S100A9),Annexin A1(Anxa1),and Clusterin(Clu)in lacrimal glands of rats in dryness group were higher than control group.●CONCLUSION:The up-regulated expression proteins of S100A9,Anxa1,and Clu may be the potential mechanisms of dry eye symptoms caused by dry environment.This study provides clues of dry environments causing eye-related diseases for further studies.

Prognostic factors for lacrimal gland adenoid cystic carcinoma:a retrospective study in Chinese patients

AIM:To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma(LGACC)in Chinese patients.METHODS:Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC.Local recurrence,metastasis,and disease-specific death were the main outcome measures.Univariate and multivariate analyses were performed by the Kaplan-Meier method and a Cox proportional hazard model.RESULTS:This retrospective cohort study included 45 patients with pathologically confirmed LGACC between January 2008 and June 2022.Tumor(T)classification(P=0.005),nodal metastasis(N)classification(P=0.018)and positive margin(P=0.008)were independent risk factors of recurrence;T(P=0.013)and N(P=0.003)classification and the basaloid tumor type(P=0.032)were independent risk factors for metastasis;T classification(P<0.001)was an independent factor of death of disease.In the further analysis,the durations from first surgery to radiotherapy is correlated with metastatic risk in LGACC patients with basaloid component(P=0.022).CONCLUSION:Histological subtype should be emphasized when evaluating prognosis and guiding treatment.Timely radiotherapy may reduce the risk of metastasis in patients with basaloid component.

Comparison of biological behavior of lacrimal gland adenoid cystic carcinoma with high-grade transformation cells

AIM:To evaluate the differences between human lacrimal gland adenoid cystic carcinoma with high-grade transformation(LACC-HGT)primar y cells cultured by high-grade transformation tissue and non-high-grade transformation(non-HGT)primary cells cultured by non-highgrade transformation tissue in proliferation,metastasis,drug susceptibility,and genes.METHODS:LACC-HGT primary cells were established by tissue block culture,and the 4^(th)to 10^(th)generation primary cells were selected as research objects.The cells were preliminarily identified by immunofluorescent staining.The differences between non-HGT and LACC-HGT primary cells in terms of proliferation,metastasis,and drug susceptibility were compared by cell counting kit-8(CCK-8)assay,wound healing,and drug sensitivity experiments.Differentially expressed genes were screened using mRNA array.Gene expression was analyzed using real-time quantitative polymerase chain reaction(RT-qPCR).RESULTS:LACC-HGT primary cells were successfully cultured by tissue block culture.Immunofluorescence staining results showed that cytokeratin(CK)and CK7 expression levels were positive in LACC-HGT primary cells.CCK-8 results showed that the proliferation ability of LACCHGT cells was significantly higher than that of non-HGT cells.Wound healing experiment showed that the migration ability of LACC-HGT cells was significantly higher than that of non-HGT cells.LACC-HGT cells were also less sensitive to cisplatin and paclitaxel than non-HGT cells.Compared with non-HGT cells,9566 differentially expressed genes were found in LACC-HGT primary cells,of which 5162 were upregulated and 4404 were down-regulated.The expression of N-acetylneuraminate pyruvate lyase(NPL),MARVEL domain containing 3(MARVELD3),syntabulin(SYBU),and allograft inflammatory factor 1(AIF1)was higher in LACCHGT cells than in non-HGT cells,whereas that of periostin(POSTN)was lower.CONCLUSION:LACC-HGT primary cells have faster proliferation,stronger migration ability,and poorer sensitivity to chemotherapy drugs than non-HGT primary cells.The expression of mRNAs in non-HGT and LACC-HGT primary cells are significantly different.These features are speculated to be the reasons why high-grade transformation tissues exhibit higher malignant degree and poorer prognosis than their counterparts.

Different serum levels of IgG and complements and recurrence rates in IgG4-positive and negative lacrimal gland benign lymphoepithelial lesion

·AIM:To analyze the differences in immune indicators and prognosis between Ig G4-positive and negative lacrimal gland benign lymphoepithelial lesion(LGBLEL).·METHODS:This was a single-center retrospective clinical study including 105 cases of Ig G4-positive LGBLEL and 41 cases of Ig G4-negative LGBLEL.Basic information,related indicators of peripheral venous blood samples using immunoscattering turbidimetry,treatment(partial surgical excision and glucocorticoid therapy)and prognosis(recurrence and death)were collected.Survival curves for recurrence were created using the Kaplan-Meier analysis.Univariate analysis and multivariate regression analysis were used to analyze prognostic factors.·RESULTS:The mean age was 50.10±14.23y and 44.76±11.43y(P=0.033)in Ig G4-positive and negative group respectively.The serum C3 and C4 was lower in Ig G4-positive group(P=0.005,P=0.002),while the serum Ig G and Ig G2 was higher in Ig G4-positive group(P=0.000 and P=0.008).Twenty-one cases had recurrence in Ig G4-positive group and 3 cases recurrence in Ig G4-negative group.The 5-year recurrence-free cumulative percentages of Ig G4-positive group was 81.85%,and 83.46%in the Ig G-negative group(P=0.216).The history of preoperative glucocorticoid therapy,serum C4,Ig G1 and Ig G2 were the factors affecting recurrence in Ig G4-positive group,while serum C4,and Ig G1 were the factors affecting recurrence of LGBLEL.·CONCLUSION:Serum C4 and Ig G1 are the factors affecting recurrence of LGBLEL,while the Ig G4 does not affect recurrence of LGBLEL.

Association analysis of BclI with benign lymphoepithelial lesions of the lacrimal gland and glucocorticoids resistance

AIM:To evaluate the relationship between gene polymorphism(BclI,ER22/23EK,N363S)and the occurrence,progression and sensitivity to glucocorticoid of lacrimal gland benign lymphoepithelial lesion(LGBLEL).METHODS:Clinical peripheral blood samples of 52 LGBLEL patients and 10 normal volunteers were collected for DNA extraction and polymerase chain reaction sequencing to analyze single nucleotide polymorphism(SNP)genotypes.The lacrimal tissues of LGBLEL were surgically removed and made into paraffin sections for subsequent hematoxylin-eosin(HE)and Masson staining analysis.The duration of disease and hormone use of LGBLEL patients from diagnosis to surgery were also analyzed.The Meta-analysis follows PRISMA guidelines to conducted a systematic review of human studies investigating the relationship between the NR3C1 BclI polymorphism and glucocorticoids(GCs)sensitivity.RESULTS:There was no association between ER22/23EK or N363S and the occurrence of LGBLEL or GCs sensitivity(P>0.05);BclI GC genotype was closely related to GCs resistance(P=0.03)as is the minor allele C(P=0.0017).The HE staining and Masson staining showed that the GC genotype of BclI remarkably slowed down the disease progression and reduced fibrosis(P<0.05),especially for GCs-dependent patients(P<0.0001).Meta-analysis showed that BclI was not significantly associated with GCs responsiveness.CONCLUSION:The LGBLEL patients who carry the NR3C1 BclI allele C may be more sensitive to GCs and associated with lower fibrosis and slower disease progression.The results may guide the clinical treatment strategy for the LGBLEL patients.

Effects of extract of Buddleja officinalis on partial inflammation of lacrimal gland in castrated rabbits with dry eye

AIMTo assess the effects of extract of Buddleja officinalis on tear secretion volume, tear film stability, expressions of TGF-β1, IL-1β, TNF-α in lacrimal gland of castrated rabbits with dry eye.

PPARγ: the dominant regulator among PPARs in dry eye lacrimal gland and diabetic lacrimal gland

AIM: To investigate the regulatory roles of the members of the peroxisome proliferator-activated receptor(PPAR)family in lacrimal gland dysfunction under conditions of desiccating stress or diabetes.METHODS: Quantitative polymerase chain reaction(qPCR) was used to examine the expression of PPARs in the cornea, conjunctiva, meibomian gland, and lacrimal gland in adult rats. The rats were divided into 3 groups:a control group, dry eye group, and diabetic group. The phenol red threads test, tear film break-up time(BUT) test and fluorescein staining were carried out to evaluate the development of dry eye. Based on bioinformatics research,qP CR was used to examine the expression level of PPARγ,tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β),interleukin-6(IL-6), sirtuin 1(Sirt1), myeloid differentiation factor 88(MyD88) and transforming growth factor-β(TGF-β)in the lacrimal glands.RESULTS: PPARα and PPARβ/δ were mainly expressed in the conjunctiva and the lacrimal gland, respectively.However, PPARγ was expressed in both the conjunctiva and lacrimal gland, at much higher levels than those measured for PPARα and PPARβ/δ. Dry eye rats and diabetic rats both showed decreased tear secretion, shortened BUT,and increased corneal staining. Significant changes in gene expression were observed compared with the control group. In the lacrimal glands of dry eye rats and diabetic rats, expression of PPARγ decreased(P<0.05), expression of Sirt1 also decreased(P<0.01), whereas expression of TNF-α, IL-1β, IL-6, MyD88, and TGF-β increased(P<0.05).CONCLUSION: Among PPARs, PPARγ might play a dominant role in the regulation of metabolic-and inflammatorysignaling pathways on the ocular surfaces and in lacrimal glands. Down-regulation of PPARγ is highly relevant to lacrimal gland dysfunction under desiccating-stress and diabetic conditions. PPARγ, thus, is a potential therapeutic target in the treatment of environment-or diabetes-induced dry eye diseases.

B cell receptor signaling pathway involved in benign lymphoepithelial lesions of the lacrimal gland

AIM：To detect the expression of B cell receptor signaling pathway（BCRSP） in lacrimal gland benign lymphoepithelial lesions（LGBLEL）.METHODS：Gene microarray was used to compare whole-genome expression in lacrimal gland tissues from LGBLEL patients to tissues from orbital cavernous hemangioma（control tissues）. Expression of BCRSP was confirmed by polymerase chain reaction（PCR） and immunohistochemistry. RESULTS：The expression of 22 genes of the BCRSP increased significantly in LGBLEL patients. PCR analysis showed that CD22, CR2, and BTK were all highly expressed in LGBLEL tissues. Immunohistochemical analysis showed that CR2 protein was present in LGBLEL, but CD22 and BTK proteins were negative. CR2, CD22, and BTK were not observed in the orbital cavernous hemangiomas with either PCR or immunohistochemistry. CONCLUSION：BCRSP might be involved in the pathogenesis of LGBLEL.

Similar therapeutic effects of ^(125I) seed radiotherapy andγ-ray radiotherapy on lacrimal gland adenoid cystic carcinoma

AIM:To evaluate the survival outcomes of patients with lacrimal gland adenoid cystic carcinoma who underwent eye-sparing surgery combined with ^(125I)seed implantation radiotherapy or local externalγ-ray radiotherapy.METHODS:In this retrospective comparative case series,the clinical records of 27 primary and 8 recurrent patients were reviewed.Univariate and multivariate analyses were used to identify risk factors associated with distant metastasis(DM),and the overall survival(OS)after the initial surgery was analyzed.RESULTS:The median follow-up after radiotherapy was 36 mo(range 6-120 mo).At the last follow-up after radiotherapy,26(74.3%)patients had no evidence of disease,7(20%)patients had DM,2(5.9%)patients died of DM,and 1 patient with DM was lost to follow-up.Univariate analyses showed that duration of symptoms,bone destruction,T stage classification,and wide excision surgery were risk factors influencing DM(P<0.05).The 5-year and 10-year OS rates after the initial surgery were 95.8%and 79.9%,respectively.The 5-year DM-free survival and disease-free survival rates after radiotherapy were 66.4%and 52.7%,respectively.CONCLUSION:^(125I)seed radiotherapy and local externalγ-ray radiotherapy may have similar therapeutic effects in preventing DM.Patients with T1/T2 stage disease have a better prognosis than those with T3/T4 stage disease.

Association of TCR-signaling pathway with the development of lacrimal gland benign lymphoepithelial lesions

·AIM: To identify the association of the T cell receptor(TCR) signaling with the development of benign lymphoepithelial lesions(BLEL) of the lacrimal gland.· METHODS: We collected affected lacrimal gland tissues from 9 patients who underwent dacryoadenectomy in the Capital Medical University Beijing Tongren Hospital Eye Center between August2010 and March 2013 and were confirmed to have lacrimal gland BLEL by histopathological analysis. Tumor tissues from 9 patients with orbital cavernous hemangioma were also collected and used as control.Whole genome gene expression microarray was used to compare gene expression profiles of affected lacrimal gland tissues from patients with lacrimal gland BLEL to those from of orbital cavernous hemangiomas.Differential expression of TCR pathway genes between these tissues was confirmed by polymerase chain reaction(PCR) and immunohistochemistry.·RESULTS: Microarray analysis showed that in lacrimal glands with BLEL, 32 signaling pathways were enriched in the upregulated genes, while 25 signaling pathways were enriched in the downregulated genes. In-depth analysis of the microarray data showed that the expression of 27 genes of the TCR signaling pathway increased significantly. To verify the differential expression of three of these genes, CD3, CD4, and interleukin(IL)-10, reverse transcription-PCR(RT-PCR)and immunohistochemistry assays were performed. RT-PCR analysis showed that CD3 and CD4 were expressed in the lacrimal glands with BLEL, but IL-10 was not expressed. Immunohistochemistry confirmed that CD3 and CD4 proteins were also present, but IL-10 protein was not. CD3, CD4, or IL-10 expression was not found in the orbital cavernous hemangiomas with either RT-PCR or immunohistochemistry.· CONCLUSION: TCR signaling pathway might be involved in the pathogenesis of lacrimal gland BLEL.

Space-occupying lesions of the lacrimal gland at one tertiary eye center in China: a retrospective clinical study of 95 patients

AIM: To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS: A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS: Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION: Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis.

Lacrimal gland tumors in Turkey：types,frequency,and outcomes

AIM： To evaluate the clinical, radiological, and treatment features of lacrimal gland tumors.METHODS： Retrospective review of 99 eyes of 92 patients with lacrimal gland tumors diagnosed and managed in a single institution between January 1999 and March 2017. Clinical and radiological features, histopathology, treatment methods, and prognosis were evaluated.RESULTS： The mean patient age was 40.3（range： 7-80）y.The diagnosis was made histopathologically in 91（91.9%） tumors and on a clinical and radiological basis in 8（8.1%） tumors. Final diagnoses included idiopathic orbital inflammation（pseudotumor） in 46（46.5%） lesions, pleomorphic adenoma in 14（14.1%）, adenoid cystic carcinoma in 12（12.1%）, granulomatous inflammation in 10（10.1%）, lymphoma in 5（5.0%）, benign reactive lymphoid hyperplasia in 3（3.0%）, dacryops in 3（3.0%）, carcinoma ex pleomorphic adenoma in 2（2.0%）, adenocarcinoma in 1（1.0%）, dermoid cyst in 1（1.0%）, cavernous hemangioma in 1（1.0%）, and leukemic infiltration in 1（1.0%）. Nonepithelial tumors comprised 64.6%（n=64） of all lacrimal gland tumors, epithelial tumors 32.3%（n=32）, dermoid cyst 1%（n=1）, cavernous hemangioma 1%（n=1）, and leukemic infiltration 1%（n=1）. There were in total 78（78.8%） benign and 21（21.2%） malignant tumors. CONCLUSION： Overall, 65% of lacrimal gland tumors were of non-epithelial origin and 32% of epithelial origin. By histopathology and clinical evaluation, 79% of lacrimal gland tumors were benign. The most common lacrimal gland tumors include idiopathic orbital inflammation（46.5%）, epithelial（32.3%）, and lymphoproliferative（8.1%） lesions.

Incidence of orbital,conjunctival and lacrimal gland malignant tumors in USA from Surveillance,Epidemiology and End Results,1973-2009

AIM： To determine the types and incidence of tumors affecting the orbit, conjunctiva and lacrimal glands and to study the trend line of these tumors in the United States from 1973 to 2009.METHODS： We used the publicly available Surveillance, Epidemiology and End Results （SEER） database registries to determine the incidence rates. Age was adjusted to the 2000 US Standard Population. Patients were stratified according to age group, gender, race and histological grouping of tumor lesions. Three age groups were defined： 0-19, 20-49 and ≥50y. Annual percentage changes were calculated to examine trends.RESULTS： The overall age adjusted incidence rate was 3.39 （95%CI： 3.27-3.52） per million person-years. The tumors were more prevalent in age group ≥50 counting 9.51 （95%CI： 9.11-9.92） per million person-years. Most of the soft tissue sarcomas occurred in the young age with incidence rate of 0.35 （95%CI： 0.28-0.42） per million person-years. Lymphomas were the dominant subtype in the adult population with incidence rate of 5.74 （95%CI： 5.43-6.06） per million person-years. Incidence rates were higher in males than females with an overall rate ratio of 1.31 （95%CI： 1.21-1.41） mainly caused by the increase in carcinoma subtypes. White race had a higher tumor incidence with a rate ratio of 1.47（95%CI： 1.25-1.73） driven by the higher incidence of most histological subtypes. Orbital tumors showed a higher incidence rate followed by conjunctival and lacrimal gland tumors with incidence rates of 1.59, 1.37 and 0.43 per million person-years respectively. The trend line of overall incidence of tumors showed a significant increase （APC=3.11, 95%CI： 2.61-3.61） mainly due to increase of lymphomas. This increase was higher than the increase of lymphomas at other sites.CONCLUSION： Orbital, conjunctival and lacrimal gland malignant tumors differ among children and adults. Over the years there has been a noticeable increase in incidence rates of orbital and lacrimal gland tumors mainly caused by an increase in lymphomas and an apparent increase due to advances in diagnostic techniques. ICD-O-3 topographical coding should be improved to consider the different orbital bones and ocular structures.

Clinical analysis of 109 cases of lacrimal gland pleomorphic adenoma

AIM:To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma(LGPA)following surgical resection within the past 10y.The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized.METHODS:In this retrospective,comparative case series,clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed.All 109 patients underwent surgery,histopathological examination,and imaging examination.For patients who underwent surgery for the first time,LGPA could be resected completely,including tumor and capsule tissues,using a surgical approach via the eyebrow arch or double eyelid crease.RESULTS:The ratio of males to females was 1:1.60,the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old,and the ratio of left to right eyes was 1:1.37.A total of 109 patients underwent surgical excision and five of these收稿日期radiotherapy after malignant transformation.Of these patients,15 were lost to follow up within the April 1,2020 deadline and 1 was diagnosed as a recurring pathology.The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%.Single factor analysis revealed that the course of disease,bone destruction,invasion of surrounding tissues,tumor size,capsule integrity,and expression of Ki-67 were statistically significant(P<0.05).Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence(P=0.008).CONCLUSION:LGPA has a risk of recurrence and potential for malignant transformation.Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.

Association of the macrophage migration inhibitory factor promoter polymorphisms with benign lymphoepithelial lesion of lacrimal gland

AIM： To identify the association of the macrophage migration inhibitory factor （MIF） gene polymorphism with the susceptibility of benign lymphoepithelial lesions （BLEL） of the lacrimal gland. METHODS： A total of 40 BLEL of lacrimal gland cases were matched with 40 healthy subjects （HS）. Extraction the plasma and whole blood DNA of patients of lacrimal gland BLEL and HS. Elisa and polymerase chain reaction was used to determine in plasma contents of MIF and MIF gene SNP-173G〉C and STR -794 CATT（8） polymorphism, respectively. RESULTS： The MIF levels in plasma were significantly higher in patients with lacrimal gland BI.EL versus HS （P〈0.001）. The -173 G〉C MIF polymorphism was significantly associated with lacrimal gland BLEL, with a significantly higher frequency of the C allele in lacrimal gland BLEL patients compared with HS （OR=2.38, 95% C1=1.07-5.31, P=0.032）, and the -173 C/x is more frequent in patients than in HS, P=0.037. Besides, we found that the carriage rate of the MIF -173C/x is associated with higher plasma levels of MIF in the BLEI. of lacrimal gland. CONCLUSION： MIF -173G/C variants play an insidious role in susceptibility of BLEL of lacrimal gland. Otherwise,there is no statistically significant correlation exists between MIF-794 CATT （） and BLEL of lacrimal gland.

Effect of Flos Buddlejae Granules on Apoptosis Factors Bax,Bcl-2,Fas and FasL in Lacrimal Gland Cells of Castrated Male Rabbits

Objective To observe the effect of different concentration Flos Buddlejae(Mi Meng Hua,密蒙花)granules on apoptosis factors of lacrimal gland cells of castrated male rabbits,and study the treatment effects of Flos Buddlejae(Mi Meng Hua,密蒙花)granules in the dry eye model of castrated male rabbits.Methods Flos Buddlejae(Mi Meng Hua,密蒙花)raw material was made into granules.Thirty healthy adult New Zealand rabbits were randomly divided into five groups,six rabbits in each group.Group A:blank group,Group B:model group,Group C:Flos Buddlejae(Mi Meng Hua,密蒙花)granule group,Group D:placebo group,Group E:testosterone group.Except for group A,all rabbits underwent removal of bilateral testis and epididymis.Rabbits in group C were administered Flos Buddlejae(Mi Meng Hua,密蒙花)granules(100 mg/kg),three times per day;rabbits in group D were administered normal saline,three times per day.Rabbits in group E were injected with testosterone propionate(0.5 mL/kg)in the thigh muscle,every 3 days.All rabbits were tested by Schirmer I test(SIT)and tear film break-up time(BUT)before operation and 4 weeks after operation.After 4 weeks,all rabbits were sacrificed by air embolism and clipping of the lacrimal gland.Apoptosis factors,including Bax,Bcl-2,Fas and FasL of lacrimal gland cells were characterized by immunohistochemistry,and resulting data were statistically analyzed.Results(1)Comparison of SIT and BUT before and after operation:There were statistically significant differences between groups B and D(P<0.01),but not among other groups(P>0.05).(2)Comparison of apoptosis factors Bax,Bcl-2 Fas and FasL:In a comparison of groups B and D,there was no statistically significant difference after operation(P>0.05).In a comparison of the other groups,there were statistically significant differences(P<0.01).In comparisons among A,C and E groups,there were no statistically significant differences(P>0.05).Conclusion Compared with androgen,Flos Buddlejae(Mi Meng Hua,密蒙花)granules caused similar but slightly weaker depression of Bax,Fas and FasL,and increased expression of Bcl-2.

Optimizing surgical approaches for lacrimal gland adenoid cystic carcinoma to minimize cross-organ invasion

AIM:To evaluate the outcomes of eye-sparing surgery for lacrimal gland adenoid cystic carcinoma and the impact on tumor recurrence and orbital integrity.METHODS:The study enrolled four patients with recurrent lacrimal gland adenoid cystic carcinoma.The outcome focused on the relevance of the integrity of the lateral orbital wall to the occurrence of extraorbital metastasis in the local recurrence of lacrimal gland adenoid cystic carcinoma.RESULTS:Three patients underwent eye-sparing surgery via lateral orbitotomy without postoperative radiotherapy,and one patient who underwent eye-sparing surgery via sub-brow approach.These four patients all demonstrated a recurrence involving the invasion of extraorbital tissues as metastatic form through surgical bone seams.CONCLUSION:Preserving intact orbital bone tissue is crucial for mitigating direct cross-organ metastasis of lacrimal gland adenoid cystic carcinoma.The findings suggest avoiding the lateral orbitotomy approach with no or limited orbital bone wall invasion.

Clinical Research on Benign Lymphoepithelial Lesions of Lacrimal Gland in 20 Chinese Patients

Background：Benign lymphoepithelial lesion （BLEL） is characterized by symmetric bilateral swelling of the lacrimal and salivary glands and considered a subtype of immunoglobulin G4 （IgG4）-related sclerosing disease,the etiology and pathogenesis of which has not been determined.The purpose of the present study was to analyze the clinical features of BLEL in the lacrimal gland and the relationship between the serum level of IgG4 and BLEL.Methods：Twenty consecutive patients with BLEL diagnosed in Department of Ophthalmology at Beijing Tongren Hospital,Capital Medical University between January 2012 and December 2013 were observed.The clinical features,imaging findings,laboratory tests,treatments and follow-up status of these 20 consecutive patients were analyzed.Results：In all 20 patients,the ratio of male to female was 1：4,the ages ranged from 28 to 57 years,the ratio of unilateral to bilateral eyes involvement was 1：4,and painless uncongested symmetrical swelling of the upper eyelid was the main clinical manifestation.Orbital magnetic resonance imaging （MRI） showed that all patients involved lacrimal gland,which were obviously enlarged with equal signals in T1W images and T2W images and obvious enhancement on contrast MRI.Extraocular muscles were involved in 5 patients,salivary gland in 8 patients,and frontal nerve in 3 patients.Serum IgG4 concentration was elevated in 18 patients.The treatment strategy mainly included surgery and steroid administration.Three patients were lost to follow-up,17 patients reached complete response,and no recurrence was observed.Conclusions：Eyelid swelling is the typical symptom of BLEL.Most of the patients involved bilateral lacrimal glands.High serum IgG4 level and abundant IgG4-positive plasma cell infiltration are the important features,which can be found in most of BLEL patients.Surgery combined with glucocorticoids is an efficient treatment strategy.

Clinicopathological survey of 23 patients with lacrimal fossa lesions in Hong Kong

AIM: To survey the clinicopathological correlations of lacrimal fossa lesions in the Hong Kong population. METHODS: A total of 23 patients with lacrimal fossa lesions were identified radiologically. The mean age at the time of diagnosis was 52 year-old. The medical records of patients diagnosed with lacrimal fossa lesions and subsequently underwent radiological investigations were collected and reviewed retrospectively throughout a six years period from 2000 to 2006 from three regional hospitals (Tung Wah Eastern Hospital, Pamela Youde Nethersole Eastern Hospital and Queen Mary Hospital) belonging to the Hong Kong Mega Cluster. Patient demographics, presenting signs and symptoms, imaging modalities, pathological reports and subsequent management were recorded. RESULTS: The most common initial presenting symptom was upper lid swelling (83%) followed by proptosis (13%). 19 patients (83%) had benign lacrimal fossa lesion and 4 patients (17%) had malignancy. Three of the malignancies were lymphomas and one was adenoid cystic carcinoma. CONCLUSION: Age is an important factor in considering the differential diagnosis of lacrimal fossa lesion. Lymphoproliferative diseases have the highest incidence in patients over 60 years of age while inflammatory lesions are more common in younger patients in Hong Kong.