Afectación orbitaria por linfoma no Hodgkin de células T NK

Clinical caseThe case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells.DiscussionNon-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment.     

Systemic non-Hodgkin's lymphoma simulating primary intraocular lymphoma

PURPOSE: To describe a case of an unusual presentation of systemic non-Hodgkin's lymphoma with clinical and histopathologic findings closely resembling that of primary intraocular lymphoma. DESIGN: Observational case report. METHODS: A 58-year-old woman with a history of treated systemic non-Hodgkin's lymphoma presented 2 years later with a subretinal lesion and intraocular inflammation in her left eye. RESULTS: Diagnostic enucleation and histopathologic studies revealed findings consistent with primary intraocular lymphoma including intraretinal, subretinal, and subretinal pigment epithelial tumor cells without involvement of the choroid. CONCLUSIONS: We conclude that systemic non-Hodgkin's lymphoma can present remotely with findings resembling primary intraocular lymphoma and should be included in the differential diagnosis of intraocular inflammation and subretinal infiltrates.     

Bilateral blindness as the initial presentation of lymphoma of the sphenoid sinus

PURPOSE: To report a patient with large-cell lymphoma of the sphenoid sinus presenting with bilateral blindness and no other signs or symptoms. METHOD: Case report. A previously healthy 5-year-old boy complained of sudden vision loss without other systemic complaints. RESULTS: Ophthalmologic examination revealed no light perception bilaterally. The pupils of the patient were fixed at 8 mm without reaction to the brightest light stimulus. Systemic examination was unremarkable, and neuroimaging revealed a large sphenoid tumor extending intracranially. Biopsy of the tumor proved to be large-cell lymphoma. CONCLUSION: Large-cell lymphoma affecting children may present initially with blindness, without other systemic symptoms.     

Sudden Visual Loss and Total Ophthalmoplegia after Brain Surgery

A 19-year-old woman underwent an occipital craniotomy for removal of a left intraventricular glioblastoma under general anaesthesia and in prone position. Postoperatively she complained of blindness of the right eye. Ocular examination revealed mild proptosis and total ophthalmoplegia of the right eye. Computerized tomography (CT) of the orbits revealed right exophthalmos and enlargement of the extraocular muscles without optic nerve compression. CT angiography showed dilated right supraorbital and supratrochlear arteries without evidence of emboli. Treatment with intravenous methylprednisolone and oral acetazolamide was given. The ocular motility defect improved but the visual loss persisted. As has been emphasized in many similar situations adequate intra-operative ocular protection may reduce such complications.     

非霍奇金淋巴瘤复发先兆-眼内淋巴浸润

女性患者1例,60岁,4a前患有非霍奇金淋巴瘤,康复后主诉右眼视力丧失。检查发现前房和玻璃体有浮游细胞及脉络膜浸润表明淋巴病复发。数周后的脑磁共振成像显示有颅内肿瘤浸润,而后进行了全身化疗开始,眼内浸润是非霍奇金淋巴瘤复发的极为罕见的形式。     

Systemic non-Hodgkin's lymphoma with optic nerve infiltration in a patient with AIDS

PURPOSE: To report the clinicopathologic features of a patient with AIDS and clinically regressed systemic non-Hodgkin's lymphoma who subsequently developed lymphomatous infiltration of the optic nerve and occlusion of the central retinal vein in both eyes. METHODS: The eyes of this patient were examined ophthalmologically and by fluorescein angiography. The eyes, brain, and body were obtained after death and studied by light microscopy. RESULTS: Ophthalmic examination and fluorescein angiography revealed optic nerve swelling and central retinal vein occlusion first in the left eye and shortly thereafter in the right eye. Postmortem histopathologic examination showed dense infiltration of both optic nerves by lymphoma as well as necrotizing vasculitis involving the retinal vessels near the left optic nerve head. Examination of the brain revealed lymphomatous involvement in the paraventricular region with associated necrosis and inflammation. No bone marrow recurrence or other residual systemic lymphoma was present. CONCLUSION: This case demonstrates that infiltrative optic neuropathy may occur as the sole ocular manifestation of disease recurrence in a patient with systemic non-Hodgkin's lymphoma otherwise thought to be in clinical remission.     

Optic disk edema in a patient with non-Hodgkin's lymphoma: is there a metastasis to the brain?

BACKGROUND: The manifestation of bilateral disk swelling raises the suspicion of papilledema and mandates that an etiology for increased intracranial pressure be discovered. This case report will present the manifestations and treatment of non-Hodgkin's lymphoma and review the differential diagnoses of bilateral disk edema. CASE REPORT: A 51-year-old black man manifested symptoms of dizziness and intermittent loss of vision in the left eye for one week. Dilated funduscopy revealed early left optic disk edema; edema of the right optic nerve head was questionable. The patient had pulmonary nodules noted on a recent chest x-ray that were thought to be cancerous; this raised the suspicion of a metastasis to the brain or orbit. The patient did not return until about 10 weeks later, at which time he presented with a history significant for newly-diagnosed intermediate-grade non-Hodgkin's lymphoma. He had begun chemotherapy one month before the second examination at our clinic; methotrexate therapy for CNS metastasis had been provided at the time of the spinal taps. At the second visit, there was marked progression of the swelling of the left optic disk and mild swelling of the right disk. At the third visit, six weeks later, the disk edema had improved remarkably. The patient's disk swelling resolved completely by the end of his six months of chemotherapy. CONCLUSION: This is a unique presentation of a patient at high risk for brain metastasis, in which laboratory and radiologic studies failed to provide adequate supportive evidence for the conclusions drawn from clinic observations. Bilateral disk edema in a patient with a history of non-Hodgkin's lymphoma is strongly suggestive of a metastatic tumor to the brain causing increased intracranial pressure.     

Acute proptosis as first symptom of a lung carcinoma

PURPOSE/METHOD: We present the case of a 57-year-old patient who was visited in our ophthalmology department complaining of acute right ocular proptosis, fever and malaise. The clinical, ophthalmic and radiologic examination showed the presence of an extraconal orbital tumor as the cause of this exophthalmos. RESULTS/CONCLUSION: Further complementary studies revealed a small cell carcinoma of the lung metastatic to the right orbit. We report the excellent response to chemotherapy both of the primary lung neoplasm and the orbital metastasis.     

Oculocerebral non-Hodgkin's lymphoma with uveal involvement: development of an epibulbar tumor after vitrectomy

Primary ocular lymphoma is the ocular manifestation of primary oculocerebral non-Hodgkin's lymphoma. We describe a 79-year-old woman with a 7-year history of bilateral uveitis and subsequent central nervous system lymphomas. Repeated diagnostic vitrectomy during the following 5 years failed to demonstrate intraocular lymphoma cells. Within 9 months after the second vitrectomy, an epibulbar tumor developed in the limbal region of the left eye at the site of the sclerotomy. The eye, blind and painful due to secondary angle-closure glaucoma, was enucleated. Histopathologically, the globe showed a diffuse large B-cell non-Hodgkin's lymphoma extending from the ciliary body outward through the sclerotomy. We conclude that, following vitrectomy, a primary ocular lymphoma may extend through the sclerotomy lesion and present as an epibulbar tumor. Uveal involvement may occur in oculocerebral non-Hodgkin's lymphoma.     

T-cell lymphoma presenting as painful ophthalmoplegia

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.     

Non-Hodgkin's orbital lymphoma.

BACKGROUND: The non-Hodgkin's lymphomas (NHL) are a group of neoplasms characterized by proliferation of malignant lymphocytes. Patients with NHL have a wide variety of presenting signs and symptoms, depending largely on the site of involvement and aggressiveness of the disease. Many organs in the body may be affected, including the eye and orbit. CASE REPORT: A 47-year-old male with a 3-year history of stage IV non-Hodgkin's lymphoma who had undergone recent monoclonal antibody therapy presented with a complaint of blur in the left eye with occasional diplopia. Significant ocular findings of the left eye included ptosis, mild proptosis, increased intraocular pressure, and choroidal folds. Magnetic resonance imaging of the orbit revealed an orbital lymphoma that completely resolved after 2400 rads of external beam irradiation therapy. Eight months later, the patient developed a secondary radiation retinopathy. CONCLUSION: The prevalence of NHL is on the rise, and orbital involvement may occur at any time during the course of the disease. The standard treatment for non-Hodgkin's orbital lymphoma is external beam irradiation therapy, although the optimal dose for obtaining local tumor control without complications remains to be determined. Non-Hodgkin's lymphoma, orbital lymphoma, and various treatment options are discussed.     

Primary intraocular lymphoma with unusual clinical presentation and poor outcome

BACKGROUND: Primary intraocular lymphoma is a distinct subset of primary non-Hodgkin's lymphoma of the CNS. In general, the primary non-Hodgkin's lymphoma of the CNS is rare, accounting for 1 % of all non-Hodgkin's lymphomas and less than 1 % of all intraocular tumors. HISTORY AND SIGNS: A 70-year-old man was hospitalized in June 2002 because of acute loss of vision on his left eye. A severe vitreous hemorrhage was observed. Ultrasound showed solid subretinal lesions at the posterior fundus. Diagnostic vitreous surgery including a biopsy was performed. An intraocular malignant B-cell lymphoma was determined by immunohistochemistry. General screening revealed no further manifestations of the lymphoma. THERAPY AND OUTCOME: The patient initially refused any therapy until a painful secondary neovascular glaucoma with complete loss of visual function developed, thus prompting us to perform an enucleation. The following immunohistochemical examination confirmed the initial diagnosis. A chemotherapy with high-dose methotrexate and leucovorin rescue was initiated. CONCLUSIONS: Primary intraocular lymphoma can present as diffuse uveitis refractory to corticosteroids. Diagnosis can be difficult and is often delayed.     

非霍奇金淋巴瘤转移性眼浸润放射治疗后视网膜色素上皮脱离1例

患者,女,32岁,被诊断为纵隔未分化大细胞非霍奇金淋巴瘤,化疗后3a出现双眼悬浮物和右眼视力下降。眼科检查发现带有多发深在的左眼脉络膜病变的双侧全葡萄膜炎。眼窝电脑断层扫描显示两侧球后视神经部分加强和大块的视神经鞘。该患者接受眼窝受累区域放射治疗,累积剂量为30戈瑞。放射治疗8mo后,发展为黄斑部视网膜色素上皮脱离和右侧颞上和鼻下区眼底的深脉络膜视网膜变性。在脉络膜视网膜变性区边缘有玻璃体视网膜牵引迹象,从而路障激光在受累眼睛进行。双眼视力仍然6/6。视网膜色素上皮脱离可能是放射治疗非霍奇金淋巴瘤眼内转移时的并发症。至关重要的是提醒了眼科医生这个罕见的并发症。     

眼眶神经节细胞瘤1例

报道1例罕见的眼眶神经节细胞瘤:1例13岁男性右眼突出5a+,CT检查示右眼眶下方包块,通过手术完整切除包块,病理检查证实为眼眶神经节细胞瘤,患者随访12mo无复发。     

A sphenoid en plaque meningioma aggravates exophthalmos in a patient with thyroid ophthalmopathy

PURPOSE: To describe the rare case of a patient with thyroid ophthalmopathy whose unilateral aggravated exophthalmos was caused by the development of an ipsilateral sphenoid wing en plaque meningioma. METHODS: Case report. RESULTS: The ophthalmologic examination included visual acuity assessment, anterior segment examination, funduscopy, ocular motility examination, and exophthalmometry. Magnetic resonance imaging (MRI) of the brain and orbit revealed the existence of a sphenoid meningioma. Removal of the tumor through a pterional craniotomy was performed. The histologic examination showed that it was an en plaque meningioma. There were no postoperative complications and no recurrence of the tumor was revealed 24 months after the operation. CONCLUSIONS: Detailed ophthalmologic examination and MRI of the brain and orbit are necessary in every patient with deterioration of the exophthalmos even if the suggestive cause seems obvious.     

Polypoid sinusitis mimicking orbital malignancy.

A 15-year-old boy developed a rapidly progressive exophthalmos of 6 mm within two months. Radiologic evidence showed bony erosion, a palpable firm mass in the right upper eyelid, and mass blocking the right nares. This tumor was found to be polypoid sinusitis emanating through the lamina papyracea.     

Lymphoma revealed by isolated obliquus inferior muscle involvement in exophthalmia

Orbital lymphomas account for 4% of nontraumatic orbital disorders. We report the case of a 54-year-old patient who presented with binocular diplopia associated with right exophthalmia with an isolated obliquus inferior localization. This lymphomatous localization was unexpected, as lymphomas are described more often in the rectus superior and inferior muscles. Pathological examination found a low-grade non-Hodgkin's MALT lymphoma. This case is the basis of a review of the various diagnoses and the necessity of a biopsy prior to surgical tumor ablation that may damage an oculomotor muscle. Treatment should be medical: first-intention surgery would have abolished obliquus inferior function.     

Bilateral ischemic optic neuropathy and retinal vascular occlusions associated with lymphoma and sepsis. Clinicopathologic correlation

The authors report the clinicopathologic correlation of a patient with non-Hodgkin's mixed-cell lymphoma who had impairment of the circulation of the optic nerve and retina in both eyes. The results of histopathologic examination showed that the pial septa of the optic nerves were infiltrated by lymphoma and that there was extensive infarction of the orbital portions of both optic nerves and occlusion of both central retinal arteries and the right central retinal vein by thrombi with bacteria. The infiltration of the optic nerves seemed to be resistant to therapy.