The Study Of Clinical Features And Mechanism In Sclerosing Orbital Inflammatory Pseudotumor

Orbital inflammatory pseudotumor (OIPT) can be divided into three subtype histologically according to Henderson's classification: lymphocyte infiltrative OIPT, sclerosing OIPT and mixed OIPT. The opinions on sclerosing IOPT were different, some ophthalmologists presumed that it was the end stage of OIPT, while the others regarded it as a unique disease. The clinical reports on sclerosing OIPT were also different. There have been some studies on mechanism in the world, while few studied in China.OBJECTIVEThe clinical and immunohistochemistry features of sclerosing OIPT were studied and compared with the other two subtypes to identify the clinical features of sclerosing OIPT and explore mechanisms of transforming growth betal-1(TGFβ 1) and collagen type III in sclerosing OIPT, which provide theoretical reference for clinical diagnosis and treatment of sclerosing OIPT.METHODS1 32 cases of sclerosing OIPT were collected from 1994 to 2004. The general condition, clinical manifestation, medical imaging and pathological character, medical and surgery treatment, prognosis were summarized and analyzed.2 21 cases of sclerosing OIPT were in experimental group. 21 cases of lymphocyte infiltrative OIPT and 10 cases of mixed OIPT were selected in control group. The expressions of TGF β 1 and collagen type III in 3 different histopathological patterns of OIPT were observed by SP immunohistochemisry analysis.RESULTSThe age of patients with sclerosing OIPT was lower than the other twogroups(P<0.05). There was no statistical significance in the course of disease(P>0.05). There was no gender difference in sclerosing OIPT. While vision decreasing was higher than the other two types. Injection and swelling of eyelid, chemosis in sclerosing OIPT is lower than the other two group . There is significant difference in B ultrasound and MRI while no significant difference in color Doppler image. There is significant difference on histological feature between lymphocyte infiltrative OIPT and sclerosing OIPT, Sclerosing OIPT shows insensitivity to drug therapy.The expression of TGF 3 i was higher in sclerosing OIPT group while there was no or weak expression in lymphocyte infiltrative OIPT group. There was a statistical significance among three group(P<0.05), the expression in sclerosing OIPT was higher than that in lymphocyte infiltrative OIPT (PO.05) and no statistical significance than in mixed group(P>0.05). The expression in mixed OIPT group is higher than that in lymphocyte infiltrative OIPT group (P<0.05).The expression of collagen EH was different among three groups. The expression in sclerosing OIPT was higher than that in lymphocyte infiltrative OIPT (P<0.05) and mixed OIPT (P<0.05). Mixed OIPT was higher than lymphocyte infiltrative OIPT (P<0.05). Positive correlation between TGF P 1 and collage type III among three type OIPT (P<0.05) was observed.CONCLUSIONS1 There were specific characters on patients' age, medical history, clinical feature, imaging feature and prognosis. There was no proof that one type can convert into other types.2 TGF {3 1 and collage type III played an important role in forming sclerosing OIPT. It implied that the mechanism of sclerosing OIPT was differentfrom the other two types.