翟晶 钱振彬 常雁斌 王梦迪 方伟

作者单位：1温州医科大学附属眼视光医院 浙江省眼科医院 310016；2杭州迪安医学检验中心有限公司病理部 310030

图1.眼眶Castleman病治疗前后外观及彩色多普勒超声表现A：初诊时外观见患者右下睑及颊部皮肤充血，肿胀不明显，局部无压痛；B：甲基泼尼松龙片40 mg口服1次/天，治疗10 d后患者眼睑及颊部充血范围无明显变化；C：手术切除半年后复查外观无明显异常；D：彩色多普勒超声检查见肿物周围弥漫性高回声伴血管围绕，中央区呈中低回声，衰减明显，且无明显血流信号；E：抗炎治疗10 d彩超复查肿物略缩小；F：术后半年复查彩超局部瘢痕增生，无明显肿物复发Figure 1.The appearance of orbital Castleman's disease and color doppler ultrasonic images before and after treatment.A:The patient's right lower lid and cheek skin are moderately congested at presentation,without edema or tenderness.B:After application of oral prednisolone(10 days,40 mg per day),the patient’s lower lid and cheek skin congestion show no improvement.C:Half a year after the tumor resection,the patient's facial appearance shows no congestion or inflammation.D:Color doppler ultrasonic imaging shows a diffuse high echo zone with vascular hyperplasia around the mass,while the mass shows a low-to-middle echo signal with obvious sound attenuation in the central part,but without any blood flow signals.E:After 10 days of treatment,the mass seems to be a bit smaller than before.F:Half a year after surgery,repeated ultrasonic imaging shows no recurrence of the mass,but only fibrous scar formation.

患者，女，50 岁，因右眼下睑反复发红半年就诊，当地医院曾考虑“眼睑炎”，予以抗生素联合糖皮质激素静脉滴注治疗，用药时眼睑发红可略减轻，但反复发作，且再发时下睑及颊部发红区域逐渐增大，无明显疼痛，无视力下降及肿胀等。患者就诊半年前曾于当地医院行右眼下睑霰粒肿刮除术。查体：双眼视力1.0，右眼眼压16 mmHg（1 mmHg=0.133 kPa），左眼眼压15 mmHg，双眼眼球突出度均为13.5 mm，眶距98 mm，眶压（-）。右下睑及颊部皮肤充血，肿胀不明显（见图1A），下睑结膜内侧见纵行约2 mm瘢痕。下方眶前段可触及约1.5 cm×1.0 cm实性肿物，活动度好，边缘尚清，质地中等，无压痛。眼球各方向活动良好，眼位正。头颈部浅表淋巴结触诊无殊。彩色多普勒超声检查见肿物周围弥漫性高回声伴血管围绕，中央区呈中低回声，衰减明显，且无明显血流信号（见图1D）。MRI检查可见眶前段近眶下缘处类圆形结节，T1 和T2 加权像分别呈中信号及中高信号，其中T2加权像中央区呈中低信号（见图2A─B）；……