| ?objective?1.To analyze the characteristics of CT or MRI in different epithelial tumors of lacrimal gland,and combined with its clinical characteristics,to provide a reference for the next operation.2.Objective to analyze the clinical features,surgical and postoperative recurrence of pleomorphic adenoma of lacrimal gland,and to provide evidence for the diagnosis and treatment of pleomorphic adenoma of lacrimal gland.?Methods?1.From April 2007 to April 2015 in Shanghai Changzheng Hospital after surgical treatment,postoperative pathology confirmed epithelial tumors of lacrimal gland,and a complete preoperative imaging data(CT or MRI)in 100 cases of patients,the patients were divided into primary pleomorphic adenoma,recurrent pleomorphic tumor group and malignant epithelial tumors group,the combination of the clinical data and postoperative pathology,imaging characteristics were analyzed.2.The clinical data of the patients with pleomorphic adenoma of lacrimal gland were retrospectively analyzed in our hospital from January 2002 to January 2013.The clinical features,surgical methods and postoperative complications were analyzed in 96 cases.?Results?1.All cases were unilateral.Primary pleomorphic adenoma and malignant epithelial tumor were single,10 cases of recurrent pleomorphic adenoma were single focal recurrence,and the other one was multifocal recurrence in 11 cases.CT examination of primary lacrimal gland pleomorphic adenoma in 29 cases,there were 6 cases with uneven density(20.7%),1 cases of central calcification(3.5%);4 cases with unclear border(13.8%),16 cases of bone compression(55.2%),no bone destruction;irregular shape in 7 cases(24.1%).The recurrent lacrimal gland pleomorphic adenoma in 12 cases,there were 8 cases with uneven density(66.7%),3 cases of central calcification(25%);8 cases with unclear border(66.7%),6 cases of bone compression(50%),4 cases of bone destruction(33.3%);irregular shape in 6 cases(50%).Malignant epithelial tumors of lacrimal gland in 13 cases of uneven density in 3 cases(23.1%),1 cases of central calcification(7.7%),1 cases showed cystic areas(7.7%);2 cases with unclear border(15.4%),5 cases of bone compression(38.5%),bone destruction in 2 cases(15.4%);shape rule 2(15.4% cases).The statistical analysis showed that different tumor shape no difference(P=0.138),there were differences in density,boundary and adjacent bone,recurrent pleomorphic adenoma with uneven density with high probability(P=0.015),the boundary is not clear with high probability(P=0.002),more susceptible to bone destruction(P=0.021).MRI examination of primary lacrimal gland pleomorphic adenoma in 41 cases,including 19 cases in T1WI(46.3%)showed signal,16 cases(39%)for low signal,2 cases(4.9%)high signal,4 cases(9.8%)for mixed signal intensity on T2WI;13 cases(31.7%)high signal,12 cases(29.3%)for signal,12 cases(29.3%)for high signal,4 cases(9.8%)for low signal;can be different degrees of enhancement,4 cases of cystic(9.8%).16 cases of recurrent pleomorphic adenoma of lacrimal gland,15 cases in T1 WI(93.8%)showed signal,1 cases(6.2%)for mixed signal intensity on T2WI;6 cases(37.5%)for signal,10 cases(62.5%)uneven high signal;can be different degrees of enhancement,10 cases of capsule change(62.5%).19 cases of malignant epithelial tumors of lacrimal gland,18 cases in T1WI(94.7%)showed signal,1 cases(5.3%)for high signal on T2WI;10 cases(52.6%),signal in 4 cases(21.1%)for high signal,4 cases(21.1%)for low signal,1 cases(5.3%)high signal;15 cases with obvious uneven enhancement(78.9%),4 cases(21.1%)can be strengthened,4 cases of cystic(21.1%).Statistical analysis showed that the incidence of recurrent pleomorphic adenoma was significantly higher than that of other two kinds of tumors(P=0.000).The patients were follow-up for 1 to 8 years,in 56 cases of primary pleomorphic adenoma no recurrence;In the 21 recurrent cases,7 cases again recurred(33.3%),2 cases had malignant change and died(9.5%).In the 23 malignant cases,6 cases recurred(26.1%),5 cases died(21.7%),and 4 cases were lost to follow-up(17.4%).2.All of the patients were confirmed pleomorphic adenoma of lacrimal gland by pathological examination after the surgery.Of all 96 cases,74 cases were primary ones and 22 case were recurrent ones.Primary lacrimal gland pleomorphic adenoma,common symptoms and signs were exophthalmos of 56 cases(75.7%),40(54.1%)cases of eyeball,eye movement limitation in 37 cases(50%),21 cases of ptosis(28.4%),decreased visual acuity in 9 cases(12.1%),6 cases of fundus changes(8.1%),as shadows in 4 cases(5.4%),3 cases of pain(4.1%);recurrent pleomorphic adenoma,common symptoms and signs were exophthalmos of 16 cases(72.7%),13 cases of eyeball(59.1%),10 cases of ptosis(45.5%),decreased visual acuity in 9 cases(40.9%),limitation of ocular movement in 7 cases(31.8%),7 cases of fundus changes(31.8%)as shadows in 6 cases(27.1%),4 cases of pain(18.2%).The patients were followed up for 3-10 years.In the 74 cases of primary cases,1 cases recurred(1.4%).In the 22 recurrent cases,3 cases again recurred(13.6%),2 cases had malignant change(9.1%),1 case died(4.5%),and 2 cases were lost to follow-up(9.1%).?Conclusions?1.Lacrimal gland recurrent pleomorphic adenoma in CT or MRI is more prone to uneven density,unclear boundary and adjacent bone destruction or cystic tumor necrosis,suggesting that recurrent pleomorphic adenoma is a benign biological,radiological findings have malignant characteristics.2.The recurrence of pleomorphic adenoma can be a single focal recurrence or multifocal recurrence,more prone to recurrence and malignant change.3.Recurrent pleomorphic adenoma in the imaging of the common cystic change area,the cystic necrosis of the tumor area in patients with more prone to recurrence and malignant change.4.Preoperative localization of pleomorphic adenoma of lacrimal gland,the size,boundary,scope,texture and the relationship with the surrounding tissue were carefully analyzed,select the most reasonable surgical approach.Avoiding preoperative biopsy. |
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