Couceiro Rita, Proença Helena, Pinto Filomena, Fonseca Ana, Monteiro-Grillo Manuel
Hospital de Santa Maria, Department of Ophthalmology, Lisbon, Portugal.
GMS Ophthalmol Cases. 2015 Jun 3;5:Doc04. doi: 10.3205/oc000026. eCollection 2015.
To report an unusual case of systemic non-Hodgkin lymphoma (NHL) with repeated relapse in the lacrimal glands, in spite of complete remission for several years after treatment.
A 78-year-old male with small lymphocytic B cell NHL, stage IV disease (lung invasion), was submitted to surgery and chemotherapy in 2001, with complete remission of the disease. In 2003 he developed a nodular lesion in the right lacrimal fossa. Pathology results revealed a local relapse of NHL. Radiation and chemotherapy were initiated and complete remission was again achieved. In 2012 the patient developed a new nodular lesion located in the left lacrimal fossa, resulting in diplopia, ptosis and proptosis of the left eye. Orbital computerized tomography (CT), ocular ultrasound and incisional biopsy were performed.
Orbital CT revealed a lesion infiltrating the left lacrimal gland and encircling the globe. Biopsy results confirmed a local relapse of B cell NHL. The patient was submitted to local radiation therapy with progressive resolution of ptosis, proptosis and diplopia. Response to treatment was monitored with ocular ultrasound.
Patients with NHL diagnosis should be immediately investigated if ophthalmic or orbital symptoms develop. NHL extension to the orbit and adnexa is infrequent (5% of NHL cases) but may occur at any stage of the disease, including as a relapse site. In such cases, radiation and chemotherapy achieve good results, inducing long periods of remission.
报告一例罕见的系统性非霍奇金淋巴瘤（NHL）病例，尽管治疗后数年完全缓解，但泪腺仍反复复发。
一名78岁男性，患有小淋巴细胞B细胞NHL，IV期疾病（侵犯肺部），于2001年接受手术和化疗，疾病完全缓解。2003年，他右侧泪窝出现一个结节性病变。病理结果显示为NHL局部复发。开始进行放疗和化疗，再次实现完全缓解。2012年，患者左侧泪窝出现一个新的结节性病变，导致左眼复视、上睑下垂和眼球突出。进行了眼眶计算机断层扫描（CT）、眼部超声检查和切开活检。
眼眶CT显示一个病变浸润左侧泪腺并环绕眼球。活检结果证实为B细胞NHL局部复发。患者接受了局部放射治疗，上睑下垂、眼球突出和复视逐渐缓解。通过眼部超声监测治疗反应。
如果NHL患者出现眼科或眼眶症状，应立即进行检查。NHL扩展至眼眶和附件并不常见（占NHL病例的5%），但可能在疾病的任何阶段发生，包括作为复发部位。在这种情况下，放疗和化疗可取得良好效果，诱导长期缓解。
