Matsumoto Kohei, Kase Satoru, Namba Kenichi, Iwata Daiju, Matsuno Yoshihiro, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Japan Community Health Care Organization, Sapporo Hokushin Hospital, Sapporo, Japan.
Cancer Diagn Progn. 2023 Jan 3;3(1):130-134. doi: 10.21873/cdp.10190. eCollection 2023 Jan-Feb.
BACKGROUND/AIM: Masquerade syndrome is characterized by uveitis-like manifestations caused by tumor cell infiltration into the ocular tissues. The aim of the study was to report a lung cancer patient with persistent unilateral vitreous opacity, who was eventually diagnosed with masquerade syndrome using cell block preparation.
An 82-year-old female complained of blurred vision in her left eye (OS). Because of pulmonary adenocarcinoma, she had previously received anticancer drug treatment at another Hospital and achieved partial remission. Ophthalmic examinations revealed anterior chamber inflammation and vitreous opacity OS. Corticosteroid eye drops were administered, but the inflammation did not improve, and was referred to the Hokkaido University Hospital. The left best-corrected visual acuity was 0.1 with normal intraocular pressure. Anterior chamber inflammation was 2+ cells, and vitreous haze was 4+ OS. B-mode ultrasonography showed diffuse heterogeneous high echoic changes in the vitreous cavity. She underwent vitrectomy, and cell block preparation of the vitreous infusion fluids was performed. Cytopathology revealed adenocarcinoma cells with a high nuclear/cytoplasmic ratio and glandular formation. The immunocytochemical study showed that tumor cells were positive for thyroid transcription factor-1 (TTF-1), napsin A, and CK7, therefore diagnosis of masquerade syndrome due to intraocular metastasis of pulmonary adenocarcinoma was reached. Chemoradiotherapy was administered, and the eye got phthisis bulbi after irradiation 2 years after diagnosis.
Cell block preparation using vitreous humor may be useful in the diagnosis and management of intraocular metastasis of pulmonary adenocarcinoma in patients with prolonged vitreous opacity.
背景/目的：伪装综合征的特征是肿瘤细胞浸润眼组织导致类似葡萄膜炎的表现。本研究的目的是报告一名患有持续性单侧玻璃体混浊的肺癌患者，最终通过细胞块制备诊断为伪装综合征。
一名82岁女性主诉左眼视力模糊。因肺腺癌，她此前在另一家医院接受了抗癌药物治疗并取得部分缓解。眼科检查发现左眼有前房炎症和玻璃体混浊。给予糖皮质激素眼药水治疗，但炎症未改善，遂转诊至北海道大学医院。左眼最佳矫正视力为0.1，眼压正常。前房炎症为2+细胞，左眼玻璃体混浊为4+。B型超声显示玻璃体腔弥漫性不均匀高回声改变。她接受了玻璃体切除术，并对玻璃体灌注液进行了细胞块制备。细胞病理学显示腺癌细胞核质比高且有腺管形成。免疫细胞化学研究表明肿瘤细胞甲状腺转录因子-1（TTF-1）、 napsin A和CK7呈阳性，因此诊断为肺腺癌眼内转移所致的伪装综合征。给予放化疗，诊断后2年放疗后眼球萎缩。
使用玻璃体液进行细胞块制备可能有助于诊断和管理玻璃体混浊持续时间较长的患者的肺腺癌眼内转移。
