国际眼科纵览

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眼部孤立性纤维性肿瘤

孙慧 蔡蓉蓉 王纾宜 毕颖文   

  1. 复旦大学附属眼耳鼻喉科医院病理科,上海200031
  • 收稿日期:2020-01-13 出版日期:2020-08-22 发布日期:2020-09-01
  • 通讯作者: 毕颖文,Email:corneal@qq.com E-mail:corneal@qq.com

Ocular solitary fibrous tumors

Sun Hui, Cai Rongrong, Wang Shuyi, Bi Yingwen   

  1. Department of Pathology,Eye & ENT Hospital, Fudan University, Shanghai 200031,China
  • Received:2020-01-13 Online:2020-08-22 Published:2020-09-01
  • Contact: Bi Yingwen, Email: corneal@qq.com E-mail:corneal@qq.com

摘要: 孤立性纤维性肿瘤(solitary fibrous tumor,SFT)是一种梭形细胞间叶源性肿瘤,好发于胸膜。眼部SFT作为一种少见的疾病,可发生于眼的各个部位,包括眼睑、眼眶及球内。眼部SFT主要见于成年人,单眼发病,患者多以眼睑肿胀、眼球突出、视力下降及可扪及的肿块就诊。CT和MRI上多表现为界清的卵圆形至圆形软组织肿块,增强扫描后强化显著,提示肿瘤内含有丰富的血管。组织学上肿瘤由卵圆形到梭形细胞随意排列并与粗细不等的胶原混合成“无结构”样模式,肿瘤内可见典型的“分支样、鹿角样”血管。免疫组织化学染色结果显示肿瘤细胞CD34和STAT6弥漫一致强阳性,是SFT的重要诊断线索,CD99、Vimentin、Bcl-2阳性也可帮助其诊断。基因表达谱研究揭示SFT中存在NAB2-STAT6融合基因,其可能是SFT重要的发病机制之一。眼部SFT的主要治疗手段为根治性手术切除,必要时术后辅以放射治疗,特别是非典型/恶性或复发性SFT。SFT属于中间性肿瘤,性质介于良恶性之间,部分可复发、浸润或者转移。因此,SFT患者术后必须进行长期随访和定期复查。

Abstract: Solitary fibrous tumor (SFT) is a spindle cell tumor of mesenchymal origin that typically occur in pleura tissue. Ocular SFT as a rare disease, which may occur in a variety of areas, including eyelid, intro-orbital, intra-bulbar. Ocular SFT is mainly seen in adults,monocular onset. The clinical features of the patients often present with eyelid swelling, proptosis, vision disturbances and a palpable mass. CT and MRI revealed a well-circumscribed ovoid mass with intensely enhancement, because of the prominent blood vascular channels within the tumor. The classic histopathological feature of SFT is ovoid to spindle shaped cell growing in a haphazard manner. Background stroma was fibro-collagenous and richly “storiform pattern and staghorn” vessels. A diffuse and intense staining of CD34 and STAT6 are important diagnostic clue favoring SFT. CD99, vimentin and Bcl-2 are also frequently positive in SFT. Scientists have recently identified NAB2-STAT6 gene fusions in the vast majority of SFT, which may promote the formation of SFT. Radical surgical resection seemed to be the most important treatment segment. When the lesion is not completely cleared or in recurrent and malignant cases, postoperative radiotherapy can be used as an adjuvant therapy. SFT as an intermediate tumor, its biological behavior is between benign and malignant. Because of the possibility of its local invasion, local recurrence or distant metastasis, long-term follow-up is mandatory.