2017年 · 第53卷第06期

Sebaceous gland carcinoma is one of the main malignant tumors on the human body surface. The eyelid and its adjacent tissues are the best sites for sebaceous gland carcinoma. Eyelid sebaceous gland cancer originates from the sebaceous glands of the eyelid (including the meibomian glands, Zeis glands, and tiny glands surrounding hair follicles), the vast majority of which originate in the meibomian glands. Meibomian gland carcinoma is highly malignant, easy to invade adjacent tissue structures, and even metastasize and endanger patients' lives. Meibomian gland cancer is easily misdiagnosed and delays the opportunity of treatment. Surgery is the main method for treating meibomian gland carcinoma. Choosing appropriate surgical methods can help to improve the cure rate, reduce the risk of recurrence and metastasis, and improve the prognosis and quality of life of patients.

The patient was a 43-year-old male. He was admitted to the Department of Ophthalmology of Yijishan Hospital affiliated to Wannan Medical College on January 31, 2015 due to pain in his right eye with visual acuity loss for more than one month. Past history: In November 2012, a new organism the size of a soybean grain was discovered in the vulva, located at the foreskin of the penis, with hardening of the posterior glans, bleeding from the external urethral opening with mild tenderness. Circumcision and penile space-occupying biopsy were performed in an external hospital. Pathology considered condyloma-like changes, and CO was given.₂Cryo-removal of warts and antiviral treatment; The hyperplasia reappeared in situ, and superficial mass resection was performed. The pathology showed penile cancer. On July 24, 2013, radical resection of penile cancer was performed. The pathological examination results showed that well-differentiated squamous cell carcinoma of the penis invaded the muscle layer. After re-examination, bilateral inguinal mass was found, and bilateral inguinal lymph node dissection was performed. Later, due to metastasis of subcutaneous soft tissue at the root of the left thigh, bilateral inguinal and iliac paravascular lymph nodes, vascular exploration of the left lower limb + pedicled myocutaneous flap resection and transplantation + resection of skeletal muscle and soft tissue tumor around the left hip joint + inguinal lymph node dissection was performed on September 29, 2014. On January 13, 2015, the patient visited the ophthalmology department for the first time due to visual loss in the right eye. MRI plain scan showed choroidal metastatic cancer in the right eye. Further examination was recommended but the patient refused and was later admitted due to loss of vision in the right eye with severe pain in the eyeball.

Example 1The patient was a 57-year-old female. On July 16, 2007, I went to Tianjin Eye Hospital for treatment due to the discovery of subcutaneous hard knots in the upper and lower eyelids of my left eye with red and swollen eyelids for half a year and aggravated for half a month. One year ago, the patient was operated in an external hospital for subcutaneous induration of the lower eyelid of the left eye with eyelid redness and swelling, and the postoperative pathological diagnosis was benign granulosa cell tumor of the left eyelid. Half a year after the operation, the upper and lower eyelids of the patient appeared red and swollen again, and gradually worsened without obvious pain. In order to seek further treatment, he went to our hospital. Eye examination: Right eye visual acuity 0.8. The visual acuity of the left eye is 0.3, the skin of the upper and lower eyelids is red, swollen and hypertrophic, the skin temperature is not high, and irregular shape induration can be palpable under the supraorbital notch of the upper eyelid, the size is about 10 mm ×11 mm ×4 mm, the boundary is not clear, and the mobility is poor; Irregular shaped induration can be palpable 2 mm below the temporal margin of the lower eyelid, with a size of about 12 mm ×15 mm ×5 mm, with poor border and poor mobility. The anterior segment and fundus examination of both eyes showed no obvious abnormalities, the eye position was correct, and there was no obvious restriction of movement in all directions. Left orbital pressure (+), right orbital pressure normal. Exophthalmia measurement: 11 mm in the right eye and 11 mm in the left eye, with an orbital distance of 102 mm. B-ultrasound examination showed irregular shaped hypoechoic lesions in the left orbit. Color ultrasound Doppler examination showed subcutaneous space-occupying lesions of upper and lower eyelids of left eye, with unclear boundaries and irregular shapes; Space-occupying lesions can also be seen on the medial side of the posterior part of the eyeball, with moderate internal echo, and strip-like blood flow signals can be seen inside the lesion, and the blood flow speed is relatively fast. CT scan of the transverse axis of the orbit showed irregular high-density space-occupying lesions in the upper and lower eyelids and muscle cones of the left eye, which were homogeneous, cast with the eyeball, and the boundary between the medial and lateral rectus muscles was unclear. The optic nerve was wrapped by the lesions, and there was no obvious abnormality in the adjacent bone. The CT value of the intraorbital lesion area was 53.09 HU. The clinical diagnosis was a space-occupying lesion in the left orbit. The whole body examination of the patient showed no abnormalities, and no lymph node enlargement was found. In April 2005, the patient underwent resection of the mass in the upper quadrant of the left breast in another hospital, and the postoperative pathological diagnosis was benign granulosa cell tumor of the left breast; Half a year later, the recurrence was performed again, and the pathological diagnosis was still benign granulosa cell tumor of the left breast.

The patient was a 36-year-old female. Transient visual acuity in both eyes decreased for 1 d, and he was seen in Daqing Eye Hospital of Heilongjiang Province. Previous history of diabetes mellitus 5 years. Ophthalmic examination: the best corrected visual acuity was 0.6 for the right eye and 0.6 for the left eye; IOP was 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 16 mmHg in the left eye; No obvious abnormalities were observed in the anterior segment of both eyes; Fundus examination seeQuintessence Picture 1。 Laboratory tests: peripheral blood was chyloid, fasting blood glucose concentration was 13.8 mmol/L, urine glucose (-). Clinical diagnosis: binocular retinal lipidemia.

This issue focuses on the clinical and basic research of thyroid-related ophthalmopathy. The responsible editorial members in charge of the planning, composition and review of this issue are Professor Sun Fengyuan of Tianjin Medical University Eye Hospital and Professor Luo Qingli of Chengdu Huaxia Eye Hospital.