Fend F, Süsskind D, Deuter C, Coupland S E
Institut für Pathologie und Neuropathologie, Comprehensive Cancer Center Tübingen-Stuttgart, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Deutschland.
Department für Augenheilkunde, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
Pathologe. 2017 Nov;38(6):515-520. doi: 10.1007/s00292-017-0378-6.
The eye and the ocular adnexae are rare sites for malignant non-Hodgkin lymphoma (NHL). Based on their anatomical location, intraocular lymphomas must be discerned from NHL of adnexal structures including conjunctiva, lacrimal gland, and orbit. Whereas the latter group mostly consists of indolent extranodal marginal zone B‑cell lymphomas of mucosa-associated lymphoid tissue (MALT) type or secondary manifestations of systemic NHL, most primary intraocular lymphomas are classified as diffuse large B‑cell lymphomas (DLBCL) and are considered a variant of primary DLBCL of the central nervous system. The most common form is primary vitreoretinal lymphoma (PVRL), which presents with nonspecific symptoms and is difficult to discern from uveitis. Diagnosis of PVRL is usually made by cytological, immunocytochemical, and molecular analysis of vitreous aspirates. Degenerative changes, limited material, and the occurrence of pseudoclonality in the molecular analysis of B‑cell clonality can hamper diagnostic assessment. Novel techniques such as detection of MYD88 mutations common in PVRL can increase diagnostic sensitivity. Close cooperation with clinical colleagues and rapid specimen processing are fundamental for successful diagnosis.
眼及眼附属器是恶性非霍奇金淋巴瘤(NHL)的罕见发病部位。根据其解剖位置,眼内淋巴瘤必须与附属器结构(包括结膜、泪腺和眼眶)的NHL相鉴别。后者大多由黏膜相关淋巴组织(MALT)型惰性结外边缘区B细胞淋巴瘤或系统性NHL的继发表现组成,而大多数原发性眼内淋巴瘤被归类为弥漫性大B细胞淋巴瘤(DLBCL),并被认为是中枢神经系统原发性DLBCL的一种变体。最常见的形式是原发性玻璃体视网膜淋巴瘤(PVRL),其表现为非特异性症状,且难以与葡萄膜炎相鉴别。PVRL的诊断通常通过玻璃体抽吸物的细胞学、免疫细胞化学和分子分析来进行。退行性改变、材料有限以及B细胞克隆性分子分析中假克隆性的出现会妨碍诊断评估。检测PVRL中常见的MYD88突变等新技术可提高诊断敏感性。与临床同事密切合作和快速处理标本是成功诊断的基础。