Pointdujour-Lim Renelle, Lally Sara E, Shields Jerry A, Eagle Ralph C, Shields Carol L
Ocular Oncology Service, and Ocular Pathology Department, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Ophthalmic Plast Reconstr Surg. 2018 Mar/Apr;34(2):162-167. doi: 10.1097/IOP.0000000000000900.
To evaluate the relationship between radiographic and histopathologic features of orbital schwannoma.
Retrospective review of 15 patients with orbital schwannoma managed at an ocular oncology service.
The mean patient age at the time of presentation was 42 years old (median 40, range 15-64 years). The orbital schwannoma was found incidentally (n = 2) or with symptoms of proptosis (n = 2), blurred vision (n = 3), pain (n = 3), eyelid swelling (n = 2), diplopia (n = 2), or headache (n = 1). The mean duration of symptoms was 15 months (median, 9; range 1-60 months). The tumor occupied the superior (n = 11) or inferior (n = 4) orbit. Antero-posterior tumor location involved the anterior (n = 2), middle (n = 3), posterior (n = 4), or entire (n = 6) orbit. MRI was performed in 12 patients (80%) and CT was the only form of imaging in 3 patients (20%). The T1-weighted MRI (n = 11) showed the mass as isointense (n = 10) or hyperintense (n = 1) to the extraocular muscles). On T2-weighted MRI (n = 10), the mass demonstrated hyperintensity (n = 9) or hypointensity (n = 1). Histopathologic assessment demonstrated Antoni A (n = 12) and Antoni B (n = 12) patterns. Antoni A pattern correlated with hyperintensity on T1-weighted MRI and hypointensity on T2-weighted MRI. Antoni B pattern correlated with hypointensity on T1-weighted MRI and hyperintensity on T2-weighted MRI. As Antoni B approached >50% of the solid mass (n = 8), both T1- and T2-weighted MRI images were more likely to be heterogeneous (n = 7, 88% and n = 6, 75%, respectively).
Orbital schwannomas are nearly always benign, well-encapsulated slowly progressive tumors. Due to the biphasic distribution of Antoni A and Antoni B pattern, the appearance on MRI has a variable degree of heterogeneity. Antoni A pattern correlated with hyperintensity and Antoni B pattern correlated with hypointensity on T1-weighted MRI.
评估眼眶神经鞘瘤的影像学特征与组织病理学特征之间的关系。
对在眼科肿瘤门诊接受治疗的15例眼眶神经鞘瘤患者进行回顾性研究。
患者就诊时的平均年龄为42岁（中位数40岁，范围15 - 64岁）。眼眶神经鞘瘤为偶然发现（2例）或伴有眼球突出症状（2例）、视力模糊（3例）、疼痛（3例）、眼睑肿胀（2例）、复视（2例）或头痛（1例）。症状的平均持续时间为15个月（中位数9个月，范围1 - 60个月）。肿瘤位于眼眶上部（11例）或下部（4例）。肿瘤的前后位置涉及眼眶前部（2例）、中部（3例）、后部（4例）或整个眼眶（6例）。12例患者（80%）进行了MRI检查，3例患者（20%）仅进行了CT检查。T1加权MRI（11例）显示肿块与眼外肌等信号（10例）或高信号（1例）。在T2加权MRI（10例）上，肿块表现为高信号（9例）或低信号（1例）。组织病理学评估显示Antoni A型（12例）和Antoni B型（12例）。Antoni A型与T1加权MRI上的高信号以及T2加权MRI上的低信号相关。Antoni B型与T1加权MRI上的低信号以及T2加权MRI上的高信号相关。当Antoni B型占实体肿块的比例超过50%时（8例），T1加权和T2加权MRI图像更有可能表现为不均匀（分别为7例，88%和6例，75%）。
眼眶神经鞘瘤几乎都是良性的、包膜完整的缓慢进展性肿瘤。由于Antoni A型和Antoni B型的双相分布，MRI表现具有不同程度的不均匀性。在T1加权MRI上，Antoni A型与高信号相关，Antoni B型与低信号相关。
