CD5-Positive Primary Intraocular B-Cell Lymphoma Arising during Methotrexate and Tumor Necrosis Factor Inhibitor Treatment.
CD5-Positive Primary Intraocular B-Cell Lymphoma Arising during Methotrexate and Tumor Necrosis Factor Inhibitor Treatment.
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DOI：
10.1159/000440646
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发表时间：
2015-09
影响因子：
0.4
通讯作者：
Kinoshita S
中科院分区：
文献类型：
--
作者：
Nagata K;Inaba T;Kinoshita S
目的：报道1例年轻类风湿性关节炎合并葡萄膜炎患者在甲氨蝶呤(MTX)和肿瘤坏死因子(TNF)抑制剂治疗过程中发生的CD5+原发眼内B细胞淋巴瘤。一名39岁的妇女接受MTX和一种治疗类风湿性关节炎和葡萄膜炎的肿瘤坏死因子抑制剂的治疗，发现有类固醇抗药性玻璃体混浊。玻璃体标本通过诊断性玻璃体切割术获得，根据细胞学检查被归类为V类。对玻璃体标本进行流式细胞仪分析，发现异常细胞为CD5+、CD10-、CD19+、CD20+和免疫球蛋白轻链kappa+，提示诊断为CD5+原发眼内B细胞淋巴瘤。聚合酶链式反应检测免疫球蛋白重链基因重排。用聚合酶链式反应检测玻璃体标本中EB病毒DNA，免疫组织化学检测显示EBV潜伏膜蛋白-1在玻璃体浸润性病变细胞中表达。在磁共振成像上观察视神经侵犯情况。接受MTX和肿瘤坏死因子抑制剂治疗的患者可发展为原发性眼内淋巴瘤(PIOL)。EBV感染可能在免疫抑制治疗所致PIOL的发病机制中起重要作用。
To report a case of CD5+ primary intraocular B-cell lymphoma arising during methotrexate (MTX) and tumor necrosis factor (TNF) inhibitor treatment in a young patient with rheumatoid arthritis and uveitis. A 39-year-old woman treated with MTX and a TNF inhibitor for rheumatoid arthritis and uveitis had steroid-resistant vitreous opacity. A vitreous sample was obtained by using diagnostic vitrectomy and was categorized as class V based on cytologic examination. Flow cytometric analysis of the vitreous sample revealed that abnormal cells were CD5+, CD10–, CD19+, CD20+ and immunoglobulin light-chain kappa+, suggesting the diagnosis of CD5+ primary intraocular B-cell lymphoma. Polymerase chain reaction (PCR) detected immunoglobulin heavy-chain gene rearrangement. Epstein-Barr virus (EBV) DNA was detected in the vitreous sample by using PCR, and immunohistochemistry revealed EBV latent membrane protein-1 expression in the abnormal cells infiltrating the vitreous. Optic nerve invasion was observed on magnetic resonance imaging. Primary intraocular lymphoma (PIOL) may develop in patients receiving MTX and TNF inhibitor treatment. EBV infection may play an important role in the pathogenesis of PIOL arising during immunosuppressive therapy.