lacrimal gland pleomorphic adenocarcinoma
Introduction
Introduction to lacrimal gland pleomorphic adenocarcinoma Lacrimal gland pleomorphic adenocarcinoma (pleomorphicadenocarcinomaofthelacrimalgland), also known as malignant lacrimal gland mixed tumor, its clinical manifestations similar to benign pleomorphic adenoma, histologically benign and malignant two cellular characteristics. basic knowledge The proportion of illness: 0.0008%--0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: eye movement disorder
Cause
Lacrimal gland pleomorphic adenocarcinoma
the reason
The cause is unknown.
(two) pathogenesis
The mechanism is not yet clear. The clinical manifestations of pleomorphic adenocarcinoma are similar to pleomorphic adenomas, but the course of short lacrimal gland malignancies is 1.66 years. It is often invasive due to the absence of the tumor. The clinical manifestation is a sticky mass outside the iliac crest, the boundary is unclear, tenderness, and the eyeball shifts inward and downward. Clinically, the symptoms of malignant tumors are pain
Prevention
Lacrimal gland pleomorphic adenocarcinoma prevention
1. Avoid long-term excessive contact with radiation. Long-term exposure to long-wave UV radiation can lead to chronic accumulation of lens damage, induce or accelerate the formation and development of age-related macular degeneration, so avoid working and learning under strong sunlight, light or other radiation, in outdoor activities, Wear colored glasses to prevent direct radiation to the eyes.
2. Avoid excessive visual fatigue. Use your eyes to feel tired and pay attention to the correct eye position, distance, light source and so on. Use an eye for about an hour, let your eyes relax, such as closing your eyes, walking, looking at the sky or in the distance, so that your eyes can rest. Try not to read and work in a dimly lit environment for a long time.
3. Insist on regular eye massage. You can do eye exercises for eye acupressure, such as massage Qingming, Hengzhu, scorpion bone, sun, medical wind and other acupuncture points. Through massage, it can accelerate blood circulation in the eye, increase the immune factor in the aqueous humor, improve the autoimmune power of the eyeball, thereby delaying the development of crystal opacity and preventing the occurrence of diseases.
Complication
Lacrimal gland pleomorphic adenocarcinoma Complications, eye movement disorders, ptosis
The ptosis, eye movement disorders and so on.
Symptom
Lacrimal gland pleomorphic gland cancer symptoms common symptoms lacrimal gland prolapse eyeball prominent eyelid abscess eyeball shift
The clinical manifestations of pleomorphic adenocarcinoma are similar to pleomorphic adenomas, but the course of disease is short. The average course of lacrimal gland malignancies is 1.66 years. It is often invasive due to the absence of the tumor, and the clinical manifestation is the adhesion mass above the iliac crest. Unclear, tender, eyeball shifting inward and downward, clinically with malignant tumor symptoms is pain, Wright reported that the main clinical manifestations of lacrimal gland malignant tumors are ankle mass (83%), eye movement (67%), pain (33%), Rootman believes that there are three possible considerations for malignant mixed tumors:
1 The long-term lacrimal gland mass suddenly increased.
2 There is pain, bone erosion and tumor growth.
3 The previously resected lacrimal gland pleomorphic adenoma suddenly recurred, malignant mixed tumor is primary or secondary, the current opinions are different, some scholars believe that malignant mixed tumor began to be benign, and then turned into malignant, but no reliable basis, Henderson believes There are 3 types of primary malignant mixed tumors:
a short history, malignant tumor when the first resection.
b Initially, the benign mixed tumor was not completely removed, and it was malignant when the first or second recurrence occurred several years later.
c patients with progressive eyeballs, eyeball shift, no pain for several years, recent swelling of the upper jaw, pain, this type of first open surgery, pathologically often have a double change of malignant and benign mixed tumor.
Examine
Examination of lacrimal gland pleomorphic adenocarcinoma
1. Flow cytometry calculation technique shows that benign tumor cells have diploid DNA content characteristics, and aneuploidy is characterized by malignant tumor cells.
2. Pathological examination of the tumor without capsule or incomplete capsule, the cut surface is gray or grayish yellow, brittle, under the microscope, benign pleomorphic adenoma lesions have focal malignant transformation, visible nuclear epithelial cell island, lumen Irregular, abnormal nuclear division, malignant part of the majority, poorly differentiated adenocarcinoma, interstitial hyaline degeneration, a small number of adenoid cystic carcinoma or squamous cell carcinoma, electron microscopy showed tumor cells similar to normal lacrimal gland acinar cells However, the number of microvilli in the luminal surface cells is normal, the top composite connection remains good, and the remaining cells are connected widened without a bridging connection, which can be similar to the inner layer of the catheter.
3. X-ray can be found that the volume of sputum is enlarged, and the osteolytic destruction of lacrimal gland is one of the main signs of malignant mixed tumor, but it is not easy to distinguish from the bone destruction caused by other lacrimal gland malignant tumors.
Ultrasound exploration showed that the A-ultra showed the lacrimal gland space-occupying lesions, the tumor wave was high, the sound attenuation was obvious, the internal reflection was "M" shape, the sound attenuation was obvious, and the B-ultra-visible lacrimal gland area occupied lesions, the shape was round or Irregular shape, the inner echo is uneven or blocky, the sound attenuation is more, and it is incompressible. When the tumor volume is large, the optic nerve can be displayed to be displaced downward.
5. CT scan is not easy to distinguish from pleomorphic adenoma in the early stage. The shape is round, high density, localized bone formation or bone destruction, and the enhancement phenomenon is obvious. However, most tumor boundaries are unclear or irregular in shape, and local bone destruction is The mark of malignant tumors, the tumors of the malignant mixed tumors are mostly large adenomas, and extensive bone destruction can be seen in the late stage. The lesions are forward, the middle cranial fossa and the concavity or paranasal sinus spread, especially with enhanced CT scan. There may be calcified, ossified or necrotic areas inside.
6. MRI shows good MRI on malignant tumors, especially when the tumor spreads to the outside of the sputum. It can not only show the extent of the lesion, but also show whether there is necrosis in the tumor; if it invades the skull, it can also show the presence or absence of brain tissue edema. Hair changes, enhanced scanning shows a large range of lesions, there may be necrotic cavity in the tumor.
Diagnosis
Diagnosis and differentiation of lacrimal gland pleomorphic adenocarcinoma
According to the medical history and clinical manifestations, the diagnosis can be basically determined by combining the imaging features, and the diagnosis of the disease depends on pathological examination.
Differential diagnosis
1. The morphologic adenoma has a long course of disease, generally no pain, and there are more characteristic findings in imaging examination.
2. The clinical manifestations of other malignant tumors of the lacrimal gland are very similar and difficult to distinguish.
3. Other tumors can be referred to the differential diagnosis of pleomorphic adenoma.
4. If there is no history of surgical treatment of lacrimal gland tumors in the lateral orbital metastases, it is difficult to distinguish clinically and imagingly from lacrimal gland malignancies. The key lies in systemic examination. Metastatic cancer develops rapidly and has a short course.
