Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama City, Japan.
Ophthalmology, Okayama University Hospital, Okayama City, Japan.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620966843. doi: 10.1177/2324709620966843.
This study reported 2 new patients and 16 historical cases with pathologically proven intraocular infiltration with adult T-cell leukemia and lymphoma (ATLL) to know the timing of intraocular infiltration in the disease course. The first case was a 67-year-old woman who developed bilateral vitreous opacity about half a year after the onset of acute type of ATLL that had been unresponsive to chemotherapy. She underwent vitrectomy combined with cataract surgery in both eyes. She had bilateral optic disc atrophy and localized retinal white infiltrates in both eyes. Cytological examination of vitreous aspirates demonstrated medium-sized cells with aberrant flower-like convoluted nuclei, positive for CD3, and thus indicative of T-cells. The second case was a 38-year-old man who was diagnosed acute type of ATLL at the presentation of acute kidney injury. About half a year after initial chemotherapy and allogeneic hematopoietic stem cell transplantation, he developed aqueous hypopyon in the right eye, concurrent with cutaneous and central nervous system relapse. Aqueous tap disclosed class V abnormal cells. The aqueous "pseudohypopyon" resolved in response to another round of chemotherapy with mogamulizumab. In review of 18 patients, intraocular infiltration with ATLL was diagnosed by vitrectomy in 9, aqueous tap in 3, chorioretinal biopsy in 3, and autopsy in 3. The intraocular infiltration developed concurrently with systemic diagnosis of ATLL in 5 patients, but developed later after chemotherapy in 13. In conclusion, intraocular infiltration with ATLL appears rare, and pathological diagnosis by vitrectomy and aqueous tap would help determine therapeutic plan in relapse after chemotherapy.
本研究报道了 2 例新的和 16 例经病理证实的眼内浸润性成人 T 细胞白血病和淋巴瘤（ATLL）的病例，以了解疾病过程中眼内浸润的时间。第一个病例是一位 67 岁女性，在急性型 ATLL 发病后约半年出现双侧玻璃体混浊，对化疗无反应。她在双眼行玻璃体切除术联合白内障手术。她双眼视盘萎缩，视网膜局部有白色浸润。玻璃体液抽吸细胞学检查显示中等大小的细胞，具有异常的花状卷曲核，CD3 阳性，提示为 T 细胞。第二个病例是一位 38 岁男性，在出现急性肾损伤时被诊断为急性型 ATLL。在初始化疗和异基因造血干细胞移植后约半年，他右眼出现水性前房积脓，同时伴有皮肤和中枢神经系统复发。房水抽吸显示 V 级异常细胞。由于另一轮莫格珠单抗化疗，水性“假性前房积脓”得到缓解。回顾 18 例患者，9 例通过玻璃体切除术、3 例通过房水抽吸、3 例通过脉络膜视网膜活检、3 例通过尸检诊断为 ATLL 眼内浸润。5 例患者的眼内浸润与全身 ATLL 的诊断同时发生，但在化疗后 13 例患者中发生较晚。总之，ATLL 的眼内浸润似乎很少见，通过玻璃体切除术和房水抽吸进行病理诊断有助于确定化疗后复发的治疗方案。
