Damasceno Renato Wendell Ferreira, Holbach Leonard M
Department of Ophthalmology and Eye Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Germany.
Arq Bras Oftalmol. 2012 Jan-Feb;75(1):64-6. doi: 10.1590/s0004-27492012000100014.
A 78-year-old male patient presented with double vision, painless palpable mass under the right superolateral orbital rim, downward displacement and restricted adduction of the right eye. His visual acuity was 20/50 OD and 20/20 OS. Hertel exophthalmometry was 21 mm OD and 17 mm OS. Computed tomographic scans showed an infiltrative orbital mass with ill-defined, irregular margins, involving the lacrimal gland and the lateral rectus muscle. The patient underwent an anterior transcutaneous transseptal orbitotomy with incisional biopsy and surgical debulking. Histopathologic evaluation revealed primary ductal adenocarcinoma of the lacrimal gland. Following the metastatic work up, he underwent an eyelid-sparing orbital exenteration. Microscopically, the tumor elements were characterized by large polygonal cells with vesicular nuclei, prominent nucleoli and amphophilic cytoplasm. The tumor components comprised duct-type structures with papillary and cribriform patterns, surrounded by prominent basement membrane. The tumor cells were positive for cytokeratin-7, matrix metalloproteinase (MMP)-2, MMP-9, MMP-13 and proto-oncogene Her-2/neu, but negative for cytokeratin-5, cytokeratin-20, p63, prostate-specific antigen, S-100 protein and thyroid transcription factor. These histopathologic findings were compatible with poorly differentiated ductal adenocarcinoma of the lacrimal gland, T3N0M0. Twenty-four months after orbital exenteration, the patient was diagnosed with ipsilateral parotid gland and cervical lymph node metastases and died of disease.
一名78岁男性患者出现复视，右侧眶上缘外下方可触及无痛性肿块，右眼向下移位且内收受限。其右眼视力为20/50，左眼视力为20/20。Hertel眼球突出计测量结果为右眼21mm，左眼17mm。计算机断层扫描显示眶内有一浸润性肿块，边界不清、形态不规则，累及泪腺和外直肌。患者接受了经皮经鼻中隔前路眶切开术，并行切开活检和手术减瘤。组织病理学评估显示为泪腺原发性导管腺癌。在进行转移灶检查后，他接受了保留眼睑的眶内容剜除术。显微镜下，肿瘤细胞以大的多边形细胞为特征，核呈泡状，核仁明显，胞质嗜两性。肿瘤成分包括具有乳头和筛状结构的导管样结构，周围有明显的基底膜。肿瘤细胞细胞角蛋白-7、基质金属蛋白酶（MMP）-2、MMP-9、MMP-13和原癌基因Her-2/neu呈阳性，但细胞角蛋白-5、细胞角蛋白-20、p63、前列腺特异性抗原、S-100蛋白和甲状腺转录因子呈阴性。这些组织病理学表现符合泪腺低分化导管腺癌，T3N0M0。眶内容剜除术后24个月，患者被诊断为同侧腮腺及颈部淋巴结转移，最终死于该疾病。
