复发的急性髓系白血病表现为眼结合膜髓系肉瘤：病例报告。
Relapsed acute myeloid leukemia presenting as conjunctival myeloid sarcoma: a case report.
机构信息
Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
BMC Ophthalmol. 2022 Feb 10;22(1):65. doi: 10.1186/s12886-022-02286-1.
BACKGROUND
Conjunctival myeloid sarcoma (MS) as an isolated presentation of acute myeloid leukemia (AML) relapse is rare. Here, we report a case of unilateral conjunctival MS revealed as a sign of AML relapse.
CASE PRESENTATION
A 50-year-old man with a history of AML in remission visited our clinic presenting with a left conjunctival injection persisting for 1 month. Diffuse subconjunctival thickening with conjunctival vascular engorgement was observed. Ultrasound biomicroscopy revealed a hyper-reflective, thickened conjunctiva in his left eye. During the incisional biopsy, the lesion was strongly attached to the underlying sclera; histopathologic examination revealed infiltration of leukemic blasts. The relapse of AML was confirmed by a successive bone marrow biopsy. The ocular lesion disappeared after allogeneic peripheral blood stem cell transplantation (PBSCT) and concomitant salvage radiotherapy on the left eye. The patient has remained in remission for 3 years after allogeneic PBSCT.
CONCLUSIONS
Incidental conjunctival lesions can indicate AML relapse in patients treated earlier for AML. An ophthalmologist may have a role in the early detection of AML when a patient presents with an atypical conjunctival lesion.
背景
作为急性髓系白血病（AML）复发的孤立表现，结膜髓系肉瘤（MS）较为罕见。在此，我们报告了一例单侧结膜 MS，其表现为 AML 复发的迹象。
病例介绍
一名 50 岁男性，AML 缓解期，因左眼结膜充血持续 1 个月就诊于我院。超声生物显微镜检查显示左眼弥漫性结膜下增厚伴血管充盈。行结膜活检时，病变与下方巩膜紧密相连；组织病理学检查显示白血病细胞浸润。随后行骨髓活检证实 AML 复发。行异基因外周血造血干细胞移植（PBSCT）和左眼挽救性放疗后，眼部病变消失。异基因 PBSCT 后 3 年，患者仍处于缓解期。
结论
既往接受 AML 治疗的患者出现偶然的结膜病变可能提示 AML 复发。当患者出现非典型的结膜病变时，眼科医生可能在 AML 的早期发现中发挥作用。
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