Retrospective Analysis of Clinicopathological Characteristics of Lacrimal Gland Pleomorphic Adenoma and Mechanism of Tumorigenesis by the Imbalance Between Apoptosis and Proliferation.

BACKGROUND Lacrimal gland pleomorphic adenoma (LGPA) is the most common clinically benign epithelial tumor of the lacrimal gland and is predominantly comprised of epithelial cells and interstitial components. At present, the exact pathogenesis of LGPA remains unclear. Previous research has indicated that the occurrence of LGPA may be related to excessive cell proliferation. MATERIAL AND METHODS This study observed the clinicopathological characteristics of LGPA and investigated the tumorigenesis mechanism of cell over-proliferation caused by the imbalance between apoptosis and proliferation. A total of 27 cases were collected from the Department of Ophthalmology of the Affiliated Hospital of Chengde Medical University and the Third Medical Center of Chinese PLA General Hospital from April 2017 to November 2019. Hematoxylin-eosin (HE) staining and immunohistochemical staining were used to observe the pathological characteristics and analyze the expression of bcl-2 and bax in the lacrimal gland. RESULTS Compared with normal lacrimal gland tissues, LGPA tumor tissues had obvious changes in pathological morphology. The expression of bcl-2 in LGPA lesion tissues was dramatically higher (P<0.001), the expression of bax was not significantly different between groups (P=0.25), but the ratio of bcl-2/bax was significantly higher in tumor tissues (P=0.01). CONCLUSIONS We found that the lacrimal gland tumor tissues had obvious excessive proliferation in pathomorphology, which revealed the necessity of complete surgical removal of the capsule from the perspective of pathological morphology and provided a theoretical basis for the hypothesis that the imbalance between apoptosis and proliferation could lead to cell hyperproliferation.

Establishment of a combination scoring method for diagnosis of ocular adnexal lymphoproliferative disease.

Lymphoproliferative diseases (LPDs) of the ocular adnexa encompass the majority of orbital diseases and include reactive follicular hyperplasia (RFH), atypical lymphoid hyperplasia (ALH), and mucosa-associated lymphoid tissue lymphoma (MALToma). Lymphoid follicles (LFs) are usually observed during the histological examination of LPDs. Currently, because there is a lack of specific clinical signs and diagnostic immunohistochemical biomarkers, it is difficult for pathologists to distinguish MALToma from ocular RFH and ALH, which makes the clinical management of these conditions difficult. Here, we analyzed the clinical features of patients with ocular adnexal LPDs (n = 125) and investigated the structure of LFs in paraffin-embedded tissue samples using anti-CD23 and anti-IgD immunochemistry. We found that some clinical features including age, sex, and laterality were different among RFH, LFH, and MALToma. Additionally, immunohistochemistry revealed that the expression of IgD and CD23 was higher in RFH patients and decreased in patients with ALH and MALToma. Moreover, LFs in RFH were intact, whereas the structures of most LFs were disrupted in ALH. In MALToma specimens, few intact LFs were observed. In a further investigation, we combined the results for CD23/IgD immunohistochemistry and the structure of LFs to establish a scoring method for the differential diagnosis of LPDs. According to the BIOMED-2 protocol, we further detected IgH gene monoclonal rearrangement in 73 cases (35 RFH, 17 ALH, and 21 MALToma cases). The sensitivity of our scoring method, based on a comparison with the results of IgH gene monoclonal rearrangement detection, was 85.7% (18/21) for MALToma and 35.3% (6/17) for ALH. Our study provides a method that may be useful for the differential diagnosis of RFH, ALH, and MALToma.

[Clinical analysis of 14 cases of congenital orbital fibrosis].

OBJECTIVE: The purpose of this study was to show the clinical and imaging characteristics in patients with congenital orbital fibrosis. METHODS: A retrospective review of a series of 14 patients with congenital orbital fibrosis hospitalized in Institute of Orbital Disease during 2005 to 2009 have been characterized. Patients aged from 3 months to 18 years old, the median age was 7 years old, 6 cases (43%) were male. RESULTS: Ocular changes were found at birth in all patients, symptoms at onset of the disease included dysfunction of eye movement (12 cases), lagophthalmos (7 cases), diplopia (5 cases), exophthalmos (4 cases), conjunctival congestion (4 cases) and endophthalmos (2 cases). The results of medical examinations including visual acuity, exophthalmos or endophthalmos, diplopia with or without compensative head station, displacement of the eye, lagophthalmos, blephroptosis and ocular dyskinesia all have been record. In the 14 cases, 13 patients have undertaken the CT imaging examination, soft tissue lesions have been found in the orbit with high density and irregular shape, accompanied with thickened ocular muscles and anatomical changes. Of the 9 cases which underwent MRI examination, all of the lesions showed medium signals in T(1)WI, with medium to low signals in T(2)WI. Local excision has been performed in 2 patients, we found that the orbital lesions packaged with hard fibrous tissues around, and the ocular muscles were thick and stark. Pathological examination showed fibrosis and degeneration in the lesions, lacrimal gland and ocular muscles. Some lymphocyte infiltration also has been observed. CONCLUSIONS: Congenital orbital fibrosis is an orbital disease occurs at birth and is characterized with series of signs such as endophthalmos or exophthalmos, ocular dyskinesia and diplopia. Imaging examinations often find abnormal mass with irregular shape and soft tissue density in orbit. Till now, no efficient therapy has been established.

[Analysis on the safety of ophthalmic artery cannulation for intra-arterial chemotherapy in 42 patients with intraocular stage retinoblastoma].

OBJECTIVE: To investigate the safety of treatment with ophthalmic artery cannulation for intra-arterial chemotherapy (IAC) for children with intraocular retinoblastoma (RB). METHOD: In the RB Treatment Center of General Hospital of Armed Police Forces between January 2009 and September 2011, 42 patients who were diagnosed intraocular RB and treated with ophthalmic artery cannulation for IAC, 8 patients were treated 1 circle, 31 patients were treated 2 circles and 3 patients were treated 3 circles (total, 96 times). Each month had IAC once. The ophthalmic and the whole body evaluations were performed during IAC and after IAC for each circle, the blood cell count, alanine aminotransferase (ALT), serum creatinine (Scr), CK-MB content before and after IAC for 1 circle, 2 circles and 3 circles were determined. RESULT: (1) In 52 eyes of 42 patients, 44 eyes (84.6%) were in remission. (2) Successful IAC was achieved in all cases, no severe side effects occurred during IAC. (3) The main ophthalmic complications were eyelid edema and blepharoptosis after IAC, the incidence for 1 circle was 18% (2/11) and 9% (1/11); for 2 circles was 29% (11/38) and 21% (8/38); for 3 circles was all 100% (3/3). The rare complications were vitreous hemorrhage and heterotropia, the incidence was all 2% (1/42). The incidence of eyelid edema and blepharoptosis had no significant differences for 1 circle IAC compared with 2 circles (P > 0.05); the incidence of eyelid edema and blepharoptosis had significant differences for 3 circles IAC compared with 2 circles and 1 circle (P < 0.01). (4) No fever, septicemia and other systemic toxic effects occurred. (5) ALT of 19% patients (8/42) elevated temporarily and CK-MB of 24% patients (10/42) increased. The blood cell counts, ALT, Scr, and CK-MB content before IAC had no significant differences compared with that at 24 h after IAC for 1 circle, 2 circles and 3 circles (P > 0.05). CONCLUSION: Ophthalmic artery cannulation for IAC is a safe and effective method in treating intraocular stage retinoblastoma.

[Study on peripheral blood T lymphocyte cell membrane in thyroid associated ophthalmopathy by using atomic force microscopy].

OBJECTIVE: To study the cell membrane of T-lymphocytes in thyroid associated ophthalmopathy (TAO) by using atomic force microscopy (AFM). METHODS: Case-control study. Forty-two patients were selected as the subjects, and divided into two groups: acute stage (18) and stationary stage (24) ones on the basis of symptom. Ninety-two healthy persons were in the normal groups. Dynal immunomagnetic beads isolation method was used to separate the T cells. CD3+ was chosen as a surface molecule marker of T cells to determine the purity of cells isolated. Cultivated T cells were observed by AFM. Amplitude and height images were obtained in the tapping mode with a scan rate of 2 Hz and an integral gain of 0.3 to 0.5. Statistical analysis was performed using single-factor analysis of variance and the P value was calculated. RESULTS: The topographies of these three groups of T cells showed significant difference (F = 28.809, 58.213, 169.789, 35.933, 121.325; P < 0.05. Average diameter and roughness of T cells in acute stage of TAO were significantly greater than those of the other two groups. One way analysis of variance showed that significant differences in various parameters (Ra, Peak count, Rpm, Rvm, Surface area diff) were found between these three groups (P = 0.047, 0.002). CONCLUSIONS: The morphology and ultrastructure of lymphocytes in TAO are different from the normal subjects by observation with AFM. Lymphocytes in acute stage of TAO are also different from those in stationary stage.

[Preliminary observations of embolization treatment of orbital varices with Glubran 2 acrylic glue].

OBJECTIVE: To evaluate the outcome of embolization via orbital surgical exposure for a series of orbital varices. METHODS: This study is a retrospective review of 28 patients (28 eyes, 11 men, 17 women) which were diagnosed as orbital varix from March to December in 2007, in the Institute of Orbital Diseases. Patient's age ranged from 11 to 54 years old, mean 32 years old. Right orbit 18 cases, left orbit 10 cases. All patients is under general anesthesia, operative approach included lateral orbitotomy (9 cases), anterior orbitotomy (11 cases), transconjunctival (7 cases) and percutaneous puncture (1 case). During the operation, venous malformations were dilatated and punctured with an 20-gauge catheter needle, then injected into 33% Glubran 2 with several punctures with different orientations of the needle were required to reach the different lobules of the venous pouch. RESULTS: Proptosis, visual acuity and eye movement for pre- and post-treatment were observed. All the patients treated with 100% efficiency, in which 16 cases (57%) were complete resolution of the signs and symptoms, no proptosis with Valsalva and correct completely or partially enophthalmos, 12 cases (43%) marked resolution. Six patients partial resection as lesion was stiffen after glue injection, and can touch in anterior part of the orbit. Complications included the vision acuity loss (1 case), limitation of ocular movement (3 cases), and proptosis (2 cases). CONCLUSION: The embolization with Glubran 2 after direct surgical exposure is the safe and effective treatment for orbital varix and can correct some enophthalmos.

[Analysis of the results of surgical management of orbital osteoma].

OBJECTIVE: To analyze the results and skill of surgical management of orbital osteoma retrospectively. METHODS: It was a retrospective case series. Nineteen cases of orbital osteoma (the diagnosis was confirmed by surgical and pathological studies) were analyzed retrospectively in the present study. RESULTS: The location of orbital osteoma was as following: 10 cases in medial wall of the orbit, 4 cases in orbital roof and 5 cases in lateral wall of the orbit. Surgical approaches included anterior orbitotomy (8 cases), lateral orbitotomy (7 cases), and medial orbitotomy (2 cases). Complete resection was performed in 12 cases,while partial resection was done in 7 cases. CONCLUSIONS: Orbital osteoma is easy to diagnosis but difficult in surgical treatment. Appropriate surgical approach and skilled surgical technique are able to reduce the surgical complications.

[Diagnosis and management of orbital metastatic tumors].

OBJECTIVE: To evaluate the type, clinical features and diagnostic methods of orbital metastatic tumors. METHODS: In a retrospective study, the records of 30 consecutive cases with orbital metastatic tumors as confirmed by pathologic examination were analyzed with special attention to the epidemiology, clinical manifestations and imaging findings. RESULTS: Most orbital metastatic tumors in China originated from the breast, followed, in order, by the lung and liver. The metastatic tumors of the orbit most frequently originated from the liver and lung in males, and from the breast and lung in females. The male or female ratio of patients with orbital metastasis was 1:1. The orbital metastases were more common in the children and the elderly. In 50% of patients, the orbital symptoms were the first signs of the disease. The longest course was seen in metastasis from the breast and the shortest from various types of blastomas. Orbital metastases could occur unilaterally or bilaterally. The most common symptoms of orbital metastatic tumors included diplopia and orbital pain. The signs included proptosis, limited ocular movement and increased intraorbital pressure. Based on the images of computed tomography or magnetic resonance imaging, orbital metastatic tumors could be divided into four different types according to the location and morphology of the tumors. Follow-up results revealed that 60% of orbital metastasis had poor prognosis. CONCLUSIONS: The spectrum of orbital metastatic tumors in China is different from that in western countries. Familiarity with the clinical manifestation and diagnostic methods of orbital metastatic tumors can be helpful to relief the ocular symptoms and prolong the life of patients.

[Retrospectively analysis of diagnosis and treatment of the orbital neurilemomas].

OBJECTIVE: To evaluate the diagnosis and surgery of orbital neurilemoma. METHODS: Thirty-eight patients with pathologically confirmed orbital neurilemomas were analyzed retrospectively. The age of the patients ranged from 9 years to 69 years. Twenty-three patients were female and fifteen were male. Standardized A/B scan was performed in 37 cases. CT scanning was performed in 38 patients with contrast scanning in 15 patients and MR imaging was performed in 33 patients with contrast scanning in 32 patients. RESULTS: Neurilemoma was generally low to medium reflective or echo in the ultrasound. Of the 38 cases with orbital neurilemomas, location of tumors was superior of the orbit in 17 cases; lateral and inferior in 19 cases and medial in 2 cases. Shape of the tumors was elongate or round-like 26 cases, leaf-like and dumb-bell 12 cases. CT scanning showed soft tissue high density mass in 32 cases, 6 cases were heterogeneity (for cystoid change). MR imaging in 33 patients displayed a identical T1 and a long T2 signal intensity weighted images in 4 cases; identical T1 and T2 mixed signal (short, identical and long signal) in 28 cases; identical T1 and T2 in 1 cases. After Gd-DTPA enhancement in 32 cases, heterogeneity enhancement of the mass was seen in 28 cases, marked enhancement 4 cases. Four cases in all cases was found orbital-cranial communicate mass. Surgical approach was lateral orbitotomy in 26 cases, combined lateral and medial orbitotomy in 2 cases, anterior orbitotomy 4 cases and medial orbitotomy in 2 cases. CONCLUSIONS: Modern medical imaging, especial MR imaging can demonstrate the site, configuration, and characteristics of the tumors and contribute to the diagnosis and treatment. Skill of surgery can improve the rate of success and decrease the complications.

[The features of pathology and immunohistochemistry in orbital meningiomas].

OBJECTIVE: To study the biological characteristics of orbital meningiomas using histological and immunohistochemistrical analysis. METHODS: 19 specimens taking from orbital meningiomas were included in the study. HE staining was used for histology analysis and the immunohistochemistry was applied to demonstrate the expression of Vimentin, EMA, Ki-67, p53 in the tissue of orbital meningiomas. RESULTS: The main configuration of orbital meningiomas was meningothelial, transitional and fibrous meningioma. The expression rations of Vimentin and EMA were 94.75% (18/19), 52.63% (10/19), respectively. The detected rations of Ki-67 and p53 were very lower. CONCLUSIONS: Our study shows that the major histological configuration of orbital meningiomas are meningothelial, transitional and fibrous meningioma. Compare with intracranial meningiomas, the expression rate of EMA in orbital meningiomas is lower. No difference of the expression rates of p53 and Ki-67 are found in benignant, recrudescent and malignant of tumor.

[Study on extraction technology for extract and flavonoids in Chrysanthemum morifolium by orthogonal design].

OBJECTIVE: To ascertain extraction technology condition for extract and flavonoids from Chrysanthum morifoliwn. METHOD: The optimizing ultrasonic extraction condition on the basis of extractive yield and flavonoids were determined by orthogonal design. RESULT: The order of factors which affected the flavonoid extraction was extraction times > ethanol concentration > ultrasonic time > solvent quantity. CONCLUSION: The optimum ultrasonic extractions are A2B3C3D3. Compared with traditional extraction, ultraction method is timesaving, simple to operate, stable and need not be heated.

[Study on ultrasonic extraction techniques of flavonoids in Chrysanthemum morifolium].

OBJECTIVE: To optimize the ultrasonic extraction condition for flavonoids from Chrysanthemum morifolium. METHOD: The extraction rate of flavonoids optimized condition (ethanol concentration, ultrasonic time, solvent quantity and extraction times) was determined by orthogonal design. UV-Spectrophotometry was used for the determination. RESULT: The order of factors to affect the flavonoid extraction was ethanol concentration > extraction times > solvent quantity > ultrasonic time. CONCLUSION: The optimum ultrasonic extractions were: A2 B2 C3 D3. Compared with traditional extraction, ultraction method can save time, be easy to operate, improve extraction rates and need no heating.