[The expression of MMP-2 and MMP-9 in adenoid cystic carcinoma of lacrimal gland].

OBJECTIVE: To investigate the expression of matrix metal proteinase (MMP)-2 and MMP-9 in adenoid cystic carcinoma of lacrimal gland as well as their relation with biological behaviour of adenoid cystic carcinoma. METHODS: Experimental study. The research objects were 60 cases of adenoid cystic carcinoma of lacrimal gland which were collected from No.2 Hospital of Tianjin Medical University from January 1991 to Jule 2011. There were 25 males and 35 females aged from 29 to 42 years. Based on histological revision, there were 36 cases of cribriform-tubular subtype and 24 cases of solid subtype. Forty-five cases were primary lesions and 15 cases were recurrent lesions. Ten samples of normal lacrimal gland around polymorphic adenoma were selected as the control group. The expression of CD105, MMP-2 and MMP-9 were evaluated by immunohistochemistry. The microvessel density (MVD) was defined by expression of CD105. One way ANOVA, χ(2)-test and spearman correlation test were used to analyzed the data. RESULTS: The number of MVD [(17.71 ± 5.63)/100 folds field of vision] and the positive rates of MMP-2 (45.0%, 27/60) and MMP-9 (55.0%, 33/60) in the samples of adenoid cystic carcinoma of lacrimal gland were higher than those in the normal lacrimal gland [the number of MVD was (0.70 ± 0.95)/100 folds field of vision, the expressions of MMP-2 and MMP-9 were negative] (t' = 2.039, P < 0.05; χ(2) = 5.550, P < 0.05; χ(2) = 8.315, P < 0.01), the solid subtypes had more MVD [(26.12 ± 5.32)/100 folds field of vision] and higher positive rates of MMP-2 (62.5%, 15/24) and MMP-9 (79.2%, 19/24) than the cribriform-tubular subtypes (t' = 2.060, P < 0.05; χ(2) = 4.950, P < 0.05; χ(2) = 9.439, P < 0.05); the recurrent lesions had more MVD and higher positive rate of MMP-2 and MMP-9 than the primary lesions (t' = 2.129, P < 0.05; χ(2) = 9.899, P < 0.05; χ(2) = 8.103, P < 0.05). The number of MVD in ACC of lacrimal gland patients was correlated with the positive rate of MMP-2 and MMP-9 respectively (rs = 0.636, P < 0.05; rs = 0.524, P < 0.05). CONCLUSIONS: The number of MVD and the expression of MMP-2 and MMP-9 are higher level in adenoid cystic carcinoma of lacrimal gland and are significantly correlated with pathological type and recurrence. Detecting the number of MVD and the expression of MMP-2 and MMP-9 may become biological indexes for malignancy, recurrence and metastasis of adenoid cystic carcinoma of lacrimal gland.

[Clinical diagnosis and curative effect observation of seventeen patients hemangiopericytoma in orbit].

OBJECTIVE: To conclusion the clinical features and image features, the diagnosis and management of orbital hemangiopericytoma, in order to direct clinical diagnosis and differential diagnosis. METHODS: Seventeen patients with pathologically confirmed orbital hemangiopericytoma were analyzed retrospectively. RESULTS: Patients usually complained of exophthalmos. Fourteen patients can be touched the tumor in the orbit. In B-scan ultrasound, a well outlined lesion was revealed. The type of it was often similarly circular or anomaly. The extent of internal echo was associated with histological structure of lesion. Color doppler flow imaging show that the tumor has rich feeding vessels. Some of them is arterial feeding vessels. On CT scan, hemangiopericytoma generally appears to be a uniform high-density mass with obvious enhancement upon injection of contrast material. All cases underwent surgical resection and are proved by pathological examination. CONCLUSIONS: Orbital hemangiopericytoma is a potentially malignant tumor. The prognosis and clinical behavior can't be predicted on the basis of their histopathologic classification. Medical imaging can help to demonstrate the site, configuration, and characteristics of the tumors and contribute to the treatment. But, there has not characteristic medical features. The final diagnosis must be depend on the pathology. The best management of hemangiopericytoma is complete local excision. All the patients must be observed nearly.

[Overexpression of the receptor tyrosine kinase EphA2 in choroidal melanoma: correlation with vesculogenic mimicry and prognosis].

OBJECTIVE: To study the correlation of EphA2 protein expression with vesculogenic mimicry (VM), clinicopathological characteristics and prognosis in choroidal melanoma (CM). METHODS: It was a retrospective case series study. Between January 1992 and December 2005, 56 cases of human CM with clinicopathologic data from the Second Hospital of Tianjin Medical University were studied. HE stainings were performed to observe the microcirculation patterns in tumor tissue specimens. VM was found in 26 of the 56 cases using CD31/periodic acid-Schiff (PAS) double staining and transelectron microscopy. All cases were divided into two groups: VM-positive and VM-negative. Immunohistochemical staining was performed on paraffin sections of the 56 cases of CM specimens to investigate the expression of EphA2. According to tumor cells positive rate and staining intensity of the results of evaluation, the specimens were divided into low expression and high expression groups.χ(2)-test and t-test were used to analyzed the enumeration data and measurement data, respectively. Survival analysis was used to further elucidate its correlation with clinicopathological characteristics, VM and prognosis. Cox proportional hazard model was used to analyzed the influence factors of prognosis. RESULTS: VM channels were found in 26 of the 56 CM cases and VM-negative 30 cases. VM-positivity was related to cell type, tumor size and recurrence and metastasis, and the differences were statistically significant (χ(2) = 4.612, 5.346, 5.213; P = 0.036, 0.021, 0.027). The results showed that EphA2 was up-regulated in the VM-positive group compared with the group of VM-negative group. The positive rates of EphA2 expression in the VM-positive group and VM-negative group were 92.3% (25/26) and 70.0% (21/30), respectively, with a significant difference between the two groups (t = 2.247, P = 0.009). The EphA2 protein was expressed in epithelioid (10/12), mixed (11/15) and spindle (41.40%) cell types, with a significant difference among these histological types (χ(2) = 6.513, P = 0.010). The expression rate of EphA2 protein were significantly higher in large (54.55%, 18/33) than small (45.45%, 15/33) tumors, and the expression of EphA2 in metastatic and recurrence patients (10/11) were significantly higher compared with controls (31.11%, 14/45) (χ(2) = 4.556, 8.211;P = 0.016, 0.005). Kaplan-Meier survival analysis showed the presence of VM resulted in a poor prognosis (t = 9.263, P = 0.000). The Cox proportional hazards model indicated that the EphA2 overexpression and the presence of VM were independent predictors of a poor prognosis (χ(2) = 12.041, P = 0.001). Moreover, there was a significant positive correlation between them (r = 0.412, P < 0.05). CONCLUSION: The results of this study demonstrate that EphA2 may play a critical role in the formation process of VM in CM, implicating EphA2 as a valuable marker for the prediction of recurrence, metastasis and prognosis in CM patients.

[Clinical analysis of orbital chloroma].

OBJECTIVE: To analyze and summarize the clinical aspects, diagnostic methods and treatment principle of the orbit chloroma. METHODS: It was a retrospective case series study. The clinical aspects of 17 orbital chloroma cases were analyzed, which included symptoms, signs, imageology, diagnosis, treatment and prognosis. RESULTS: Orbit chloroma was more prevalent in males, and usually occurred in children and individuals under 14 years old. The main symptoms were exophthalmos and orbit masses. B ultrasonic examination was performed in 16 cases, which found that the mass was located in the temporal side of the orbit, with irregular shape and clear edge. Color doppler imaging was performed in 5 cases, which found that the sufficient blood supply signal was the main manifestation. CT scan was performed in 11 cases, which revealed that the mass was located in temporal side of the orbit, with irregular shape, regular density, a clear edge and seldom destruction of the orbital bone. Blood examination was performed in 17 cases, which revealed the increase of white blood cells and the presence of numerous immature blood cells. Sixteen cases were referred to the department of hematology for treatment. In 4 following cases, 2 cases were died within 3 months. CONCLUSIONS: Orbital chloroma can be easily misdiagnosed as other types of malignant orbital tumor in children. The diagnosis of orbital chloroma can be established by radiology and hematological examinations. This tumor can be treated by chemotherapy and radiotherapy.

[Clinical analysis of primary extraocular muscles tumors].

OBJECTIVE: To analyze the clinical manifestation of primary extraocular muscles tumors and to study the diagnosis and therapy of this disorder. METHODS: Retrospective analysis of the clinical data of all primary extraocular muscles tumors (the diagnosis was confirmed by operation and pathological examination) in our hospital. RESULTS: There were 9 cases of primary extraocular muscle tumors. Six cases involved the internal rectus, 2 cases involved the external rectus, 1 case involved both inferior rectus and inferior oblique. Three cases involved the total length of the muscle; 2 cases involved the anterior muscle tendon and belly, 3 cases involved the posterior muscle tendon and belly, 1 case involved the muscle belly only. There were 3 cases of venous hemangioma, 2 cases of fibroangioma, 2 cases of neurilemoma, 1 case of fibrous histiocytoma and 1 case of paraganglioma. Image examination showed significant enlargement of extraocular muscle with clear boundary. B-scan ultrasonography, color Doppler flow image, CT and MRI scan showed different features. Patients were treated by excision of the tumor. Transplantation of the rectus was performed in several cases after the excision of the muscle. CONCLUSIONS: Vascular tumors are the most common type of primary extraocular muscle tumors. Congestion and swelling can be observed at the insertion of the rectus. The eyeball is proposed and moved to the opposite side of the affected muscle. Changes in the image analysis are related to the pathologic features. A good therapeutic results can be achieved by surgical excision of the tumor.

[Etiology, diagnosis and treatment analysis of 37 cases with orbital fistula].

OBJECTIVE: To present some instruction in diagnosis and treatment of the orbital fistula by analyze the clinical manifestation. METHOD: The clinical data for 37 cases with orbital fistula treated during 1980 to 2007 were analyzed retrospectively. RESULTS: Among 37 cases with orbital fistula, there are 21 cases caused by foreign bodies, including 17 cases by retained wooden bodies, 3 cases by iatrogenic foreign bodies and 1 case by firecrackers. There are 9 cases caused by orbital cysts, including 5 cases dermoid cysts, 3 cases epidermoid cysts and 1 case frontal mucopyocele. There are 6 cases orbital infection inflammation, including 5 cases osteomyelitis and 1 case orbital abscess. There is 1 case eosinophilic granuloma. Different etiologies have characteristic features. Medical history, fistula examinations and imaging examinations must be analyzed synthetically in order to make proper etiological diagnosis. Eradicate etiologies and resect fistula are most important. It is necessary to make an ancillary therapy, such as ENT treatment. CONCLUSIONS: The common etiologies of orbital fistula are retained foreign body, dermoid cysts and osteomyelitis. The pathogenesis include infective inflammation, congenital heteroplasia, operation and tumor. B-scan ultrasonography, CT, and MRI can be used for the localization and qualitation diagnosis. There are comprehensive approaches for diagnosis and management of this type of injury. In order to give an effective therapy, we must make an accurate diagnosis and analyze the features of fistula.

[Analysis of treatment and prognosis of orbital adenoid cystic carcinoma].

OBJECTIVE: To summarize the treatment outcomes of orbital adenoid cystic carcinoma and to evaluate prognostic factors. METHOD: A retrospective case series study was performed on 75 patients with orbital adenoid cystic carcinoma treated from 1991 to 2006. RESULTS: The 2- and 5-year local recurrence rate of solid type orbital adenoid cystic carcinoma was significantly higher than that of the adeno-tubiform type [2-year, 85% (17/20) vs 23.53% (8/34), chi(2) = 19.14, P = 0.000; 5-year, 100% (19/19) vs 64.52% (20/31), Fisher's exact test, P = 0.003]. The regional extension and distant metastasis of solid type were more than those of adeno-tubiform type. The 5-year local recurrence rate treated by postoperative radiation was lower than that treated with only surgical excision [70% (14/20) vs 92.86% (13/14); Fisher's exact test, P = 0.198]. The 5-year local recurrence rate in patients initially treated by orbital evisceration during the first time was lower than that of cases which evisceration procedure was used after the recurrence [25% (1/4) vs 75% (6/8), Fisher's exact test, P = 0.222]. Tumors may extend into intracalvarium, nasal cavity and temporal fossa. They may spread to the lung, bone, liver and lymph node. The 5-year metastasis rate was 25.71% (9/35). Both of the lung and bone metastasis rates were 33.33% (3/9). The overall 5-year accumulative survival was 74.29% (26/35), mortality was 25.71% (9/35), and rate of survival without tumor recurrence was 37.14% (13/35). The 10-year disease free survival rate was 17.14% (6/35). Patients were most likely to die with intracranial extension. Surgical excision with postoperative radiation improved the 5-year survival rate to 80% (16/20). CONCLUSIONS: Orbital adenoid cystic carcinoma is one of the most malignant tumors in the orbit. They have a high local recurrence rate and survival rate. Tumor histological types and the treatment procedure can influence the prognosis. Combined therapy may decrease the recurrence and increase the survival rate.

[Gene and protein expression of thyrotropin-receptor in retro-bulbar tissue from thyroid-associated ophthalmopathy].

OBJECTIVE: To investigate gene and protein expression level of thyrotropin-receptor (TSHR) in retro-bulbar connective tissue and fat tissue in patients with thyroid-associated ophthalmopathy (TAO). METHODS: Retro-bulbar tissues specimens were obtained from 11 cases of TAO patients and 10 control cases during the operation. RNA was extracted from the tissue specimens using single-step method of acid guanidinium-thiocyanate-phenol-chloroform extraction and TSHR mRNA was analyzed by reverse transcription polymerase chain reaction (RT-PCR). Immunochemistry staining was performed in patients expressed TSHR, using a mouse polyclonal anti-TSHR peptide antibody to observe protein expression level of TSHR. RESULTS: The size of TSHR mRNA segment is 521 bp. The rate of TSHR mRNA expression in TAO retro-bulbar tissue was 91% and was 20% in the control cases, the former was significantly greater than the later. Protein expression rate was 66.7% in TAO patients, and was negative in the controls. CONCLUSIONS: High TSHR mRNA expression level and protein level in TAO retro-bulbar tissue and no expression in control tissue indicate that TSHR exists as a common antigen in the orbit and thyroid, and plays a key role in the pathogenesis of TAO.

[Recent advances in the studies of orbital diseases].

Orbital diseases are not common, but they are closely related with various systems of the body. A significant progress in orbital diseases has been achieved both in China and abroad in the last several years. The study of etiology of thyroid-associated ophthalmopathy and the establishment of an experimental animal model have provided the hope for a novel treatment of this disease; the studies of rhabdomyosarcoma and tumors of lacrimal gland at the molecular level have provided the basis for the development of a novel treatment; new plaque radiotherapy and application of various kinds of seed have enriched the treatment and improved the prognosis of orbital tumors. Some significant progresses, for example, a new viewpoint of meningioma of the optic nerve sheath and glioma, improved approach for entering the orbit and complex treatment of malignant tumors have revealed a new path for the diagnosis and treatment of orbital disease.

[Emphasizing the fundamental and clinical research on thyroid-associated ophthalmopathy].

In this article, we discussed the pathogenesis and current status of the research in thyroid-associated ophthalmopathy (TAO). TAO, the most common orbital disease in adults, is an orbital autoimmune disease closely related to Graves' disease. Now, the fundamental and clinical research on TAO should be further enhanced.

[The clinical significance of calcification in orbital computed tomography].

OBJECTIVE: To study clinic significance of ocular and orbital diseases with computed tomographic (CT) scans. METHODS: 2181 ocular and orbital photos of computed tomographic scans were reviewed. The relevance with pathogenesis, diagnosis criteria and differential diagnosis of calcification was analyzed. RESULTS: Of 2181 CT scans, 129 showed calcified densities. 40 cases (31%) with retinoblastoma, and 3 cases (1%) with chorodal osteoma were revealed intraocular lesions containing calcium. The massive calcification was demonstrated in orbital diseases including 58 cases (45%) with vascular lesions, 19 (15%) cases with other orbital benign tumors and 9 cases (8%) with orbital malignant tumors. CONCLUSION: The calcification number, location and shape within lesions are of great value in the diagnosis of ocular and orbital diseases.

[Clinical analysis of orbital histocytosis X].

OBJECTIVE: To study the clinical and imaging features together with diagnosis and management of orbital histocytosis X. METHODS: In a retrospective study from 1973 to 1999, 47 cases of histocytosis X were reviewed related with clinical materials, including eosinophilic granuloma 17 cases and Hand-Schuller- Christian disease 30 cases. RESULTS: Most occur in children and teenagers, mainly in male. Characteristic clinical features, roentgenography, ultrasonography, CT, MRI provide the most diagnostic assistance. CONCLUSIONS: Solitary unifocal eosinophilic granuloma mainly involves teenagers. Hand-Schuller-Christian disease usually take places between birth and 5 years of age, which is characterized by multifocal variant of eosinophilic granuloma, especially the classic triad. Characteristic images contribute to the diagnosis. Multiple management is needed, including surgery, chemotherapy and radiotherapy. The prognosis varies with the three types.