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Der Ophthalmologe

, Volume 107, Issue 12, pp 1139–1144 | Cite as

Selektive Tränensackbiopsie bei externer Dakryozystorhinostomie

Eine klinisch-pathologische Studie
  • L.M. Heindl
  • E. Treutlein
  • A.G.M. Jünemann
  • F.E. Kruse
  • L.M. Holbach
Originalien

Zusammenfassung

Hintergrund

Tränenwegstumoren sind selten, aber potenziell lebensbedrohlich. Ziel war es, die Anwendbarkeit der selektiven Tränensackbiopsie bei 500 externen Dakryozystorhinostomien von Patienten mit erworbener Tränenwegsstenose zu untersuchen.

Patienten und Methoden

Eine Biopsie wurde selektiv bei klinisch und/oder intraoperativ atypischen Befunden gewonnen. Häufigkeit und Spektrum der Biopsate wurden erfasst, und mit den Follow-up-Ergebnissen korreliert.

Ergebnisse

Eine Tränensackbiopsie erfolgte bei 19 externen Dakryozystorhinostomien (3,8%): Non-Hodgkin-B-Zell-Lymphom (3), Plattenepithelkarzinom (2), Mukoepidermoidkarzinom (1), malignes Melanom (1), Onkozytom (1), pyogenes Granulom (4), Wegener-Granulomatose (4), Sarkoidose (3). Innerhalb von 5 Jahren entwickelte keiner der Patienten ohne Biopsie entzündliche Systemerkrankungen oder Tränenwegsneoplasien. Die Fünfjahresüberlebensrate betrug bei Patienten mit signifikanter Tränenwegspathologie 87%, bei Patienten ohne signifikante Pathologie 96%.

Schlussfolgerung

Die externe Dakryozystorhinostomie mit selektiver Biopsie klinisch und intraoperativ atypischer Befunde erlaubt eine zuverlässige Diagnose und Therapie potenziell lebensbedrohlicher Tränenwegsprozesse.

Schlüsselwörter

Externe Dakryozystorhinostomie Tränensack Ophthalmologische Onkologie Histopathologie 

Selective lacrimal sac biopsy for external dacryocystorhinostomy

A clinical pathological study

Abstract

Background

Tumors of the lacrimal drainage system are rare but potentially life-threatening. The purpose of this study was to investigate the applicability of selective lacrimal sac biopsy in 500 cases of external dacryocystorhinostomy for acquired dacryostenosis.

Patients and methods

Lacrimal sac biopsy was obtained selectively for atypical clinical and/or intraoperative findings. The frequency and spectrum of biopsies were recorded and correlated with the follow-up results.

Results

Lacrimal sac biopsy was performed in 19 external dacryocystorhinostomies (3.8%) including non-Hodgkin B-cell lymphoma (3), squamous carcinoma (2), mucoepidermoid carcinoma (1), malignant melanoma (1), oncocytoma (1), pyogenic granuloma (4), Wegener’s granulomatosis (4) and sarcoidosis (3). Within 5 years none of the patients without biopsy developed systemic inflammatory diseases or lacrimal neoplasms. The 5-year survival was 87% in patients with significant lacrimal sac pathology and 96% in patients without significant pathology.

Conclusion

External dacryocystorhinostomy with selective biopsy for atypical clinical and intraoperative findings allows safe diagnosis and management of potentially life-threatening lacrimal lesions.

Keywords

External dacryocystorhinostomy Lacrimal sac Ophthalmic oncology Histopathology 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Anderson NG, Wojno TH, Grossniklaus HE (2003) Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy. Ophthal Plast Reconstr Surg 19:173–176CrossRefPubMedGoogle Scholar
  2. 2.
    Bartley GB (1992) Acquired lacrimal drainage obstruction: an etiologic, classification system, case reports and a review of the literature. Part 1. Ophthal Plast Reconstr Surg 8:237–242CrossRefPubMedGoogle Scholar
  3. 3.
    Bernardini FP, Moin M, Kersten RC et al (2002) Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy. How useful is it? Ophthalmology 109:1214–1218CrossRefPubMedGoogle Scholar
  4. 4.
    Boboridis KG, Bunce C, Rose GE (2005) Outcome of external dacryocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol 139:1051–1055CrossRefPubMedGoogle Scholar
  5. 5.
    Emmerich KH, Busse H, Meyer-Rüsenberg HW (1994) Dacryocystorhinostomia externa. Technique, indications and results [in German]. Ophthalmologe 91:395–398PubMedGoogle Scholar
  6. 6.
    Font RL (1996) Eyelids and lacrimal drainage system. In: Spencer WH (ed) Ophthalmic pathology, Vol 4. Saunders, Philadelphia, p 2412–2427Google Scholar
  7. 7.
    Heindl LM, Jünemann A, Holbach LM (2008) Lacrimal drainage system. In: Naumann GOH, Holbach L, Kruse FE (eds) Applied pathology for ophthalmic microsurgeons. Springer, Berlin, pp 45–48Google Scholar
  8. 8.
    Heindl LM, Jünemann A, Holbach LM (2009) A clinicopathologic study of nasal mucosa in 350 patients with external dacryocystorhinostomy. Orbit 28:7–11CrossRefPubMedGoogle Scholar
  9. 9.
    Heindl LM, Jünemann A, Holbach LM (2010) Clinicopathologic features of lesions affecting the lacrimal drainage system in external dacryocystorhinostomy. In: Guthoff R, Katowitz JA (eds) Oculoplastics and orbit (Essentials in Ophthalmology). Springer, Berlin, pp 95–104Google Scholar
  10. 10.
    Heindl LM, Schick B, Kämpgen E et al (2008) Malignant melanoma of the lacrimal sac [in German]. Ophthalmologe 105:1146–1149CrossRefPubMedGoogle Scholar
  11. 11.
    Kottler UB, Schlötzer-Schrehardt U, Holbach LM (2004) Epiphora and conjunctivitis for 6 years [in German]. Ophthalmologe 101:730–732CrossRefPubMedGoogle Scholar
  12. 12.
    Lee-Wing MW, Ashenhurst ME (2001) Clinicopathologic analysis of 166 patients with primary acquired nasolacrimal duct obstruction. Ophthalmology 108:2038–2040CrossRefPubMedGoogle Scholar
  13. 13.
    Linberg JV, McCormick SA (1986) Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology 93:1055–1063PubMedGoogle Scholar
  14. 14.
    Mauriello JA, Palydowycz S, DeLuca J (1992) Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients with complete acquired nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg 8:13–21CrossRefPubMedGoogle Scholar
  15. 15.
    McNab AA (1994) Manual of orbital and lacrimal surgery. Churchill Livingstone, Edinburgh, p 75–86Google Scholar
  16. 16.
    Merkonidis C, Brewis C, Yung M, Nussbaumer M (2005) Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review. Br J Ophthalmol 89:1589–1591CrossRefPubMedGoogle Scholar
  17. 17.
    Olver J (2002) Colour atlas of lacrimal surgery. Butterworth Heinemann, Oxford, p 94–114 und 158–162Google Scholar
  18. 18.
    Parmar DN, Rose GE (2003) Management of lacrimal sac tumours. Eye 17:599–606CrossRefPubMedGoogle Scholar
  19. 19.
    Stefanyszyn MA, Hidayat AA, Pe’er JJ, Flanagan JC (1994) Lacrimal sac tumors. Ophthal Plast Reconstr Surg 10:169–184CrossRefPubMedGoogle Scholar
  20. 20.
    Tucker N, Chow D, Stockl F et al (1997) Clinically suspected primary acquired nasolacrimal duct obstruction. Clinicopathologic review of 150 patients. Ophthalmology 104:1882–1886PubMedGoogle Scholar
  21. 21.
    Valenzuela AA, McNab AA, Selva D et al (2006) Clinical features and management of tumors affecting the lacrimal drainage apparatus. Ophthal Plast Reconstr Surg 22:96–101CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • L.M. Heindl
    • 1
  • E. Treutlein
    • 1
  • A.G.M. Jünemann
    • 1
  • F.E. Kruse
    • 1
  • L.M. Holbach
    • 1
  1. 1.Augenklinik mit PoliklinikFriedrich-Alexander-Universität Erlangen-NürnbergErlangenDeutschland

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