摘要
59岁男性,因"右眼球突出1年余"入院.眼部检查:右眼球前突,向外上方移位,内转、下转受限,眶压T+2,结膜轻度充血,余查体阴性.影像学示右眼内下方肌锥内外可见较大的实性肿物,与视神经、内直肌、下直肌等结构紧密相连,肿物边界清楚,内部信号不均匀,瘤体上、下半部磁共振成像(MRI)信号表现不一致,上半部瘤体明显强化,下半部部分不强化.入院后予下睑皮肤切口入路行右眼眶肿物完整切除,病理提示孤立性纤维瘤.讨论体会:孤立性纤维瘤不完全切除易复发,部分孤立性纤维瘤有恶变倾向,甚至危及患者生命;对于影像特征不典型需要鉴别诊断,术前鉴别诊断分析、选择合适手术方式及入路对完整切除肿瘤防止肿瘤复发具有重要意义.
Abstract
A 59-year-old male presented with a 1-year history of proptosis in the right eye.Ocular examination revealed proptosis,global displacement,limited adduction and infraduction and slight conjunctival hyperemia in the right eye with increased orbital compartment pressure(T+2).The rest of the physical examination was unremarkable.Radiological examinations demonstrated that a soft-tissue mass involving both intraconal and extraconal space was located behind the globe and at the nasal and downward side of the optic nerve,which was tightly adjacent to the optic nerve,medial rectus and inferior rectus.The internal signal of the tumor was inhomogeneous.The signals of the upper and under part were different in the MRI:the upper half of tumor body was enhanced obviously and the lower half was not enhanced.Thus,an orbital tumorectomy through lower eyelids was performed after hospital admission,and a diagnosis of solitary fibrous tumor was confirmed by histopathological examination.Discussion and experience:for orbital solitary fibrous tumor,incomplete resection led to the recurrence of tumor.There is a tendency of malignant transformation,even threatening the patient's life in partial cases.For orbital tumors with atypical imaging features,differential diagnosis before operation,appropriate surgical approach and complete resection are important to the prevention of tumor recurrence.
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