眼内淋巴瘤：诊断与治疗的最新进展
Intraocular lymphoma: update on diagnosis and management.
作者信息
Chan Chi-Chao, Wallace Dana J
机构信息
Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
出版信息
Cancer Control. 2004 Sep-Oct;11(5):285-95. doi: 10.1177/107327480401100502.
BACKGROUND
Primary intraocular lymphoma (PIOL) is a subset of primary central nervous system lymphoma (PCNSL) in which lymphoma cells initially invade the retina, vitreous, or optic nerve head, with or without concomitant CNS involvement. The incidence of this previously rare condition has increased dramatically. Given its nonspecific presentation and aggressive course, PIOL provides a diagnostic and therapeutic challenge.
METHODS
We review the current strategies for diagnosis and treatment of PIOL and present our own experience with PIOL.
RESULTS
Recent developments in the diagnosis of PIOL include immunohistochemistry, flow cytometry, cytokine evaluation, and molecular analysis. However, definitive diagnosis still requires harvesting of tissue for histopathology. Optimal treatment for PIOL remains unclear. Initial therapeutic regimens should include methotrexate-based chemotherapy and radiotherapy to the brain and eye. In addition, promising results have been seen with intravitreal methotrexate and autologous stem cell transplantation for recurrent and refractory disease.
CONCLUSIONS
Efforts to further determine the immunophenotype and molecular characteristics of PIOL will continue to assist in the diagnosis of PIOL. Future studies are required to determine the role of radiotherapy and optimal local and systemic chemotherapeutic regimens.
背景
原发性眼内淋巴瘤（PIOL）是原发性中枢神经系统淋巴瘤（PCNSL）的一个亚型，其中淋巴瘤细胞最初侵犯视网膜、玻璃体或视神经乳头，伴或不伴有中枢神经系统受累。这种以前罕见的疾病的发病率已急剧上升。鉴于其非特异性表现和侵袭性病程，PIOL带来了诊断和治疗方面的挑战。
方法
我们回顾了PIOL的当前诊断和治疗策略，并介绍了我们自己治疗PIOL的经验。
结果
PIOL诊断方面的最新进展包括免疫组织化学、流式细胞术、细胞因子评估和分子分析。然而，明确诊断仍需要获取组织进行组织病理学检查。PIOL的最佳治疗方法仍不明确。初始治疗方案应包括以甲氨蝶呤为基础的化疗以及对脑部和眼部的放疗。此外，玻璃体内注射甲氨蝶呤和自体干细胞移植治疗复发和难治性疾病已取得了令人鼓舞的结果。
结论
进一步确定PIOL免疫表型和分子特征的努力将继续有助于PIOL的诊断。未来需要开展研究以确定放疗的作用以及最佳的局部和全身化疗方案。
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