Intraocular lymphoma: a clinical perspective
Intraocular lymphoma: a clinical perspective
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DOI：
10.1038/eye.2012.250
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发表时间：
2013-02-01
期刊：
影响因子：
3.9
通讯作者：
Davis, J. L.
中科院分区：
文献类型：
--
作者：
Davis, J. L.
原发性玻璃体视网膜淋巴瘤（PVRL）是一种罕见的恶性肿瘤，据推测发生在眼外，并优先侵入和蓬勃发展的眼睛和中枢神经系统的微环境。约20%的原发性中枢神经系统淋巴瘤涉及眼睛，但约80%的PVRL最终涉及大脑。大多数是B细胞淋巴瘤，少数T细胞淋巴瘤转移到玻璃体和视网膜。转移性系统性B细胞淋巴瘤通常累及脉络膜。原发性脉络膜淋巴瘤是罕见的。眼内淋巴瘤通常可以在临床上与葡萄膜炎区分，尽管存在重叠，这可能在具有与肿瘤监视和控制相关的反应性炎症的大部分的眼睛中明显。在诊断和治疗方面存在争议。通过检查眼液进行诊断在技术上是困难的，并且可以利用细胞学、免疫组织化学、流式细胞术、基因重排的分子检测和细胞因子分析。对于未检测到CNS疾病的眼内淋巴瘤的治疗，可根据临床中心的偏好，包括全身化疗+眼部预防性治疗或仅进行眼部治疗。在仅眼部的情况下，其中玻璃体已被缩小以改善视力，并且没有威胁视力的视网膜色素上皮受累，眼眶照射或玻璃体内化疗稳定了眼内过程，但似乎没有改变中枢神经系统成分，中枢神经系统成分可以在晚期状态下出现。这是一种高度恶性的疾病，预后不良。与病理学家和肿瘤学家的密切合作，以及与患者的良好沟通至关重要。Eye（2013）27，153-162; doi：10.1038/eye.2012.250; 2012年11月30日在线发表
Primary vitreoretinal lymphoma (PVRL) is a rare malignancy that is speculated to arise extraocularly, and preferentially invade and flourish in the ocular and CNS microenvironments. The eye is involved in about 20% of primary central nervous system lymphomas, but the brain is eventually involved in about 80% of PVRL. Most are B-cell lymphomas with small numbers of T-cell lymphomas metastatic to the vitreous and retina. Metastatic systemic B-cell lymphoma usually involves choroid. Primary choroidal lymphoma is rare. Intraocular lymphoma can usually be distinguished from uveitis clinically, although there are overlaps, which may be pronounced in eyes with a large component of reactive inflammation related to tumor surveillance and control. There are controversies in diagnosis and treatment. Diagnosis through examination of ocular fluid is technically difficult and can utilize cytology, immunohistochemistry, flow cytometry, molecular detection of gene rearrangements, and cytokine profiling. Treatment of intraocular lymphoma without detectable CNS disease could consist of a full course of systemic chemotherapy with ocular adjunctive treatment, or ocular treatment alone depending on the preference of the clinical center. In ocular only cases where the vitreous has been debulked to improve vision and there is no sight-threatening involvement of the RPE, orbital irradiation or intravitreal chemotherapy stabilizes the intraocular process but does not seem to modify the CNS component, which can present symptomatically in an advanced state. This is a highly malignant disease with a poor prognosis. Close collaboration with a pathologist and oncologist, and good communication with patients is essential. Eye (2013) 27, 153-162; doi:10.1038/eye.2012.250; published online 30 November 2012