眼眶肿瘤及瘤样病变患者699例的临床组织病理学构成分析

Analysis of clinical histopathological composition of 699 cases with orbital tumors and tumor-like lesions

摘要:

目的：分析眼眶肿瘤及瘤样病变的临床组织病理学构成情况。

方法：回顾性系列病例研究。连续收集2010-01/2020-12天津市眼科医院眼眶病眼整形科收治的眼眶肿瘤及瘤样病变患者699例707眼的临床组织病理学资料，参考美国癌症联合会第8版眼肿瘤分期标准和WHO2018版眼部肿瘤分类标准，将诊断结果分为良性、交界性及恶性三类。将全部患者按照年龄划分为0～17、18～39、40～59和60岁及以上共4组。对各组组织病理学诊断构成情况进行分析。

结果：纳入699例患者707眼中男311例316眼，女388例391眼。就诊年龄为1～84(平均39.9±2.2)岁。右侧眼眶307例，左侧眼眶384例，双侧8例。良性肿瘤及瘤样病变598例604眼(85.6%)，交界性肿瘤7例7眼(1.0%)，恶性肿瘤94例96眼(13.4%)。在良性肿瘤及瘤样病变中，位于前5位的依次为海绵状血管瘤(110例，15.7%)，皮样囊肿(96例，13.7%)，多形性腺瘤(54例，7.7%)，炎性假瘤(38例，5.4%)，神经鞘瘤(29例，4.1%)； 交界性及恶性肿瘤中，位于前5位的依次为非霍奇金淋巴瘤(42例，41.6%)，孤立性纤维性肿瘤(12例，11.9%)，腺样囊性癌(11例，10.9%)，转移癌(9例，8.9%)，横纹肌肉瘤(8例，7.9%)。在常见的眼眶良性肿瘤及瘤样病变中，海绵状血管瘤和多形性腺瘤中女性患者明显多于男性。在常见的眼眶交界性和恶性肿瘤中，非霍奇金淋巴瘤和间叶性软骨肉瘤中男性患者多于女性。0～17岁患者中最常见的良、恶性肿瘤分别是皮样囊肿和横纹肌肉瘤，18～39岁中最常见的良、恶性肿瘤分别为皮样囊肿和孤立性纤维性肿瘤，40～59岁中最常见的良、恶性肿瘤分别为海绵状血管瘤和非霍奇金淋巴瘤，60岁以上最常见的良、恶性肿瘤分别为海绵状血管瘤和非霍奇金淋巴瘤。

结论：眼眶肿瘤及瘤样病变中多数为良性。其中良性肿物以海绵状血管瘤和皮样囊肿多见。恶性肿瘤以非霍奇金淋巴瘤多见。

Abstract:

AIM: To analyze the clinical and histopathological composition of orbital tumors and tumor-like lesions.

METHODS: Retrospective case-series study. The clinical histopathological data of 699 cases(707 eyes)with orbital tumor and tumor-like lesions who treated in the orbital disease and ophthalmic plastic department of Tianjin Eye Hospital between January 2010 and December 2020 were collected. All the pathology diagnosis results were divided into three categories which were benign tumor, borderline tumor and malignant tumor according to the eighth edition of the American Joint Committee on Cancer staging system and the 2018 World Health Organization Classification of tumors of the eye. All cases were divided into four groups according to age, including 0～17 years old, 18～39 years old, 40～59 years old, 60 years and above. The histological composition of each group was analyzed.

RESULTS: Among the 699 cases(707 eyes), 311 patients(316 eyes)were male and 388 patients(391 eyes)were female. The patient's age at diagnosis ranged from 1 to 84 years(mean 39.9±2.2)years. The right orbit was involved in 307 patients, the left orbit in 384 patients, and 8 patients in bilateral orbit. There were 598 patients(604 eyes, 85.6%)with benign tumor and tumor-like lesions, 7 patients(7 eyes, 1.0%)with borderline tumor, and 94 patients(96 eyes, 13.4%)with malignant tumors. The top 5 benign tumor and tumor-like lesions were cavernous hemangioma(110 cases, 15.7%), dermoid cysts(96 cases, 13.7%), pleomorphic adenomas(54 cases, 7.7%), inflammatory pseudotumors(38 cases, 5.4%), and schwannomas(29 cases, 4.1%)respectively. The top 5 borderline and malignant tumors were non-Hodgkin lymphomas(42 cases, 41.6%), solitary fibrous tumors(12 cases, 11.9%), adenoid cystic carcinomas(11 cases, 10.9%), metastatic tumor(9 cases, 8.9%), and rhabdomyosarcoma(8 cases, 7.9%), respectively. Among the common orbital benign tumors and tumor-like lesions, cavernous hemangioma and pleomorphic adenoma showed a female predominance. Among the common borderline and malignant tumors, non-Hodgkin lymphoma and mesenchymal chondrosarcoma showed a male predominance. The most common benign and malignant tumors were dermoid cysts, rhabdomyosarcomas respectively in group under 18 years old. And dermoid cysts and solitary fibrous tumors were the most common benign and malignant tumors respectively in patients between 18 and 39 years old. Cavernous hemangioma and non-Hodgkin lymphomas were the most common benign and malignant tumors respectively in patients between 40 and 59 years old. While cavernous hemangioma and non-Hodgkin lymphomas were the most common benign and malignant tumors respectively in cases over 60 years old.

CONCLUSION: Most orbital tumors and tumor-like lesions are benign. The most common benign orbital tumor is cavernous hemangioma, followed by dermoid cyst. Non-Hodgkin lymphoma is the most common malignant orbital tumor.