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隐匿于眼部的复发性系统性血液系统疾病:6 例报告及文献复习。

Hidden in the Eyes-Recurrence of Systemic Hemopathies Reportedly "In Remission": Six Cases and Review of Literature.

机构信息

Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France.

Institut de Pathologie, CHRU de Lille, 59000 Lille, France.

出版信息

Medicina (Kaunas). 2022 Mar 21;58(3):456. doi: 10.3390/medicina58030456.

Abstract

: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. : We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. : Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. : Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient's progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient's ocular symptoms after treatment.

摘要

: 血液系统恶性肿瘤的眼部继发性局部病变是致盲性疾病,预后较差,往往导致诊断延迟。: 我们描述了 6 例血液系统恶性肿瘤缓解后患者眼部受累的罕见病例,这些患者表现出眼部继发性局部病变,难以诊断。2 例患者患有急性淋巴细胞白血病(ALL),分别发生了后巩膜炎或假性全葡萄膜炎伴睫状体浸润。1 例患者患有虹膜浆细胞瘤,表现为前葡萄膜炎。2 例患者目前患有系统性弥漫性大 B 细胞淋巴瘤(DLBCL),分别因中葡萄膜炎或视乳头炎和玻璃体炎伴继发性视网膜病变而就诊。最后,1 例急性髓细胞白血病(AML)患者出现髓样肉瘤的结膜定位。我们在此总结了髓外血液病的眼部表现的现有知识。: 炎症迹象与症状性浸润性病变相关,这些病变在虹膜、视网膜、脉络膜或海绵窦中得到很好的显示,这些患者在眼科就诊时均有这些表现。这些发现表明,即使在经过有效的全身治疗和/或同种异体移植后被报告为缓解,ALL、AML、系统性 DLBCL 和骨髓瘤患者也可能出现眼部受累。: 早期发现眼部隐匿性复发可能允许进行有效治疗。此外,在监测患者初始治疗后的进展时,肿瘤学家和眼科医生应该意识到这些罕见的眼部恶性病变,并且在治疗后发现患者出现眼部症状时,应建议进行密切的眼科检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b8a2/8950814/45be84b5884a/medicina-58-00456-g001.jpg

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