眼部恶性多形性腺瘤43例临床病理及CT/MRI影像分析 [中文引用][英文引用]

 【摘要】 目的：探讨眼部恶性多形性腺瘤(MPA)的临床表现及CT/MRI特征，以提高对此病的诊断能力。方法：回顾性分析2012年1月至2021年10月郑州大学第一附属医院43例MPA患者的临床影像资料，均为单眼患病，其中男性20例，女性23例，年龄16～76(53.79 ± 15.54)岁；初发病例23例，复发病例20例，其中复发1次者13例，2次者3例，3次者2例，4次者1例，5次者1例。结果：MPA主要的症状和体征依次为眼球突出、眼部肿胀、视物模糊、流泪、眼睛疼痛。1例病理表现为癌肉瘤，42例表现为癌在多形性腺瘤中。MPA位于右眼17例，左眼26例；起源于肌锥内区23例，肌锥区19例，肌锥外区1例；病变呈不规则形23例，圆形或类圆形14例，边缘浅分叶6例；边缘清晰13例，欠清晰和模糊各15例；MPA表现为局限性病变5例，弥漫性病变38例；28例沿视神经向深部生长，11例向眼眶外生长，4例横向生长，其中1例侵犯前颅底，1例侵犯鼻窦，2例侵犯颞窝。CT显示27例为等密度，7例为稍低密度，2例为稍高密度，其中7例内见斑块状钙化，14例内见较明显囊变坏死；增强后轻度强化4例，中度强化5例，强化不均匀8例；包膜不完整25例；邻近骨质无变化5例，受压变形13例，骨质破坏/缺损18例。MRI显示T1WI呈稍低信号16例，等信号5例，低信号4例；T2WI呈稍高信号16例，高信号8例，稍低信号1例；DWI呈稍高信号16例，高信号5例，稍低信号4例；信号不均匀22例；增强后中度强化2例，明显强化11例，强化不均匀13例；包膜不完整16例。结论：对于眼部膨胀性生长、体积较大的肿物，应考虑到MPA的可能性，不需事先切开活检即可考虑进行肿瘤全切除。CT和MRI检查可对MPA的手术入路进行准确可视化，对制定治疗方案及预后随访具有重要意义。

 【Abstract】  Objective  To investigate the clinical presentation and CT/MRI features of malignant pleomorphic adenoma (MPA) of the eye in order to improve the diagnosis of this disease. Methods  The clinical imaging data of 43 patients with MPA in the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2021 were retrospectively analyzed. All patients were monocular disease, including 20 males and 23 females, aged 16-76 (53.79 ± 15.54) years old. There were 23 initial cases and 20 recurrent cases, including 13 cases with recurrence once, 3 cases with recurrence twice, 2 cases with recurrence three times, 1 case with recurrence four times, and 1 case with recurrence five times. Results  The main symptoms and signs of MPA were ocular proptosis, ocular swelling, blurred vision, lacrimation and ocular pain. One case showed pathological manifestation of carcinosarcoma, and 42 cases showed carcinoma ex pleomorphic adenoma. MPA was located in the right eye in 17 cases and left eye in 26 cases; 23 cases originated from the inner myoconus region, 19 cases from the myoconus region, and 1 case from the outer myoconus region; the lesions were irregularly shaped in 23 cases, round or round-like in 14 cases, and shallowly lobulated at the margin in 6 cases. There were 13 cases of clear edge, 15 cases of unclear edge and 15 cases of fuzzy edge. MPA showed limited lesions in 5 cases and diffuse lesions in 38 cases; 28 cases grew deeper along the optic nerve, 11 cases grew outside the orbit, and 4 cases grew laterally, including 1 case invading the anterior skull base, 1 case invading the sinus and 2 cases invading the temporal fossa. CT showed 27 cases of iso-density, 7 cases of slightly low density and 2 cases of slightly high density. Plaque calcification was observed in 7 cases and obvious cystic necrosis was observed in 14 cases. Mild enhancement was observed in 4 cases, moderate enhancement in 5 cases, and uneven enhancement in 8 cases after enhancement. Incomplete capsule was observed in 25 cases. There was no change in adjacent bone in 5 cases, compression deformation in 13 cases and bone destruction/defect in 18 cases. MRI showed slightly low signal in T1WI in 16 cases, iso-signal in 5 cases, and low signal in 4 cases. T2WI showed slightly high signal in 16 cases, high signal in 8 cases, slightly low signal in 1 case; DWI showed slightly high signal in 16 cases, high signal in 5 cases, slightly low signal in 4 cases; signal inhomogeneity in 22 cases; moderate enhancement after enhancement in 2 cases, significant enhancement in 11 cases, and inhomogeneous enhancement in 13 cases; incomplete envelope in 16 cases. Conclusion  The possibility of MPA should be considered for swelling growth and large masses in the eye, and total tumor resection should be considered without prior incisional biopsy. CT and MRI examinations can accurately visualize the surgical approach of MPA, which is important for the development of treatment plans and prognostic follow-up.