Primary central nervous system lymphoma masquerading as bilateral vitreous floaters
Primary central nervous system lymphoma masquerading as bilateral vitreous floaters
复制标题
伪装成双侧玻璃体飞蚊症的原发性中枢神经系统淋巴瘤
DOI：
--
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
C. Katelaris
中科院分区：
文献类型：
--
作者：
G. Tsanaktsidis;O. McNeill;C. Katelaris
一位72岁女性，有6个月双侧飞蚊和视物模糊的病史。临床上，双眼后玻璃体呈细胞状，无视网膜下浸润性病变、视网膜血管炎、视盘水肿或黄斑水肿的征象。由于致密性白内障的存在，左眼白内障手术后计划进行玻璃体活检和玻璃体切除术。白内障手术后一个月，患者出现花斑性左大动脉炎征象，累及视网膜中央动脉的一级分支。进行了23号玻璃体活检和玻璃体切除，并注射了不含防腐剂的曲安奈德。活检的细胞学检查显示良性T淋巴细胞和组织细胞仅提示轻度慢性炎症。脑部的磁共振成像(MRI)正常，腰椎穿刺术也是如此。随后，患者出现右上运动神经元面神经麻痹。核磁共振成像显示多发性高信号脑白质病变。随后，由于新的神经缺陷，进行了第三次核磁共振检查，显示先前存在的病变扩大。脑活组织检查证实存在原发性脑淋巴瘤。本病例强调了各种组织活检的作用，包括玻璃体、脑脊液和脑组织，以良性玻璃体漂浮物为表现的原发性中枢神经系统淋巴瘤难以诊断。
A 72‐year‐old female presented with a 6‐month history of bilateral floaters and visual blurring. Clinically, the posterior vitreous was cellular bilaterally, with no signs of subretinal infiltrates, retinal vasculitis, disc oedema or macula oedema. A vitreous biopsy and vitrectomy were scheduled following left cataract surgery because of the presence of a dense cataract. One month after cataract surgery, the patient developed signs of florid left arteritis involving the first‐order branches of the central retinal artery. A 23‐gauge vitreous biopsy and vitrectomy were performed, and preservative‐free triamcinolone was injected. Cytology of the biopsy demonstrated benign T‐lymphocytes and histiocytes suggestive of mild chronic inflammation only. Magnetic resonance imaging (MRI) of the brain was normal as was lumbar puncture. Subsequently, the patient developed right upper motor neuron facial nerve palsy. MRI imaging on this occasion demonstrated multiple hyper‐intense white matter lesions. A third MRI was subsequently obtained due to new neurological deficits and demonstrated enlargement of the pre‐existing lesions. Brain biopsy confirmed the presence of primary cerebral lymphoma. The present case highlights the role of various tissue biopsies, including vitreous, cerebrospinal fluid and brain tissue, to establish an elusive diagnosis of primary central nervous system lymphoma presenting as benign vitreous floaters.
DOI：
10.1177/107327480401100502
发表时间：
2004-09
期刊：
Cancer control : journal of the Moffitt Cancer Center
影响因子：
--
作者：
C. Chan;Dana J. Wallace
通讯作者：
C. Chan;Dana J. Wallace
影响因子：
13.7
作者：
Smith, JR;Rosenbaum, JT;Pe'er, J
通讯作者：
Pe'er, J