Adnexal Service, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2021;37(2):125-128. doi: 10.1097/IOP.0000000000001682.
To report the characteristics and management for patients with palpebral pleomorphic adenoma of the lacrimal gland.
The records for patients with palpebral pleomorphic adenoma seen at Moorfields Eye Hospital between 1978 and 2019 were reviewed for demographics, presentation, imaging, histopathology, management, and outcome.
Forty-three patients (25 male; 58%) with palpebral pleomorphic adenoma were identified, presenting at a mean age of 46 years (median 46.4 years; range 24-81 years) with symptoms for an average of 31 months (median 18.0 months; range 1 month to 17 years). The commonest symptom was a painless upper lid lump (37 patients; 86%), although 4 patients (9%) had a localized ache, and 1 (2%) had episodic epiphora. A moderately-mobile, firm round mass (like a "chick-pea") was readily palpable in 39/43 (91%) patients, and significant ptosis and upper lid swelling was noted in 6 cases (14%). Imaging was reviewed in 35 patients, 28 (80%) having a well-defined homogeneous mass in front of the orbital rim, on the anterior pole of the lacrimal gland. With the exception of 8 tumors removed from the actual palpebral lobe using a conjunctival incision, all others were excised intact through an upper eyelid skin-crease incision. Histopathology confirmed an intact pseudocapsule in 39/43 (91%) and 10 (23%) had a mild chronic lymphocytic inflammation within the tumor and/or neighboring lacrimal gland. There were no tumor recurrences at an average follow-up of 40 months (median 9.1; range 2 weeks to 230 years).
Most palpebral pleomorphic adenomas are discovered as an upper lid lump and a few first become manifest as upper lid swelling with ptosis. To avoid inadvertent incisional biopsy, they should be recognized preoperatively-especially as most are readily palpable as a hard lump superotemporally, often freely mobile in the suborbicularis plane (anterior to the tarsus and main lacrimal gland). Excision, generally easiest through a transcutaneous route, was judged intact in all cases and confirmed in 91% of histological reports, with no recurrent tumors.
报告泪腺睑部多形性腺瘤患者的特征和治疗方法。
回顾了 1978 年至 2019 年间在 Moorfields 眼科医院就诊的睑部多形性腺瘤患者的病历，记录了患者的人口统计学、表现、影像学、组织病理学、治疗和结果。
共发现 43 例（25 例男性，占 58%）睑部多形性腺瘤患者，平均年龄为 46 岁（中位数 46.4 岁；范围 24-81 岁），平均症状持续时间为 31 个月（中位数 18.0 个月；范围 1 个月至 17 年）。最常见的症状是无痛性上眼睑肿块（37 例患者；86%），但 4 例（9%）患者有局限性疼痛，1 例（2%）患者有间歇性流泪。39/43 例（91%）患者可触及一个移动性好、质地坚硬的圆形肿块（如“鹰嘴豆”），6 例（14%）患者出现明显的上睑下垂和肿胀。35 例患者进行了影像学检查，28 例（80%）患者在前眶缘前、泪腺前极有一个界限清楚的均匀肿块。除 8 例肿瘤通过结膜切口从实际的睑板切除外，其余肿瘤均通过上眼睑皮肤皱褶切口完整切除。组织病理学检查证实 39/43 例（91%）肿瘤有完整的假包膜，10 例（23%）肿瘤内和/或邻近泪腺有轻度慢性淋巴细胞炎症。平均随访 40 个月（中位数 9.1；范围 2 周至 230 年）后，无肿瘤复发。
大多数睑部多形性腺瘤是在上眼睑发现肿块，少数首先表现为上眼睑肿胀伴上睑下垂。为避免无意中进行切口活检，应在术前识别这些肿瘤，尤其是因为大多数肿瘤在眶上外侧很容易触及到坚硬的肿块，通常在眼轮匝肌平面（位于睑板和主要泪腺的前方）内可自由移动。通过经皮途径切除通常最容易，所有病例均被判断为完整切除，并在 91%的组织学报告中得到证实，无肿瘤复发。
