Matsuo Toshihiko, Ichimura Kouichi, Ichikawa Tomotsugu, Okumura Yoshihiro, Kaji Mitsumasa, Yoshino Tadashi
Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Shikata-cho, Okayama City, Japan.
J Clin Exp Hematop. 2009 Nov;49(2):77-87. doi: 10.3960/jslrt.49.77.
The purpose of this study is to report the role of whole-body 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG) positron emission tomography fused with computed tomography (PET/CT) after immunocytochemical and clonal diagnosis of intraocular lymphoma with vitrectomy cell blocks. Eleven patients with intraocular lymphoma were involved in this study: 6 patients presented with vitreous opacity in both eyes and 5 patients presented with unilateral involvement. The concurrent retinal lesions were present in 6 eyes of 5 patients. Brain lymphoma was diagnosed in 7 of the 11 patients : simultaneous with eye lesions in one patient, following the eye lesions in 3, and prior to the eye lesions in 3. Vitrectomy was done in 17 eyes of the 11 patients, and vitrectomy cell blocks were processed for immunocytochemical staining and clonality analysis by polymerase chain reaction amplification of the immunoglobulin heavy chain gene. The 7 most recent patients were evaluated with fluorodeoxyglucose whole-body PET/CT. Immunocytochemical staining of vitrectomy cell blocks in all patients showed large cells which were positive for CD20 and Ki-67 but negative for CD3, consistent with diffuse large B-cell lymphoma. The size and sequence of amplified fragments of the immunoglobulin heavy chain gene were different between the lesions of both eyes in one patient while they were the same in another patient. PET/CT after the diagnosis by vitrectomy revealed abnormal uptake in the cerebellum of two patients, in the eye as a recurrent lesion of one patient, and in both eyes as residual retinal lesions of one patient. In conclusion, PET/CT could be considered as a method to confirm brain lymphoma or as a reference for initiating additional therapy in the case of eye recurrence or residual lesions after vitrectomy. The clonality of lymphoma cells was variable between the lesions in both eyes.
本研究的目的是报告在通过玻璃体切除细胞块进行眼内淋巴瘤的免疫细胞化学和克隆诊断后，全身2-[(18)F]氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描与计算机断层扫描融合（PET/CT）的作用。本研究纳入了11例眼内淋巴瘤患者：6例患者双眼出现玻璃体混浊，5例患者为单侧受累。5例患者的6只眼中存在并发的视网膜病变。11例患者中有7例被诊断为脑淋巴瘤：1例患者与眼部病变同时发生，3例在眼部病变之后发生，3例在眼部病变之前发生。11例患者的17只眼进行了玻璃体切除术，对玻璃体切除细胞块进行处理，用于免疫细胞化学染色以及通过免疫球蛋白重链基因的聚合酶链反应扩增进行克隆性分析。对最近的7例患者进行了氟脱氧葡萄糖全身PET/CT检查。所有患者玻璃体切除细胞块的免疫细胞化学染色显示，大细胞CD20和Ki-67呈阳性，但CD3呈阴性，符合弥漫性大B细胞淋巴瘤。1例患者双眼病变的免疫球蛋白重链基因扩增片段大小和序列不同，而另1例患者的则相同。玻璃体切除诊断后进行的PET/CT显示，2例患者的小脑有异常摄取，1例患者的眼部为复发病变，1例患者的双眼为残留视网膜病变。总之，PET/CT可被视为确认脑淋巴瘤的方法，或在玻璃体切除术后眼部复发或残留病变的情况下作为启动额外治疗的参考。双眼病变之间淋巴瘤细胞的克隆性是可变的。
