Nassar D L, Raab S S, Silverman J F, Kennerdell J S, Sturgis C D
Department of Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, 15212-4772, USA.
Diagn Cytopathol. 2000 Nov;23(5):314-7. doi: 10.1002/1097-0339(200011)23:5<314::aid-dc5>3.0.co;2-f.
Ocular and periocular hematolymphoid diseases are a diverse group of lesions affecting various soft tissue structures within the orbital cavity. Lymphoid proliferations in particular are among the most commonly diagnosed entities in orbital pathology. When noninvasive techniques fail to confirm or rule out the suspicion of orbital neoplasia, fine-needle aspiration (FNA) may be of use in establishing a diagnosis in a reliable, timely, cost-effective and safe manner. From 1986 to 1999, 79 orbital/ocular needle aspiration biopsies were conducted by staff ophthalmologists at Allegheny General Hospital. Slides from these cases and corresponding reports were pulled from the cytology files and grouped into the two broad categories of hematolymphoid and other. Specimens came from patients ranging in age from 14 to 88 years (mean, 64 years) with eight patients having known histories of hematolymphoid disorders. Immunocytochemical (ICC) studies were performed in 33% of the cases (14/43). Review of the diagnoses for the 79 aspiration specimens revealed 30 cases diagnosed as lymphoma/atypical lymphocytic infiltrate, cases diagnosed as inflammation or abscess, three cases diagnosed as plasmacytoma, three cases called suboptimal with scant inflammatory cells, and one case of Langerhans' cell histiocytosis. Hematolymphoid diagnoses accounted for 54% (43/79) of all diagnoses. Histologic correlation was available in 33% (14/43) of the cases (nine cases diagnosed as cytologically atypical/malignant and five cases called cytologically benign/suboptimal) with 100% correlation. Hematolymphoid lesions of the orbit are readily diagnosed by FNA. Because many hematolymphoid malignancies are treated as systemic or multiorgan system diseases and because ocular lymphomas may also involve the central nervous system, nonsurgical attempts at diagnosis have the potential to spare the patient procedural morbidity which may be associated with open biopsy. Our experience indicates that the combination of FNA, judicious use of immunocytochemical studies, and correlation with pertinent clinical information and imaging studies allows for reliable and effective classification and diagnosis of orbital hematolymphoid lesions.
眼及眼周血液淋巴系统疾病是一组影响眶腔内各种软组织结构的多样病变。尤其是淋巴样增生，是眼眶病理学中最常诊断出的病变类型之一。当非侵入性技术无法证实或排除眼眶肿瘤的怀疑时，细针穿刺抽吸（FNA）可能有助于以可靠、及时、经济有效且安全的方式做出诊断。1986年至1999年期间，阿勒格尼综合医院的眼科 staff 医生进行了79例眼眶/眼针吸活检。从细胞学档案中取出这些病例的玻片及相应报告，并分为血液淋巴系统和其他两大类别。标本来自年龄在14岁至88岁（平均64岁）的患者，其中8例患者有已知的血液淋巴系统疾病病史。33%（14/43）的病例进行了免疫细胞化学（ICC）研究。对79例抽吸标本的诊断进行回顾发现，30例诊断为淋巴瘤/非典型淋巴细胞浸润，cases诊断为炎症或脓肿，3例诊断为浆细胞瘤，3例因炎症细胞稀少而诊断为欠佳，1例为朗格汉斯细胞组织细胞增多症。血液淋巴系统诊断占所有诊断的54%（43/79）。33%（14/43）的病例（9例诊断为细胞学非典型/恶性，5例诊断为细胞学良性/欠佳）有组织学相关性，相关性为100%。眼眶血液淋巴系统病变通过FNA很容易诊断。由于许多血液淋巴系统恶性肿瘤被视为全身性或多器官系统疾病，并且由于眼淋巴瘤也可能累及中枢神经系统，非手术诊断尝试有可能使患者避免与开放性活检相关的手术并发症。我们的经验表明，FNA、明智地使用免疫细胞化学研究以及与相关临床信息和影像学研究相结合，能够对眼眶血液淋巴系统病变进行可靠且有效的分类和诊断。
