Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
JAMA Ophthalmol. 2013 Sep;131(9):1151-8. doi: 10.1001/jamaophthalmol.2013.334.
Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma.
To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma. DESIGN Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes. SETTING Mayo Clinic pathology database.
Fifty-five patients with vitreous specimens available for review.
Vitreous aspiration biopsy.
Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL).
Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium.
Vitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.
眼内淋巴瘤是一组涉及眼部不同组织的血液恶性肿瘤。在全身淋巴瘤中，视网膜和玻璃体的主要受累而脉络膜无浸润，类似于原发性玻璃体视网膜淋巴瘤，极为罕见。我们的研究强调，在所有新诊断的玻璃体视网膜淋巴瘤患者中，除了中枢神经系统评估外，还应进行全身评估。
确定以玻璃体视网膜浸润为表现、无中枢神经系统受累、类似于全身淋巴瘤患者原发性玻璃体视网膜淋巴瘤的继发性眼内淋巴瘤的发生率。
回顾性分析 2000 年 1 月 1 日至 2010 年 12 月 31 日期间，我院因恶性肿瘤疑似临床采集的所有玻璃体抽吸活检样本。回顾内容包括患者临床病史、影像学研究结果、细胞学和/或组织学准备、免疫表型研究结果、治疗和结局。
梅奥诊所病理学数据库。
55 名有玻璃体标本可供审查的患者。
玻璃体抽吸活检。
弥漫性大 B 细胞淋巴瘤（DLBCL）的诊断得到确认。
55 名有玻璃体标本可供审查的患者中，有 3 名（5%）患有玻璃体无任何中枢神经系统受累的 DLBCL 浸润，表现为全身淋巴瘤。所有 3 名患者均为男性，年龄分别为 54、66 和 73 岁，在接受诊断性玻璃体切除术之前，视力模糊和漂浮物已持续数周。眼科检查显示玻璃体细胞团块，但无脉络膜受累。1 例患者无淋巴瘤病史；在淋巴结活检后，诊断为玻璃体视网膜淋巴瘤，随后诊断为 DLBCL。另外 2 例患者在眼部大细胞转化前分别患有低级别 B 细胞淋巴瘤和慢性淋巴细胞白血病 29 个月和 7 个月。患者接受全身化疗联合眼内注射利妥昔单抗或甲氨蝶呤钠治疗。
全身淋巴瘤患者的玻璃体视网膜 DLBCL 症状可能比以前认为的更为常见（本研究为 5%）。并非所有玻璃体视网膜受累的淋巴瘤均代表原发性眼内淋巴瘤；对有视觉症状的患者进行全面的眼科评估，对有明确眼部淋巴瘤的患者进行全面分期至关重要。
