Kim Jane S, Liss Jason
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States.
J Neurol Surg B Skull Base. 2021 Feb;82(1):100-106. doi: 10.1055/s-0040-1722700. Epub 2021 Feb 18.
Lacrimal gland lesions account for approximately 9 to 10% of all biopsied orbital masses. Potential causes include nongranulomatous and granulomatous inflammation, autoimmune disease, lymphoproliferative disorders, benign epithelial proliferation, malignant neoplasia, and metastatic disease. Inflammatory lesions and lymphoproliferative disorders are the most common and may be unilateral or bilateral; they may also be localized to the orbit or associated with systemic disease. Both benign and malignant epithelial lacrimal gland masses tend to be unilateral and involve the orbital lobe, but a more rapid onset of symptoms and periorbital pain strongly suggest malignant disease. On orbital imaging, both inflammatory and lymphoproliferative lesions conform to the globe and surrounding structures, without changes in adjacent bone, whereas epithelial lacrimal gland masses often show scalloping of the lacrimal gland fossa. Malignant epithelial lacrimal gland tumors can also have radiographic evidence of bony invasion and destruction. Masses of the lacrimal gland may be due to a broad range of pathologies, and a good working knowledge of common clinical characteristics and radiographic imaging findings is essential for diagnosis and treatment. All patients with inflammatory, lymphoproliferative, and epithelial neoplastic lesions involving the lacrimal gland require long-term surveillance for disease recurrence and progression.
泪腺病变约占所有经活检的眶内肿物的9%至10%。潜在病因包括非肉芽肿性和肉芽肿性炎症、自身免疫性疾病、淋巴增殖性疾病、良性上皮增生、恶性肿瘤及转移性疾病。炎性病变和淋巴增殖性疾病最为常见，可为单侧或双侧；也可局限于眼眶或与全身性疾病相关。良性和恶性上皮性泪腺肿物往往为单侧，累及眶叶，但症状出现更快且伴有眶周疼痛强烈提示为恶性疾病。在眼眶影像学检查中，炎性和淋巴增殖性病变与眼球及周围结构相符，相邻骨质无改变，而上皮性泪腺肿物常显示泪腺窝呈扇形。恶性上皮性泪腺肿瘤在影像学上也可有骨质侵犯和破坏的证据。泪腺肿物可能由多种病理情况引起，熟悉常见临床特征和影像学表现对诊断和治疗至关重要。所有累及泪腺的炎性、淋巴增殖性和上皮性肿瘤性病变患者均需长期监测疾病复发和进展情况。
