To investigate the clinical presentation and CT/MRI features of malignant pleomorphic adenoma(MPA)of the eye in order to improve the diagnosis of this disease.

The clinical imaging data of 43 patients with MPA in the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2021 were retrospectively analyzed.All patients were monocular disease, including 20 males and 23 females, aged 16-76(53.79±15.54)years old.There were 23 initial cases and 20 recurrent cases, including 13 cases with recurrence once, 3 cases with recurrence twice, 2 cases with recurrence three times, 1 case with recurrence four times, and 1 case with recurrence five times.

The main symptoms and signs of MPA were ocular proptosis, ocular swelling, blurred vision, lacrimation and ocular pain.One case showed pathological manifestation of carcinosarcoma, and 42 cases showed carcinoma ex pleomorphic adenoma.MPA was located in the right eye in 17 cases and left eye in 26 cases; 23 cases originated from the inner myoconus region, 19 cases from the myoconus region, and 1 case from the outer myoconus region; the lesions were irregularly shaped in 23 cases, round or round-like in 14 cases, and shallowly lobulated at the margin in 6 cases.There were 13 cases of clear edge, 15 cases of unclear edge and 15 cases of fuzzy edge.MPA showed limited lesions in 5 cases and diffuse lesions in 38 cases; 28 cases grew deeper along the optic nerve, 11 cases grew outside the orbit, and 4 cases grew laterally, including 1 case invading the anterior skull base, 1 case invading the sinus and 2 cases invading the temporal fossa.CT showed 27 cases of iso-density, 7 cases of slightly low density and 2 cases of slightly high density.Plaque calcification was observed in 7 cases and obvious cystic necrosis was observed in 14 cases.Mild enhancement was observed in 4 cases, moderate enhancement in 5 cases, and uneven enhancement in 8 cases after enhancement.Incomplete capsule was observed in 25 cases.There was no change in adjacent bone in 5 cases, compression deformation in 13 cases and bone destruction/defect in 18 cases.MRI showed slightly low signal in T1WI in 16 cases, iso-signal in 5 cases, and low signal in 4 cases.T2WI showed slightly high signal in 16 cases, high signal in 8 cases, slightly low signal in 1 case; DWI showed slightly high signal in 16 cases, high signal in 5 cases, slightly low signal in 4 cases; signal inhomogeneity in 22 cases; moderate enhancement after enhancement in 2 cases, significant enhancement in 11 cases, and inhomogeneous enhancement in 13 cases; incomplete envelope in 16 cases.

The possibility of MPA should be considered for swelling growth and large masses in the eye, and total tumor resection should be considered without prior incisional biopsy.CT and MRI examinations can accurately visualize the surgical approach of MPA, which is important for the development of treatment plans and prognostic follow-up.