Mudhar Hardeep Singh, Fernando Malee, Sheard Richard, Rennie Ian
National Specialist Ophthalmic Pathology Service (NSOPS-Sheffield Lab), Department of Histopathology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, England, UK.
Int Ophthalmol. 2010 Aug;30(4):341-3. doi: 10.1007/s10792-009-9340-9. Epub 2010 Jan 14.
We describe a unique case of a patient with an established diagnosis of Hodgkin's lymphoma in clinical remission who later presented with apparent vitreous inflammation. A vitreous biopsy (including fortuitously some peripheral retinal fragments) exhibited granulomatous inflammation. Since the latter can be a paraneoplastic phenomenon of active Hodgkin's lymphoma in distant organ sites, the haematologists were alerted to the possibility of recurrent lymphoma, despite the patient having no clinical symptoms. Repeat body imaging showed enlarged mediastinal lymph nodes, biopsy of which confirmed recurrent Hodgkin's lymphoma. The patient responded well to systemic chemotherapy with resolution of the visual symptoms. This case report illustrates the importance of vitreous biopsy in this clinical setting and how to interpret the significance of granulomas in this context, and outlines a unique vitreo-retinal paraneoplastic granulomatous presentation in the setting of recurrent Hodgkin's lymphoma and how this diagnosis triggered a prompt review of the patient who had no constitutional symptoms, with hopefully a favourable impact on prognosis given the early recurrent disease detection.
我们描述了一例独特的病例，该患者确诊为霍奇金淋巴瘤，处于临床缓解期，后来出现明显的玻璃体炎症。玻璃体活检（偶然包括一些周边视网膜碎片）显示为肉芽肿性炎症。由于后者可能是远处器官部位活动性霍奇金淋巴瘤的副肿瘤现象，血液科医生警惕了淋巴瘤复发的可能性，尽管该患者没有临床症状。重复的身体成像显示纵隔淋巴结肿大，活检证实为复发性霍奇金淋巴瘤。患者对全身化疗反应良好，视觉症状得以缓解。本病例报告说明了玻璃体活检在这种临床情况下的重要性以及如何解读这种情况下肉芽肿的意义，并概述了复发性霍奇金淋巴瘤背景下独特的玻璃体视网膜副肿瘤性肉芽肿表现，以及这种诊断如何促使对没有全身症状的患者进行及时复查，鉴于早期复发疾病的检测，有望对预后产生有利影响。
