목적 : we report an unusual case of a relapsed intraocular lymphoma patient, who has experienced long lasting complete remission after the chemotherapy. The diagnosis was especially hard because the intraocular lymphoma(IOL) is not only rare but can masquerade as different types of uveitic entities, and in this case, lymphoma only involved in vitreous body.
방법 : A 51-year-old woman was presented with gradual visual disturbance due to eye floater for six months. Two weeks prior to the visit to our clinic, she was treated with oral prednisolone (40mg/day) for 2 weeks under the diagnosis of severe intermediate uveitis. However, there was no symptomatic improvement. From a clinical point of view, lymphoma cells in the vitreous seemed possible as the initial phase of CNS involvement. We were suspicious of the CNS lymphoma. Thus, she underwent diagnostic vitrectomy in her right eye
결과 : The cytologic examination of the vitreous showed large atypical lymphoid cells with large and irregular nuclei and prominent nucleoli which were immunoreactive for CD20. Immunophenotyping results obtained from flow cytometry were also suggestive of monoclonal B cell lymphoma. B cell marker CD19 was stained positively in 92.2%. The supernatant of the vitreous specimen was used for cytokines analyses. IL-10 to IL-6 ratio was 98.5, which was greater than 1.0, highly suggestive of lymphoma. Monoclonality also confirmed in these cells using PCR through the demonstration of rearrangement of Ig chain
결론 : This is the first report, to our knowledge, of a patient with diffuse large B-cell uterine lymphoma, who was treated with CHOP chemotherapy, presented with isolated visual complaints due to only vitreous malignant cells, not retinal infiltration, during complete remission.
In this report, we emphasized the clinical suspicion is the most important to diagnosis ocular lymphoma. Even if a patient is at an early stage low grade lymphoma or has reached complete remission, intraocular lymphoma should be considered with any uveitis and neurological symptoms.
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