Metastatic B-cell lymphoma masquerading as infectious retinitis and vasculitis
Metastatic B-cell lymphoma masquerading as infectious retinitis and vasculitis
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DOI：
10.3892/ol.2012.659
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发表时间：
2012-06-01
期刊：
影响因子：
2.9
通讯作者：
Chavala, Sai H.
中科院分区：
文献类型：
--
作者：
Say, Emil Anthony T.;Knupp, Charles L.;Chavala, Sai H.
眼内淋巴瘤是一种罕见的眼部恶性肿瘤，可能发生在视网膜或葡萄膜上。视网膜或玻璃体视网膜淋巴瘤占大多数病例，通常继发于弥漫性大B细胞淋巴瘤。在目前的研究中，一位66岁的高加索男性，有Waldenstrom巨球蛋白血症合并弥漫性大B细胞淋巴瘤的病史，在R-CHOP方案4周期后一个月出现左眼视力模糊。发病时，患者正在接受细菌性肺炎治疗。右眼视力为20/25，左眼为20/30。眼科检查显示视网膜内白色浸润物，伴有视网膜中上缘出血和玻璃体炎OS。最初的诊断考虑包括感染性(巨细胞病毒性视网膜炎、梅毒、弓形虫病、结核病)、炎症性(视网膜血管炎与自身免疫性疾病或高凝状态相关)或恶性(眼内淋巴瘤)疾病。患者玻璃体内注射磷甲酸钠和口服万乃洛韦后无反应。全身检查和房水活组织检查均无定论。诊断性玻璃体切割术结果不确定，患者继续进行性失明。重复诊断的玻璃体切除视网膜和视网膜下活检证实大B细胞符合转移性B细胞淋巴瘤。同时进行了PET/CT扫描，发现双侧新的肺结节导致了额外的化疗。我们的病例显示了系统性淋巴瘤患者的诊断困境，以及在眼部主诉患者中同时进行全身再定位的可能作用，即使在全身缓解时也是如此。
Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina or vitreoretinal lymphoma accounts for the majority of cases and is often secondary to diffuse large B-cell lymphoma. In the present study, a 66-year-old Caucasian male with a history of Waldenstrom's macroglobulinemia with diffuse large B-cell lymphoma, presented with blurred vision in the left eye one month following cycle 4 of an R-CHOP regimen. At the time of onset, the patient was being treated for bacterial pneumonia. Visual acuity was 20/25 in his right eye (OD) and 20/30 in the left (OS). Ophthalmologic examination showed intraretinal white infiltrates associated with hemorrhage in the superotemporal midperiphery of the retina and vitritis OS. Initial diagnostic considerations included infectious (cytomegalovirus retinitis, syphilis, toxoplasmosis, tuberculosis), inflammatory (retinal vasculitis associated with autoimmune disease or hypercoagulable states) or malignant (intraocular lymphoma) diseases. The patient did not respond to intravitreal injection of foscarnet and oral valgancyclovir. Systemic work-up and aqueous fluid biopsy were inconclusive. Diagnostic vitrectomy yielded inconclusive results and the patient continued to have progressive loss of vision. A repeat diagnostic vitrectomy with retinal and subretinal biopsy confirmed large B cells consistent with metastatic B-cell lymphoma. A concomitant PET/CT scan was performed that revealed bilateral new pulmonary nodules resulting in additional chemotherapy. Our case shows the diagnostic dilemmas in patients with systemic lymphoma and the possible role of concurrent systemic restaging in patients with ocular complaints, even when in systemic remission.