【摘要】 目的 探讨双眼睑巨大结节状黄色瘤的临床、病理特点,发病机制及治疗原则。方法 结合文献分析双眼睑巨大结节状黄色瘤的临床、病理特点和治疗过程。结果 眼睑巨大结节状黄色瘤病人常有血脂代谢异常,可有血糖异常,伴身体其他部位黄色瘤。病变均侵及真皮及真皮下结缔组织和眼轮匝肌,组织病理学示皮下或真皮内大量泡沫状组织细胞和黄瘤巨细胞(Touton巨细胞),切片苏丹染色,胞浆内充满脂滴,病理学均诊断为眼睑结节状黄色瘤。结论 眼睑巨大结节状黄色瘤的诊断除依据临床表现外,主要依据病理学诊断,其发病原因和机制尚不明了,治疗方法首选手术切除。
【关键词】 黄色瘤
CLINICAL AND PATHOLOGICAL STUDY ON HUGE TUBEROUS XANTHOMA OF BOTH EYELIDS: A REPORT OF ONE CASE LI TING, KONG QING-LAN, WANG ZUN-JING, et al(The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China) [ABSTRACT]ObjectiveTo study the clinical and pathological features, pathogenesis and therapeutic principle of tuberous xanthoma of both eyelids. MethodsThe clinical and pathological characteristics and treatment of the case was analyzed with re-ference of literatures. ResultsAbnormal lipid metabolism, abnormal blood glucose, and xanthoma on other parts of the body were commonly seen in patients with the disease. Dermis, subcutaneous connective tissue and orbicularis oculi muscle were involved. Histopathologically, substantial bubble-shaped yellow giant cell tissue and Touton giant cells were observed.ConclusionThe diagnosis of this disease mainly based on pathology apart from clinical manifestations. The pathogenesis is not clear. Surgical resection is the first of choice.[KEY WORDS]Eyelids; Tuberous xanthoma; Pathology, clinical
黄色瘤是一种异常的局限性皮肤隆起, 其颜色可为黄色、橘黄色或棕红色, 多呈结节、斑块或丘疹形状, 质地一般柔软, 无触压痛。主要是由于真皮内集聚了吞噬脂质的巨噬细胞(泡沫细胞,又名黄色瘤细胞)所致。黄色瘤可以分为不伴有高脂血症的黄色瘤和伴有高脂血症的黄色瘤两类。前者以眼睑黄色瘤最为多见,后者多见于糖尿病黄色瘤、多发结节性黄色瘤等。结节性黄色瘤可发生于任何年龄和性别,皮损常表现为多发性黄色结节,大小不等,坚实而有弹性,对称群集于肘、膝、指(趾)关节的伸面,偶尔可发生于腋窝或腹股沟皱褶部、面部、臀部和黏膜等处。而发生在眼睑的结节状黄色瘤十分罕见。本文报告1例双眼睑巨大黄色瘤病人,并结合文献探讨其发病机制,以提高临床诊治水平。
1 临床资料
病人,女,44岁,因发现双上睑肿物5年入院。病人于5年前发现双上睑黄色结节状肿瘤,渐长大,色黄,柔软,无红痛、流泪等不适。曾于外院诊为“慢性泪腺炎(双)”,接受头孢类抗生素及糖皮质激素治疗半年,肿瘤较前缩小,后因自行停药渐复发,双眼上睑外上隆起较前显著。既往健康,无家族史。查体:双上睑呈弥漫性结节状隆起,约4 cm×3 cm×2 cm大小,质韧、与皮肤粘连,表面皮肤色黄、无压痛,伴上睑上提困难。双眼向前平视时遮盖上方角膜约5 mm,上睑提肌肌力正常,质地稍韧,皮肤呈局限黄色。双眼向上注视时角膜下缘未达内外眦连线。双眼向下注视时肿瘤凸现,闭目功能良好。双眼视力均为0.8,眼前节及眼底均正常。眼眶CT示双上侧眼睑组织弥漫性增厚,双泪腺形态略增大。血三酰甘油2.3 mmol/L,血糖6.1 mmol/L。入院后3 d在局麻下行双眼睑肿瘤切除术+重睑矫正术。术中依次画线、局部浸润麻醉、切开皮肤,分离皮下组织,见肿瘤呈黄色,无包膜,边界不清,占据整个上睑组织,皮肤浸润明显,病变侵及真皮、真皮下结缔组织和眼轮匝肌,质韧,分离后切除肿瘤,大小为4 cm×3 cm×2 cm,肿瘤切面呈蜂窝状,剪除部分皮肤,作重睑缝合,加压包扎。术后7 d拆线,切口愈合良好。术后2周,睑缘形状可,无睑内外翻。半年无复发。病理检查示真皮、真皮下结缔组织有大量泡沫状组织细胞,呈空泡状,细胞体积大,胞浆内含有脂肪滴。病理诊断为眼睑结节状黄色瘤。
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