背景:我们描述了第一例ALHE在眼眶中延伸至上颌窦的情况,以及采用多学科方法实现病灶切除的重要性。
方法:一名72岁的男性患者出现左眼泪滴和多次反复发作的急性泪囊炎。磁共振成像显示位于左眼眶下内侧区域的固体均匀肿块。此外,它与左上颌窦上壁和相邻筛壁的破坏有关。眼眶肿块的切开活检与ALHE兼容。
结果:决定使用眶底入路进行手术,左内侧壁通过结膜下和颈经入路以及鼻内窥镜入路(ESS),实现完全去除眼眶肿块和上颌窦的清洁。经过一年的治疗,通过内镜检查和影像学检查,患者无明显肿瘤复发,且无症状.
结论:ALHE是一种非常罕见的良性血管肿瘤,表现为头颈部皮下结节。我们不知道文献中描述的鼻旁窦有任何ALHE病例,单独或与眼眶或皮肤ALHE一起。总之,当面对延伸至鼻旁窦的眼眶肿块时,应将ALHE疾病视为诊断,在大多数情况下,通过经鼻和眼眶联合入路完全切除可防止复发。
BACKGROUND: We describe the first case of ALHE in the orbit with extension to the maxillary sinus and the importance of a multidisciplinary approach to achieve removal of the lesion.
METHODS: A 72-year-old man presented with epiphora of the left eye and several episodes of recurrent acute dacryocystitis. Magnetic resonance imaging revealed a solid homogeneous mass located in the inferomedial region of the left orbit. In addition, it was associated with destruction of the adjacent ethmoidal wall and upper wall of the left maxillary sinus. Incisional biopsy of the orbital mass was compatible with ALHE.
RESULTS: It was decided to perform surgery using an orbital floor approach, left medial wall via subconjunctival and caruncular approach together with an endoscopic nasal approach (ESS), achieving complete removal of the orbital mass and cleaning of the maxillary sinus. After one year of treatment, no tumor recurrence was evident through endoscopy and imaging tests and the patient is asymptomatic.
CONCLUSIONS: ALHE is a very rare benign vascular tumor that presents subcutaneous nodules in the head and neck region. We do not know of any case of ALHE in the paranasal sinuses described in the literature, either in isolation or together with orbital or cutaneous ALHE. In conclusion, ALHE disease should be considered as a diagnosis when faced with an orbital mass with extension to the paranasal sinuses, and a complete excision through a combined endonasal and orbital approach prevents recurrence in most cases.