Colaço Raul, Portela Mariana, Costa Ilda, Guedes Marta, Mota António
Radiotherapy Department, Instituto Português de Oncologia Francisco Gentil E.P.E, Lisbon, Portugal.
Ophthalmology Department, Hospital de Egas Moniz Centro Hospitalar Lisboa Ocidental E.P.E, Lisbon, Portugal.
Case Rep Oncol. 2021 Mar 1;14(1):184-189. doi: 10.1159/000512216. eCollection 2021 Jan-Apr.
A 67-year-old previously healthy woman presented with progressive visual impairment including bitemporal hemianopsia. A brain magnetic resonance imaging revealed a contrast-enhancing mass in the optic chiasm, spreading along the left optic tract. The patient underwent a transcranial biopsy of the left optical tract that yielded a diagnosis of diffuse large B-cell lymphoma. CT scans of the chest, abdomen, and pelvis, PET-CT, and bone marrow biopsy revealed no evidence of systemic lymphoma. Thus, the final diagnosis was of primary central nervous system lymphoma of the optic chiasm. Systemic treatment was initiated with full response. Six months after the end of the treatment, recurrence at cerebellum parenchyma and left tentorium was recorded. A new systemic treatment achieved full response. A second recurrence was noted in an optical coherence tomography of the right eye, 2 years after the initial diagnosis. The patient was treated with intravitreal methotrexate with initial success, but eventual failure after 10 months. Intravitreal rituximab was used with no effect. The patient was then referred to radiotherapy and underwent external beam radiotherapy with VMAT. There were no acute toxicities to report. After the radiotherapy treatment, at 1-year follow-up, the patient has no evidence of disease. Long-term toxicities were recorded and are considered manageable. The present case emphasizes the role of ocular irradiation as an option in the management of intraocular lymphoma patients, including in the salvage setting, with an acceptable ocular toxicity profile.
一名67岁、既往健康的女性出现进行性视力损害，包括双颞侧偏盲。脑部磁共振成像显示视交叉有一个强化肿块，并沿左侧视束蔓延。患者接受了左侧视束的经颅活检，诊断为弥漫性大B细胞淋巴瘤。胸部、腹部和骨盆的CT扫描、PET-CT及骨髓活检均未发现系统性淋巴瘤的证据。因此，最终诊断为视交叉原发性中枢神经系统淋巴瘤。开始全身治疗后获得完全缓解。治疗结束6个月后，记录到小脑实质和左侧小脑幕复发。再次进行全身治疗后获得完全缓解。初次诊断2年后，右眼光学相干断层扫描发现第二次复发发了第二次复发。患者接受玻璃体内甲氨蝶呤治疗，初期成功，但10个月后最终失败。使用玻璃体内利妥昔单抗无效。随后患者接受放射治疗，采用容积调强弧形放疗（VMAT）进行外照射。无急性毒性反应报告。放疗治疗后，在1年的随访中，患者无疾病证据。记录到长期毒性反应，但认为可控制。本病例强调了眼部照射作为眼内淋巴瘤患者治疗选择的作用，包括在挽救治疗中，且眼部毒性可接受。
