Myers Kenneth A, Nikolic Ana, Romanchuk Kenneth, Weis Ezekiel, Brundler Marie-Anne, Lafay-Cousin Lucie, Costello Fiona
Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.).
Neurooncol Pract. 2017 Mar;4(1):60-66. doi: 10.1093/nop/npw006. Epub 2016 Dec 9.
Optic neuropathy in the context of leukemia or lymphoma has a broad differential diagnosis, including infiltration, infection, inflammation, compression, and medication effects. Confirming the underlying etiology in a timely manner is crucial as, while infiltration carries a poor prognosis, treatment modalities can have serious consequences themselves.
A review of the literature was conducted for cases of isolated optic neuropathy in the context of leukemia or lymphoma, in which the underlying etiology remained unclear following initial clinical examination and neuroimaging. Clinical, radiological, and pathological characteristics of the cases are summarized.
Ninety-two cases meeting inclusion criteria were identified. Leukemic or lymphomatous infiltration was the presumed diagnosis in 72% of the reports, indicating this is the most likely etiology in such cases. The remaining reports were attributed to inflammation, infection, or drug toxicity. For illustrative purposes, the previously unpublished case of an 11-year-old girl with remitted T lymphoblastic lymphoma is presented. She suffered recurrence in the form of isolated left optic nerve infiltration that required transconjunctival biopsy to confirm diagnosis.
Optic nerve infiltration by leukemia or lymphoma requires both diagnostic certainty and urgent management. Recommendations are made for a step-wise, yet rapid investigative approach that may ultimately require biopsy of the optic nerve.
白血病或淋巴瘤相关的视神经病变有广泛的鉴别诊断，包括浸润、感染、炎症、压迫及药物作用。及时确定潜在病因至关重要，因为虽然浸润预后不良，但治疗方式本身也可能产生严重后果。
对白血病或淋巴瘤背景下孤立性视神经病变的病例进行文献回顾，这些病例在初始临床检查和神经影像学检查后潜在病因仍不明确。总结这些病例的临床、放射学和病理学特征。
确定了92例符合纳入标准的病例。72%的报告推测诊断为白血病或淋巴瘤浸润，表明这是此类病例最可能的病因。其余报告归因于炎症、感染或药物毒性。为说明起见，介绍了一名11岁缓解期T淋巴细胞母细胞淋巴瘤女孩的既往未发表病例。她以孤立性左侧视神经浸润的形式复发，需要经结膜活检以确诊。
白血病或淋巴瘤对视神经的浸润需要明确诊断并紧急处理。建议采用逐步但快速的调查方法，最终可能需要对视神经进行活检。
