The patient, female, 50 years old, was found to have bilateral orbital mass for 6 years, about the size of green beans, which was round, painless, no swelling, no visual loss, and gradually increased new organisms.
患者，女，50岁，发现双眼眶包块6年，约绿豆大小，为圆形，无疼痛，无红肿，不伴视力下降，后新生物逐渐增大。
The patient, female, 50 years old, was found to have bilateral orbital mass for 6 years, about the size of green beans, which was round, painless, no swelling, no visual loss, and gradually increased new organisms.
双侧眼眶炎性假瘤
Bilateral orbital inflammatory pseudotumor
左眼外直肌及上直肌、内直肌增粗，呈软组织密度肿块样改变，边缘模糊，双侧侧眼球稍突出，肿块与眼球分界欠清晰，与视神经分界基本清晰。
The external rectus muscle of the left eye, the superior rectus muscle and the internal rectus muscle of the left eye were thickened, showing the change of soft tissue density like a mass, with blurred edges, slightly protruding eyes on both sides, the boundary between the mass and the eyeball was not clear, and the boundary between the mass and the optic nerve was basically clear.
炎性假瘤，又称原发性眶炎，是引起单侧突眼的常见原因，如急性发作，临床表现为眼球活动障碍、疼痛、眼睑水肿、眼球突出；病灶内可有多种细胞成分，如淋巴细胞、嗜酸性粒细胞、多形性细胞及浆细胞，根据其受累的部位可分为肌炎型、泪腺型、肿块型、弥漫型。中年人多发，可呈急性、亚急性、慢性，较多患者表现为激素治疗后缓解，，以后又反复发作；部分患者伴眼球运动障碍、视力下降、红肿或复视等，少数患者可无明显疼痛；CT平扫可见眶内多个结构受累，可有圆形、椭圆形等密度软组织块影或眶内脂肪受累呈条索状影，眼外肌、泪腺、视神经均可受累，以上结构有2个或眶内脂肪受累可诊断，可分为四型：肿块型、肌炎型、弥漫型、泪腺型，急性炎症时病灶密度较低，边缘模糊，慢性期炎症以淋巴细胞浸润和纤维组织增生为主，中度密度或较高，边界清晰，多数病例显示轻到中度强化。
Inflammatory pseudotumor, also known as primary orbital inflammation, is a common cause of unilateral protrusion of the eye, such as acute attack, which is clinically manifested as eyeball movement disorder, pain, eyelid edema, and prominent eyeball. There are many kinds of cell components in the lesion, such as lymphocytes, eosinophils, polymorphous cells and plasma cells, which can be divided into myositis type, lacrimal type, mass type and diffuse type according to the affected site. In middle aged people, more cases can be acute, subacute and chronic, and more patients can be relieved after hormone treatment, and then relapse. Some patients are accompanied by eye movement disorder, visual impairment, redness, swelling or diplopia, etc. Visible orbital CT scan multiple structure involvement, but has the density of soft tissue masses such as round, oval or orbital fat involvement is a funicular, extraocular muscles, tear ducts, optic nerve involvement, the above structure has 2 or orbital fat involvement can diagnosis, can be divided into four type: lump, myositis, diffuse, tear ducts, acute inflammation in low density lesions, edge blur, chronic inflammation with lymphocytes infiltration and hyperplasia of fibrous tissue, and moderate or high density, boundary clear, most cases showed mild to moderate reinforcement.
鉴别诊断
The differential diagnosis
眶周淋巴瘤：眼眶淋巴瘤以弥漫性淋巴瘤为主，肿瘤无包膜，呈浸润性生长为主，机械性推移占位效应不明显，常累及肌锥内外间隙，与眼外肌及视神经分界不清，但眼球壁与肿物接触面无压迹或凹陷，眼环多无明显增厚；
Periorbital lymphoma: orbital lymphoma of the eye is mainly diffuse lymphoma. The tumor has no capsule and is mainly infiltrative growth. The mechanical displacement effect is not obvious.
泪腺上皮性肿瘤：泪腺上皮性肿瘤有倾向于压迫骨质产生凹陷或有骨质破坏，而炎性假瘤少有骨质破坏；
Epithelial neoplasm of lacrimal gland: epithelial neoplasm of lacrimal gland tends to compress bone to produce depression or bone damage, while inflammatory pseudotumor has little bone damage.
泪腺混合瘤：泪腺混合瘤有累及泪腺深叶倾向，向后生长，与眶外侧壁呈锐角，一般不累及眼睑及眼环。
Mixed neoplasm of lacrimal gland: mixed neoplasm of lacrimal gland has the tendency to involve the deep leaf of lacrimal gland, grow backward, show sharp Angle with the lateral wall outside orbit, do not involve eyelid and eye ring commonly.
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