何佩 王贝芬 王雯雯 李光宇

【摘要】泪囊孤立性纤维瘤是一种极其罕见的疾病。该文报道1例泪囊孤立性纤维瘤患者因发现右眼泪囊区隆起肿物伴溢泪20年，行泪道造影+眼眶CT、双眼平扫加增强MRI检查可见右侧泪囊区类椭圆肿物。行泪道冲洗右眼泪道不通，上冲下返，下冲阻力大，原路返，无脓性和血性分泌物。考虑该肿物为原发于泪囊的良性肿瘤可能性大，行内外路联合手术完整切除肿物，最终手术切除后病理证实为泪囊孤立性纤维瘤，患者治愈出院。该例提示起源于泪囊的孤立性纤维瘤极其罕见，临床表现不典型，泪道冲洗改变有时类似泪囊囊肿，容易被临床医师误诊或漏诊。

【关键词】孤立性纤维瘤，泪囊；手术切除；病理

【Abstract】Solitary fibroma of the lacrimal sac is an extremely rare disease. In this paper， we reported one case of solitary fibroma of the lacrimal sac due to the chief complaints of uplift neoplasm in her right lacrimal sac complicated with epiphora for 20 years. Dacryocystography combined with orbital CT angiography， contrast-enhanced MRI of bilateral eyes revealed an oval mass in her right lacrimal sac. Lacrimal system irrigation demonstrated that the right lacrimal duct was obstructed. The reflux of irrigation fluid was observed. No purulent or hemorrhagic secretions were noted. The possibility of lacrimal sac-derived benign mass was considered. The patient underwent complete resection of the mass via medial and lateral approach. She was pathologically diagnosed with solitary fibroma of the lacrimal sac and discharged after effective therapy. This case prompts that solitary fibroma of the lacrimal sac is extremely rare with atypical clinical manifestations. The symptoms after lacrimal system irrigation are similar to those of lacrimal sac cyst. Consequently， it is likely to make a misdiagnosis or miss the diagnosis by ophthalmologists.

【Key words】Solitary fibroma， lacrimal sac； Surgical removal； Pathology

孤立性纤维瘤是一种罕见的起源于胸膜的梭形细胞肿瘤，由Klemperer和Rabin最先报道[1]。近年来发现该肿瘤除胸膜外，在纵隔、上呼吸道、心包、腹膜、鼻腔及眼眶等部位也有发生。泪囊孤立性纤维瘤是一种极其罕见的疾病，是一种原发于泪囊的肿瘤。通常临床表现以泪囊区可见隆起边界清楚的质韧无压痛肿物，伴溢泪症状。而关于泪囊孤立性纤维瘤在国内外报道较少，即使在国外也多为个案报道。由于该病临床罕见，缺乏特异性的全身表现，给其鉴别诊断带来困难，易与眼眶周围的良性肿瘤相混淆[2]。现将我院近期诊断的1例泪囊孤立性纤维瘤患者报道如下。

病例资料

一、病史及体格检查

患者男，74岁。因发现右眼泪囊区隆起肿物伴溢泪20年收入院。……