Head James E, Shen Defen, Santiago-Maysonet Maribel, Bishop Rachel J, Chan Chi-Chao
Immunopathology Section, National Institutes of Health, Bethesda, MD, USA.
J Med Case Rep. 2007 Nov 28;1:158. doi: 10.1186/1752-1947-1-158.
In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.
In the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.
While ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.
一般来说，白血病等血液系统恶性肿瘤的眼部并发症已有充分记载。然而，眼受累于淋巴瘤样肉芽肿病和慢性粒单核细胞白血病等疾病的报道并不常见。在此，我们报告这两种相对罕见的血液系统恶性肿瘤出现临床和亚临床眼部受累的病例。
第一例中，一名先前诊断为淋巴瘤样肉芽肿病的54岁男性，在其全身疾病被认为处于缓解期时出现了新发的结膜病变。进行了活检，结果显示病变部位有大量B细胞和T细胞浸润。分子分析证实这些细胞同时对爱泼斯坦-巴尔病毒DNA和免疫球蛋白重链基因重排呈阳性，这与他全身疾病的表现一致。第二例中，一名患有慢性粒单核细胞白血病的51岁男性在病情反复后死亡。尸检研究显示脉络膜和视网膜下间隙存在非典型单核细胞，与他先前的诊断相符。
虽然血液系统恶性肿瘤累及眼部并不罕见，但这两例描述了两种相对罕见的肿瘤累及眼部的情况。我们在此强调每个病例中的新发现，包括结膜受累作为复发性淋巴瘤样肉芽肿病的首发症状，以及视网膜下和脉络膜粒单核细胞白血病浸润的联合情况。随着可能延长生命的新型抗肿瘤治疗方法的发展，这些病例体现了对诊断为血液系统恶性肿瘤的患者进行眼部护理的重要性。
