Arocker-Mettinger E, Huber-Spitzy V, Stur M, Haddad R, Grabner G
II. Univ. Augenklinik Wien.
Klin Monbl Augenheilkd. 1992 Sep;201(3):188-93. doi: 10.1055/s-2008-1045892.
A rare form of malignant large-cell non-Hodgkin's lymphoma or reticulum cell sarcoma is confined to the eye and central nervous system (CNS). We report the case of a 62-year-old man, who presented with recalcitrant progressive uveitis in his right eye. Although lymphoma was suspected, the patient refused to undergo vitrectomy. Over one year he developed large blister-like solid scattered lesions of the retinal pigment epithelium (RPE) in the same eye. Repetitive neuroimaging detected no CNS involvement. After developing optic disc-swelling and discrete RPE-changes in the left eye also, the patient agreed to enucleation of his right eye. Histopathology and Immuno-histochemistry revealed malignant intraocular large cell-lymphoma invading all eye-tissues. Liquor cytology showed lymphomatous cells. Suffering from high grade malignant lymphoma with CNS ivolvement, the patient had to undergo radiation therapy of the orbits and neuroaxsis as well as intravenous and intrathecal chemotherapy. Papilledema of the left eye resolved quickly and completely, RPE-infiltrations disappeared and led to discrete punched out lesions with no scarring, the lens remained transparent over the whole observation period of 25 months. the patient has been surviving for more than 52 months after first suspicion of malignant lymphoma, he has retained full vision in his left eye until now.
一种罕见的恶性大细胞非霍奇金淋巴瘤或网状细胞肉瘤局限于眼部和中枢神经系统(CNS)。我们报告了一例62岁男性患者,其右眼出现难治性进行性葡萄膜炎。尽管怀疑是淋巴瘤,但患者拒绝接受玻璃体切除术。一年多来,他同一只眼睛的视网膜色素上皮(RPE)出现了大水泡样实性散在病变。多次神经影像学检查未发现中枢神经系统受累。在左眼也出现视盘肿胀和离散的RPE改变后,患者同意摘除右眼。组织病理学和免疫组织化学显示恶性眼内大细胞淋巴瘤侵犯了所有眼组织。脑脊液细胞学检查发现淋巴瘤细胞。由于患有伴有中枢神经系统受累的高级别恶性淋巴瘤,患者不得不接受眼眶和神经轴的放射治疗以及静脉和鞘内化疗。左眼的视乳头水肿迅速完全消退,RPE浸润消失,形成离散的打孔样病变且无瘢痕形成,在25个月的整个观察期内晶状体保持透明。首次怀疑恶性淋巴瘤后,患者已存活超过52个月,至今左眼仍保留完全视力。