Bedaiwi Khalid, Alfawaz Abdullah M, Mohammed Shamayel F, Maktabi Azza My, Alqahtani Faisal, Alhazzaa Salwa, Alkatan Hind M
Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Ann Med Surg (Lond). 2020 Nov 27;60:646-650. doi: 10.1016/j.amsu.2020.11.066. eCollection 2020 Dec.
Most intraocular T-cell lymphomas arise from metastatic source. We are reporting a rare case of intraocular T-cell lymphoma masquerading as pseudo-hypopyon and vitritis. The eye involvement proved to represent a metastatic spread from a co-existing adrenal T-cell lymphoma, which was discovered after the initial ophthalmic presentation.
Our patient was a 71-year-old Saudi man, who was admitted for workup of anemia and weight loss. He also noticed a gradual, painless decline in his vision of both eyes, for which he was referred to the ophthalmology unit. Ocular examination revealed left eye 3 mm pinkish hypopyon. A diagnosis of T-cell lymphoma was made based on careful microscopic examination of the left aqueous fluid, immunohistochemical (IHC) and Flow cytometry analysis. Computerized tomography showed a large invasive left adrenal mass, which has proven to be a primary adrenal lymphoma with multiple metastasis including the intraocular involvement.
Primary intraocular lymphoma is the most common lymphoma in the eye. Intraocular T-cell lymphoma is rare and is mostly metastatic. On the other hand, primary adrenal lymphoma (especially T-cell lymphoma) is also rare. There are only 5 cases of primary adrenal lymphoma, two of which, resulted in eye metastasis similar to our case. Primary adrenal lymphoma is known to be aggressive. Our patient eventually passed away.
This report stresses the importance of referring patients with systemic lymphoma to an ophthalmologist to be evaluated for ocular involvement. Even though intraocular metastatic adrenal T cell lymphoma is rare, high clinical suspicion in patients who are presenting with pinkish hypopyon in the presence of other constitutional symptoms is essential.
大多数眼内T细胞淋巴瘤起源于转移灶。我们报告一例罕见的眼内T细胞淋巴瘤，表现为伪装成假前房积脓和葡萄膜炎。眼部受累经证实是由同时存在的肾上腺T细胞淋巴瘤转移所致，该肾上腺T细胞淋巴瘤是在最初眼科就诊后才被发现的。
我们的患者是一名71岁的沙特男性，因贫血和体重减轻入院检查。他还注意到双眼视力逐渐无痛性下降，为此他被转诊至眼科。眼部检查发现左眼有3毫米粉红色前房积脓。通过对左房水进行仔细的显微镜检查、免疫组织化学（IHC）和流式细胞术分析，确诊为T细胞淋巴瘤。计算机断层扫描显示左侧肾上腺有一个巨大的浸润性肿块，经证实是原发性肾上腺淋巴瘤伴多处转移，包括眼部受累。
原发性眼内淋巴瘤是眼部最常见的淋巴瘤。眼内T细胞淋巴瘤罕见，大多为转移性。另一方面，原发性肾上腺淋巴瘤（尤其是T细胞淋巴瘤）也很罕见。原发性肾上腺淋巴瘤仅有5例报道，其中2例导致眼部转移，与我们的病例相似。已知原发性肾上腺淋巴瘤具有侵袭性。我们的患者最终去世。
本报告强调了将系统性淋巴瘤患者转诊给眼科医生以评估眼部受累情况的重要性。尽管眼内转移性肾上腺T细胞淋巴瘤罕见，但对于出现粉红色前房积脓并伴有其他全身症状的患者，保持高度的临床怀疑至关重要。
