Lin Tai-Chi, Lin Pei-Yu, Wang Lei-Chi, Chen Shih-Jen, Chang Yu-Mei, Lee Shui-Mei
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2014 Jul;77(7):385-8. doi: 10.1016/j.jcma.2014.04.002. Epub 2014 Jun 6.
Intraocular involvement of T-cell lymphoma is rare. We report a case presented with inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment. An 81-year-old man presented with unilateral high intraocular pressure and keratic precipitates. Polymerase chain reaction of the aqueous humor was negative for herpes simplex virus type 1 and 2, varicella zoster virus, and cytomegalovirus. Progressive pupil dilatation, cornea anesthesia with large epithelial defect, and choroidal detachment were noted in the following month. Diagnostic vitrectomy was then performed, and cytology of the vitreous suggested malignant lymphoma. Further systemic workup revealed ulcerative lesions in the stomach, and biopsy with special stains led to the diagnosis of peripheral T-cell lymphoma of the stomach with ocular involvement. Intraocular involvement of T-cell lymphoma is very rare. Most typically, the skin, followed by the central nervous system, has the most frequently occurring concurrent systemic involvement. In fact, stomach involvement has not been reported. Most cases of intraocular lymphomas presented with vitritis and anterior uveitis, and elevated intraocular pressure was not commonly observed. A review of the literature indicates that a large corneal epithelium defect has been described only in a case of peripheral T-cell lymphoma with the involvement of sclera and oropharynx. Although very rare, inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment can be the initial presentation of intraocular involvement of T-cell lymphoma.
T细胞淋巴瘤的眼内受累情况罕见。我们报告1例表现为炎性青光眼、神经营养性角膜病变和脉络膜脱离的病例。1名81岁男性，出现单侧高眼压和角膜后沉着物。房水的聚合酶链反应检测显示，单纯疱疹病毒1型和2型、水痘带状疱疹病毒及巨细胞病毒均为阴性。在接下来的1个月里，出现了进行性瞳孔散大、角膜麻醉伴大面积上皮缺损以及脉络膜脱离。随后进行了诊断性玻璃体切割术，玻璃体细胞学检查提示为恶性淋巴瘤。进一步的全身检查发现胃部有溃疡性病变，经特殊染色活检后确诊为胃外周T细胞淋巴瘤伴眼内受累。T细胞淋巴瘤的眼内受累非常罕见。最常见的情况是，皮肤其次是中枢神经系统，是最常并发的全身受累部位。事实上，胃部受累此前未见报道。大多数眼内淋巴瘤病例表现为玻璃体炎和前葡萄膜炎，眼压升高并不常见。文献回顾表明，仅在1例累及巩膜和口咽的外周T细胞淋巴瘤病例中描述过大面积角膜上皮缺损。尽管非常罕见，但炎性青光眼、神经营养性角膜病变和脉络膜脱离可能是T细胞淋巴瘤眼内受累的初始表现。
