原发性泪腺导管腺癌伴多发淋巴结转移1例OA

Primary lacrimal duct adenocarcinoma(PLDC)is a rare and highly malignant epithelial tumor of the lacrimal gland,accounting for approximately 2％of all epithelial lacrimal gland tumors.This neoplasm has a strong propensity for lymph node metastasis and is generally associated with poor prognosis.In September 2024,a 75-year-old man presenting with cervical lymphadenopathy as the initial manifestation was admitted to Linyi Central Hospital and was subsequently diagnosed with PLDC.Imaging examination revealed a 3.1-cm mass located in the superolateral quadrant of the left orbit,accompanied by multiple metastatic lymph nodes in the left cervical region.The patient underwent surgical resection of the left orbital mass.Histopathological examination demonstrated that the tumor cells were arranged in glandular,cribriform,and solid patterns,accompanied by comedo-like necrosis.Immunohistochemical analysis showed strong positivity(3+)for human epidermal growth factor receptor 2(HER-2).Positive staining was observed for cytokeratin 7(CK7),pan-cytokeratin(CKpan),epithelial membrane antigen(EMA),GATA-binding protein 3(GATA-3),and gross cystic disease fluid protein 15(GCDFP15).Androgen receptor(AR)expression was observed in approximately 40％of tumor cells.The tumor was negative for transcriptional repressor GATA-binding protein 1(TRPS1),estrogen receptor(ER),progesterone receptor(PR),S-100,SRY-box transcription factor 10(SOX-10),and thyroid transcription factor-1(TTF-1).The pathological diagnosis was PLDC with multiple lymph node metastases.After confirmation of the diagnosis,the patient received 5 cycles of chemotherapy with albumin-bound paclitaxel plus cisplatin.No recurrence was observed during 13 months of follow-up.PLDC should be distinguished from metastatic breast and lung carcinomas.Negative TRPS1 expression is helpful for excluding breast carcinoma,whereas AR positivity may represent a potential therapeutic target.A systematic analysis of the clinical features,histopathological morphology,and immunophenotypic characteristics of PLDC provides imaging and pathological evidence for early diagnosis of this rare tumor.Moreover,the follow-up findings suggest potential therapeutic efficacy and provide valuable clinical evidence for optimizing therapeutic strategies and improving patient outcomes.