Lymphoma of the ocular adnexa: A study of 353 cases
Lymphoma of the ocular adnexa: A study of 353 cases
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DOI：
10.1097/01.pas.0000213350.49767.46
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发表时间：
2007-02-01
影响因子：
5.6
通讯作者：
Harris, Nancy L.
中科院分区：
文献类型：
--
作者：
Ferry, Judith A.;Fung, Claire Y.;Harris, Nancy L.
我们研究了1974年至2005年间在马萨诸塞州总医院诊断的353例累及眼附属器的淋巴瘤患者。患者包括153名男性和200名女性，年龄7至95岁，平均年龄64岁。在277例病例中，没有已知的淋巴瘤病史。76例患者有淋巴瘤病史，在复发或先前诊断的淋巴瘤进展时累及眼附属器。边缘区淋巴瘤滤泡性淋巴瘤182例套细胞淋巴瘤80例（18例），小淋巴细胞淋巴瘤/慢性淋巴细胞白血病淋巴浆细胞性淋巴瘤4例，脾边缘区淋巴瘤2例，均为低度恶性B细胞性淋巴瘤前体B淋巴母细胞淋巴瘤3例，弥漫性大B细胞淋巴瘤19例高级别B细胞淋巴瘤（未亚分类）、外周T细胞淋巴瘤（未特指型）、结内NK/T细胞淋巴瘤（鼻型）各1例，和结节硬化型霍奇金淋巴瘤。几乎所有边缘区淋巴瘤患者（168/182，92%）均为原发性眼附属器淋巴瘤。14例边缘区淋巴瘤患者（8%）有淋巴瘤既往史，通常发生在另一个淋巴结部位。80例滤泡性淋巴瘤患者中有25例（31%）有淋巴瘤既往史，通常发生在淋巴结。患有套细胞淋巴瘤、慢性淋巴细胞白血病、淋巴浆细胞淋巴瘤和脾边缘区淋巴瘤的患者几乎总是有淋巴瘤的既往病史或在诊断眼附属器淋巴瘤时已知有广泛的疾病。弥漫性大B细胞淋巴瘤的一个亚组与累及邻近结构（如鼻窦）的大破坏性肿块相关，这增加了它们可能起源于其中一个邻近结构并通过直接延伸累及眼附属器的可能性。低级别淋巴瘤的比例相对较高，未进行亚分类，突出了区分不同类型的低级别淋巴瘤可能出现的困难，特别是当活检较小且人为扭曲时。眼附属器淋巴瘤主要是一种老年人的疾病，女性略占优势。大多数淋巴瘤是低度B细胞淋巴瘤，边缘区淋巴瘤是迄今为止最常见的类型。边缘区淋巴瘤通常主要累及眼附属器，而其他类型的低度恶性B细胞淋巴瘤通常继发于眼附属器。高度恶性的B细胞淋巴瘤仅偶尔累及眼附属器，T细胞淋巴瘤、NK细胞淋巴瘤和霍奇金淋巴瘤在此部位也很少见。
We studied the cases of 353 patients with lymphoma involving the ocular adnexa diagnosed at the Massachusetts General Hospital between 1974 and 2005. The patients included 153 males and 200 females, aged 7 to 95 years, with a mean age of 64 years. In 277 cases, there was no known history of lymphoma. Seventy-six patients had a history of lymphoma, with the ocular adnexa being involved at relapse or with progression of the previously diagnosed lymphoma. The patients had marginal zone lymphoma (182 cases), follicular lymphoma (80 cases), mantle cell lymphoma (18 cases), small lymphocytic lymphoma/chronic lymphocytic leukemia (13 cases), lymphoplasmacytic lymphoma (4 cases), splenic marginal zone lymphoma (2 cases), low-grade B cell, not subclassified (19 cases), precursor B lymphoblastic lymphoma (3 cases), diffuse large B-cell lymphoma (26 cases), and I case each of high-grade B-cell lymphoma, not subclassified, peripheral T-cell lymphoma, unspecified type, extranodal NK/T-cell lymphoma, nasal type, and Hodgkin lymphoma, nodular sclerosis type. Almost all marginal zone lymphoma patients (168 of 182, 92%) had primary ocular adnexal lymphoma. Fourteen marginal zone lymphoma patients (8%) had a prior history of lymphoma, usually arising in another extranodal site. Twenty-five of 80 (31%) follicular lymphoma patients had a prior history of lymphoma, usually arising in lymph nodes. Patients with mantle cell lymphoma, chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, and splenic marginal zone lymphoma almost always had a prior history of lymphoma or were known to have widespread disease at the time of diagnosis of ocular adnexal lymphoma. A subset of the diffuse large B-cell lymphomas were associated with large destructive masses involving adjacent structures such as paranasal sinuses, raising the possibility that they may have arisen from one of the adjacent structures and involved the ocular adnexa by direct extension. The relatively high proportion of low-grade lymphoma, not subclassified, highlights the difficulty that may arise in distinguishing different types of low-grade lymphoma, particularly when biopsies are small and artifactually distorted. Ocular adnexal lymphoma is primarily a disease of older adults, with a slight female preponderance. Most lymphomas are low-grade B-cell lymphomas, with marginal zone lymphoma being by far the most common type. Marginal zone lymphoma typically involves the ocular adnexa primarily, whereas other types of low-grade B-cell lymphoma often involve the ocular adnexa secondarily. High-grade B-cell lymphomas only occasionally involve the ocular adnexa, and T-cell lymphoma, NK-cell lymphoma, and Hodgkin lymphoma are only rarely encountered in this site.