Bai Fang, Tao Hai, Zhou Xi-Bin, Wang Fei, Wang Peng, Wang Li-Hua, Zhang Hong-Yang
The Lacrimal Center, the Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
Int J Ophthalmol. 2023 Apr 18;16(4):532-538. doi: 10.18240/ijo.2023.04.06. eCollection 2023.
To determine the clinical characteristics, pathological types, tumor markers, treatments, and outcomes of Chinese patients with primary lacrimal sac lymphoma.
This case-based retrospective study analyzed 15 Chinese patients with primary lacrimal sac lymphoma. The clinical data collected included gender, age at diagnosis, symptoms, imaging examination results, pathologic diagnosis, pathogen identification, tumor markers, treatments, follow-up, and prognosis. Descriptive statistics were used to characterize the patients. Progression-free survival (PFS) was defined as the time from surgery to the last follow-up, first record of tumor recurrence, or death.
There were 7 males and 8 females with unilateral primary lacrimal sac lymphoma in the left eye (=6) or right eye (=9). The initial symptom in 13 patients was epiphora, and 2 patients had redness and swelling in the lacrimal sac area. All patients ultimately developed epiphora, and 12 had masses in the lacrimal sac area. Analysis of preoperative plasma tumor markers indicated 14 patients had elevated homocysteine, 9 had elevated β2-microglobulin, and 2 had elevated lactate dehydrogenase (LDH); 2 patients had elevations of all three markers, and 1 patient had no elevation of any marker. All patients underwent surgical resection and 12 patients received postoperative chemotherapy. The pathological types were DLBCL (=8), MALT lymphoma (=5), and NK/T-cell lymphoma, nasal type (=2). The mean follow-up time was 25.8mo (range: 4-41) and 2 patients died. Seven patients who underwent mass excision combined with dacryocystorhinostomy (DCR) had no postoperative epiphora. Eight patients who only underwent mass excision had varying degrees of postoperative epiphora. Preoperative LDH elevation and NK/T-cell lymphoma, nasal type were associated with poor prognoses.
Early diagnosis and treatment can lead to a good prognosis for most patients with primary lacrimal sac lymphoma. Mass resection combined with DCR can reduce the occurrence of post-surgical epiphora. The pathology type and tumor marker status are associated with prognosis.
确定中国原发性泪囊淋巴瘤患者的临床特征、病理类型、肿瘤标志物、治疗方法及预后。
本基于病例的回顾性研究分析了15例中国原发性泪囊淋巴瘤患者。收集的临床数据包括性别、诊断时年龄、症状、影像学检查结果、病理诊断、病原体鉴定、肿瘤标志物、治疗方法、随访情况及预后。采用描述性统计对患者进行特征分析。无进展生存期（PFS）定义为从手术至最后一次随访、首次记录肿瘤复发或死亡的时间。
15例患者中，男性7例，女性8例，均为单侧原发性泪囊淋巴瘤，其中左眼6例，右眼9例。13例患者的初始症状为溢泪，2例患者泪囊区出现红肿。所有患者最终均出现溢泪，12例患者泪囊区有肿块。术前血浆肿瘤标志物分析显示，14例患者同型半胱氨酸升高，9例患者β2-微球蛋白升高，2例患者乳酸脱氢酶（LDH）升高；2例患者三种标志物均升高，1例患者任何标志物均未升高。所有患者均接受了手术切除，12例患者术后接受了化疗。病理类型为弥漫大B细胞淋巴瘤（DLBCL，8例）、黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤，5例）和鼻型NK/T细胞淋巴瘤（2例）。平均随访时间为25.8个月（范围：4 - 41个月），2例患者死亡。7例行肿物切除联合泪囊鼻腔吻合术（DCR）的患者术后无溢泪。8例仅行肿物切除的患者术后有不同程度的溢泪。术前LDH升高及鼻型NK/T细胞淋巴瘤与预后不良相关。
早期诊断和治疗可使大多数原发性泪囊淋巴瘤患者获得良好预后。肿物切除联合DCR可减少术后溢泪的发生。病理类型和肿瘤标志物状态与预后相关。
