Matsuo Toshihiko, Tanaka Takehiro, Ishida Joji, Kondo Shotaro, Matsuoka Ken-Ichi
Department of Ophthalmology, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, JPN.
Department of Ophthalmology, Okayama University Hospital, Okayama, JPN.
Cureus. 2025 Mar 30;17(3):e81476. doi: 10.7759/cureus.81476. eCollection 2025 Mar.
Primary intraocular lymphoma or vitreoretinal lymphoma is a rare entity of diffuse large B-cell lymphoma that presents vitreous opacity and retinal and choroidal infiltration. Primary central nervous system lymphoma would occur previously, later, or concurrently with respect to primary intraocular lymphoma. This study reported a 72-year-old patient with a pathological diagnosis of primary intraocular lymphoma who developed central nervous system lymphoma four years later in the course of no treatment. She presented with a four-year history of blurred vision in both eyes after cataract surgeries. Three weeks previously, she underwent a vitrectomy in the left eye at a clinic, and measurements of the vitreous fluid showed a high level of interleukin-10 at 5739 pg/mL, in contrast with interleukin-6 at 142 pg/mL. Cytology of the vitreous fluid was class III on the Papanicolaou classification. Head magnetic resonance imaging detected nothing abnormal. She underwent vitrectomy in the right eye as a diagnostic procedure to show large cells in the vitreous which were positive for CD20 and Ki-67 and negative for CD3, leading to a pathological diagnosis of large B-cell lymphoma. Prophylactic chemotherapy with high-dose methotrexate was recommended as a therapeutic option, but she chose observation since she did not have any eye or systemic symptoms. In the follow-up every three months by an oncologist and an ophthalmologist, she did not have any symptoms, and serum levels of soluble interleukin-2 receptor were in the normal range at each visit. She was well for four years until the age of 76 years when she fell and hit her head, and an emergency head computed tomography scan showed a mass in the left occipital lobe. Magnetic resonance imaging demonstrated a well-defined circular mass in the left occipital lobe with a hyperintense signal in the T2-weighted fluid-attenuated inversion recovery (FLAIR) image and diffusion-weighted image. Fluorodeoxyglucose positron emission tomography showed no abnormal uptake systemically, except for the left occipital lesion. She underwent a brain biopsy by craniotomy to pathologically prove diffuse large B-cell lymphoma. She was recommended to receive first-line chemotherapy as the standard treatment but chose observation with no treatment and died of brain lymphoma nine months later. This case happened to illustrate a natural course of primary intraocular lymphoma which proceeded to central nervous system lymphoma four years later.
原发性眼内淋巴瘤或玻璃体视网膜淋巴瘤是弥漫性大B细胞淋巴瘤的一种罕见类型，表现为玻璃体混浊以及视网膜和脉络膜浸润。原发性中枢神经系统淋巴瘤可能在原发性眼内淋巴瘤之前、之后或同时发生。本研究报告了一名72岁的患者，经病理诊断为原发性眼内淋巴瘤，在未接受治疗的情况下，4年后发生了中枢神经系统淋巴瘤。她在白内障手术后双眼视力模糊已有4年病史。3周前，她在一家诊所接受了左眼玻璃体切除术，玻璃体液检测显示白细胞介素-10水平较高，为5739 pg/mL，而白细胞介素-6为142 pg/mL。玻璃体液细胞学检查在巴氏分类中为III级。头部磁共振成像未发现异常。她接受了右眼玻璃体切除术作为诊断性操作，结果显示玻璃体中有大细胞，CD20和Ki-67呈阳性，CD3呈阴性，从而病理诊断为大B细胞淋巴瘤。推荐采用大剂量甲氨蝶呤进行预防性化疗作为治疗选择，但由于她没有任何眼部或全身症状，所以选择了观察。在肿瘤学家和眼科医生每3个月的随访中，她没有任何症状，每次就诊时可溶性白细胞介素-2受体的血清水平均在正常范围内。她在4年内情况良好，直到76岁时摔倒并撞到头部，急诊头部计算机断层扫描显示左枕叶有一个肿块。磁共振成像显示左枕叶有一个边界清晰的圆形肿块，在T2加权液体衰减反转恢复（FLAIR）图像和扩散加权图像中呈高信号。氟脱氧葡萄糖正电子发射断层扫描显示全身除左枕叶病变外无异常摄取。她接受了开颅脑活检，病理证实为弥漫性大B细胞淋巴瘤。建议她接受一线化疗作为标准治疗，但她选择了不治疗并进行观察，9个月后死于脑淋巴瘤。该病例恰好说明了原发性眼内淋巴瘤4年后发展为中枢神经系统淋巴瘤的自然病程。
