Download PDF
Klin Monbl Augenheilkd 2017; 234(12): 1524-1532
DOI: 10.1055/s-0043-119992
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Primäres intraokuläres Lymphom: Relevanz der diagnostischen Vitrektomie

Primary Intraocular Lymphoma: Relevance of Diagnostic Vitrectomy
Claudia Helga Le Guin
1   Zentrum für Augenheilkunde, Universitätsklinikum Essen
,
Klaus Metz
2   Institut für Pathologie, Universitätsklinikum Essen
,
Norbert Bornfeld
1   Zentrum für Augenheilkunde, Universitätsklinikum Essen
› Author Affiliations
Further Information

Publication History

eingereicht 26 May 2017

akzeptiert 18 September 2017

Publication Date:
16 November 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Primär intraokuläre Lymphome sind sehr seltene Tumoren, die sich noch weiter in primär vitreoretinale und die noch viel selteneren primär uvealen Lymphome unterteilen lassen. In den letzten Jahrzehnten hat die Inzidenz des primär vitreoretinalen Lymphoms (PVRL) deutlich zugenommen. Die differenzialdiagnostische Abgrenzung zur posterioren Uveitis ist mitunter schwierig und daher kommt es in einigen Fällen zur verschleppten Diagnosestellung mit einer verzögerten Therapieeinleitung. Dies ist insbesondere deshalb fatal, weil das primär vitreoretinale Lymphom häufig mit dem primären ZNS-Lymphom assoziiert ist. Goldstandard zur Diagnosesicherung vor Therapieeinleitung ist der zytologische bzw. histologische Nachweis von Lymphomzellen. Hierzu wird eine diagnostische Vitrektomie mit Glaskörperbiopsie, evtl. kombiniert mit einer transretinalen Biopsie, durchgeführt. Zytokinanalyse, Durchflusszytometrie sowie molekulare Diagnostik sind lediglich ergänzende Maßnahmen, sofern genügend Probenmaterial vorhanden ist. Sobald die Diagnose eines Lymphoms gestellt ist, muss in interdisziplinärer Zusammenarbeit zwischen Onkologen und Ophthalmologen ein Therapiekonzept erarbeitet werden.

Abstract

Primary intraocular lymphomas are rare tumours that can be further subdivided into primary vitreoretinal and the even rarer primary uveal lymphoma. The incidence of primary vitreoretinal lymphoma (PVRL) has increased during the last few decades. Differential diagnostic distinction between lymphoma and posterior uveitis is often difficult, so that adequate diagnosis and treatment is often delayed. This is fatal, because PVRL is often associated with primary central nervous lymphoma. To confirm the diagnosis, prior treatment of cytological or histological detection of lymphoma cells is the gold standard. Therefore, a diagnostic vitrectomy should be performed with vitreous biopsy and sometimes transretinal biopsy. Cytokine analysis, as well as flow cytometry and molecular tests, are only additional methods that can be employed in case enough tumour material is available. After the diagnosis has been made, an interdisciplinary treatment concept must be developed by oncologists and ophthalmologists together.

Schlüsselwörter

okuläre Tumoren - Lymphom - transretinale Biopsie - Glaskörperbiopsie - diagnostische Vitrektomie - Masquerade-Syndrom

Key words

lymphoma - transretinal biopsy - vitreous biopsy - diagnostic vitrectomy - masquerade syndrome - ocular tumours
 

  • Literatur

  • 1 Swerdlow SH, Campo E, Pileri SA. et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127: 2375-2390
    CrossrefPubMedGoogle Scholar
  • 2 Coupland SE. Molecular pathology of lymphoma. Eye (Lond) 2013; 27: 180-189
    CrossrefPubMedGoogle Scholar
  • 3 Davis JL. Diagnosis of intraocular lymphoma. Ocul Immunol Inflamm 2004; 12: 7-16
    CrossrefPubMedGoogle Scholar
  • 4 Coupland SE, Damato B. Lymphomas involving the eye and the ocular adnexa. Curr Opin Ophthalmol 2006; 17: 523-531
    PubMedGoogle Scholar
  • 5 Cao X, Shen D, Callanan DG. et al. Diagnosis of systemic metastatic retinal lymphoma. Acta Ophthalmol 2011; 89: e149-e154
    CrossrefPubMedGoogle Scholar
  • 6 Coupland SE, Chan CC, Smith J. Pathophysiology of retinal lymphoma. Ocul Immunol Inflamm 2009; 17: 227-237
    CrossrefPubMedGoogle Scholar
  • 7 Chan CC, Rubenstein JL, Coupland SE. et al. Primary vitreoretinal lymphoma: a report from an International Primary Central Nervous System Lymphoma Collaborative Group symposium. Oncologist 2011; 16: 1589-1599
    CrossrefPubMedGoogle Scholar
  • 8 Coupland SE, Anastassiou G, Bornfeld N. et al. Primary intraocular lymphoma of T-cell type: report of a case and review of the literature. Graefes Arch Clin Exp Ophthalmol 2005; 243: 189-197
    CrossrefPubMedGoogle Scholar
  • 9 Hormigo A, DeAngelis LM. Primary ocular lymphoma: clinical features, diagnosis, and treatment. Clin Lymphoma 2003; 4: 22-29
    PubMedGoogle Scholar
  • 10 Coupland SE, Damato B. Understanding intraocular lymphomas. Clin Exp Ophthalmol 2008; 36: 564-578
    CrossrefPubMedGoogle Scholar
  • 11 Hochberg FH, Miller DC. Primary central nervous system lymphoma. J Neurosurg 1988; 68: 835-853
    CrossrefPubMedGoogle Scholar
  • 12 DeAngelis LM, Yahalom J, Heinemann MH. et al. Primary CNS lymphoma: combined treatment with chemotherapy and radiotherapy. Neurology 1990; 40: 80-86
    CrossrefPubMedGoogle Scholar
  • 13 Hong JT, Chae JB, Lee JY. et al. Ocular involvement in patients with primary CNS lymphoma. J Neurooncol 2011; 102: 139-145
    CrossrefPubMedGoogle Scholar
  • 14 Coupland SE, Heimann H, Bechrakis NE. Primary intraocular lymphoma: a review of the clinical, histopathological and molecular biological features. Graefes Arch Clin Exp Ophthalmol 2004; 242: 901-913
    CrossrefPubMedGoogle Scholar
  • 15 Whitcup SM, Chan CC, Buggage RR. et al. Improving the diagnostic yield of vitrectomy for intraocular lymphoma. Arch Ophthalmol 2000; 118: 446
    PubMedGoogle Scholar
  • 16 Peterson K, Gordon KB, Heinemann MH. et al. The clinical spectrum of ocular lymphoma. Cancer 1993; 72: 843-849
    CrossrefPubMedGoogle Scholar
  • 17 Chan CC, Buggage RR, Nussenblatt RB. Intraocular lymphoma. Curr Opin Ophthalmol 2002; 13: 411-418
    CrossrefPubMedGoogle Scholar
  • 18 Levasseur SD, Wittenberg LA, White VA. Vitreoretinal lymphoma: a 20-year review of incidence, clinical and cytologic features, treatment, and outcomes. JAMA Ophthalmol 2013; 131: 50-55
    CrossrefPubMedGoogle Scholar
  • 19 Hormigo A, Abrey L, Heinemann MH. et al. Ocular presentation of primary central nervous system lymphoma: diagnosis and treatment. Br J Haematol 2004; 126: 202-208
    CrossrefPubMedGoogle Scholar
  • 20 Mochizuki M, Singh AD. Epidemiology and clinical features of intraocular lymphoma. Ocul Immunol Inflamm 2009; 17: 69-72
    CrossrefPubMedGoogle Scholar
  • 21 Kimura K, Usui Y, Goto H. et al. Clinical features and diagnostic significance of the intraocular fluid of 217 patients with intraocular lymphoma. Jpn J Ophthalmol 2012; 56: 383-389
    CrossrefPubMedGoogle Scholar
  • 22 Gill MK, Jampol LM. Variations in the presentation of primary intraocular lymphoma: case reports and a review. Surv Ophthalmol 2001; 45: 463-471
    CrossrefPubMedGoogle Scholar
  • 23 Smith JR, Rosenbaum JT. Neurological concomitants of uveitis. Br J Ophthalmol 2004; 88: 1498-1499
    CrossrefPubMedGoogle Scholar
  • 24 Whitcup SM, de Smet MD, Rubin BI. et al. Intraocular lymphoma. Clinical and histopathologic diagnosis. Ophthalmology 1993; 100: 1399-1406
    CrossrefPubMedGoogle Scholar
  • 25 Chan CC. Molecular pathology of primary intraocular lymphoma. Trans Am Ophthalmol Soc 2003; 101: 275-292
    PubMedGoogle Scholar
  • 26 Gass JD, Sever RJ, Grizzard WS. et al. Multifocal pigment epithelial detachments by reticulum cell sarcoma. A characteristic funduscopic picture. Retina 1984; 4: 135-143
    CrossrefPubMedGoogle Scholar
  • 27 Buettner H, Bolling JP. Intravitreal large-cell lymphoma. Mayo Clin Proc 1993; 68: 1011-1015
    CrossrefPubMedGoogle Scholar
  • 28 De Smet MD, Nussenblatt RB, Davis JL. et al. Large cell lymphoma masquerading as a viral retinitis. Int Ophthalmol 1990; 14: 413-417
    CrossrefPubMedGoogle Scholar
  • 29 Sen HN, Bodaghi B, Hoang PL. et al. Primary intraocular lymphoma: diagnosis and differential diagnosis. Ocul Immunol Inflamm 2009; 17: 133-141
    CrossrefPubMedGoogle Scholar
  • 30 Shah GK, Kleiner RC, Augsburger JJ. et al. Primary intraocular lymphoma seen with transient white fundus lesions simulating the multiple evanescent white dot syndrome. Arch Ophthalmol 2001; 119: 617-620
    PubMedGoogle Scholar
  • 31 Ishida T, Ohno-Matsui K, Kaneko Y. et al. Fundus autofluorescence patterns in eyes with primary intraocular lymphoma. Retina 2010; 30: 23-32
    CrossrefPubMedGoogle Scholar
  • 32 Egawa M, Mitamura Y, Hayashi Y. et al. Spectral-domain optical coherence tomographic and fundus autofluorescence findings in eyes with primary intraocular lymphoma. Clin Ophthalmol 2014; 8: 335-341
    PubMedGoogle Scholar
  • 33 Velez G, Chan CC, Csaky KG. Fluorescein angiographic findings in primary intraocular lymphoma. Retina 2002; 22: 37-43
    CrossrefPubMedGoogle Scholar
  • 34 Gonzales JA, Chan CC. Biopsy techniques and yields in diagnosing primary intraocular lymphoma. Int Ophthalmol 2007; 27: 241-250
    CrossrefPubMedGoogle Scholar
  • 35 Sagoo MS, Mehta H, Swampillai AJ. et al. Primary intraocular lymphoma. Surv Ophthalmol 2014; 59: 503-516
    CrossrefPubMedGoogle Scholar
  • 36 Davis JL, Solomon D, Nussenblatt RB. et al. Immunocytochemical staining of vitreous cells. Indications, techniques, and results. Ophthalmology 1992; 99: 250-256
    CrossrefPubMedGoogle Scholar
  • 37 Rajagopal R, Harbour JW. Diagnostic testing and treatment choices in primary vitreoretinal lymphoma. Retina 2011; 31: 435-440
    CrossrefPubMedGoogle Scholar
  • 38 Mruthyunjaya P, Jumper JM, McCallum R. et al. Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy. Ophthalmology 2002; 109: 1123-1129
    CrossrefPubMedGoogle Scholar
  • 39 Kanavi MR, Soheilian M, Hosseini SB. et al. 25-gauge transconjunctival diagnostic vitrectomy in suspected cases of intraocular lymphoma: a case series and review of the literature. Int J Ophthalmol 2014; 7: 577-581
    PubMedGoogle Scholar
  • 40 Metz CH, Schueler A, Metz K. et al. [Transretinal biopsy of intraocular lymphoma]. Klin Monatsbl Augenheilkd 2015; 232: 845-849
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Mastropasqua R, Thaung C, Pavesio C. et al. The role of chorioretinal biopsy in the diagnosis of intraocular lymphoma. Am J Ophthalmol 2015; 160: 1127-1132.e1
    CrossrefPubMedGoogle Scholar
  • 42 Davis JL, Miller DM, Ruiz P. Diagnostic testing of vitrectomy specimens. Am J Ophthalmol 2005; 140: 822-829
    CrossrefPubMedGoogle Scholar
  • 43 Margolis R, Brasil OF, Lowder CY. et al. Vitrectomy for the diagnosis and management of uveitis of unknown cause. Ophthalmology 2007; 114: 1893-1897
    CrossrefPubMedGoogle Scholar
  • 44 Wang Y, Shen D, Wang VM. et al. Molecular biomarkers for the diagnosis of primary vitreoretinal lymphoma. Int J Mol Sci 2011; 12: 5684-5697
    CrossrefPubMedGoogle Scholar
  • 45 Missotten T, Tielemans D, Bromberg JE. et al. Multicolor flowcytometric immunophenotyping is a valuable tool for detection of intraocular lymphoma. Ophthalmology 2013; 120: 991-996
    CrossrefPubMedGoogle Scholar
  • 46 Davis JL, Viciana AL, Ruiz P. Diagnosis of intraocular lymphoma by flow cytometry. Am J Ophthalmol 1997; 124: 362-372
    CrossrefPubMedGoogle Scholar
  • 47 Chan CC, Sen HN. Current concepts in diagnosing and managing primary vitreoretinal (intraocular) lymphoma. Discov Med 2013; 15: 93-100
    PubMedGoogle Scholar
  • 48 Sugita S, Takase H, Sugamoto Y. et al. Diagnosis of intraocular lymphoma by polymerase chain reaction analysis and cytokine profiling of the vitreous fluid. Jpn J Ophthalmol 2009; 53: 209-214
    CrossrefPubMedGoogle Scholar
  • 49 Akpek EK, Maca SM, Christen WG. et al. Elevated vitreous interleukin-10 level is not diagnostic of intraocular-central nervous system lymphoma. Ophthalmology 1999; 106: 2291-2295
    CrossrefPubMedGoogle Scholar
  • 50 Chan CC, Whitcup SM, Solomon D. et al. Interleukin-10 in the vitreous of patients with primary intraocular lymphoma. Am J Ophthalmol 1995; 120: 671-673
    CrossrefPubMedGoogle Scholar
  • 51 Cassoux N, Giron A, Bodaghi B. et al. IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma. Invest Ophthalmol Vis Sci 2007; 48: 3253-3259
    CrossrefPubMedGoogle Scholar
  • 52 Margolis R. Diagnostic vitrectomy for the diagnosis and management of posterior uveitis of unknown etiology. Curr Opin Ophthalmol 2008; 19: 218-224
    CrossrefPubMedGoogle Scholar
  • 53 Davis JL. Intraocular lymphoma: a clinical perspective. Eye (Lond) 2013; 27: 153-162
    CrossrefPubMedGoogle Scholar
  • 54 Wolf LA, Reed GF, Buggage RR. et al. Vitreous cytokine levels. Ophthalmology 2003; 110: 1671-1672
    CrossrefPubMedGoogle Scholar
  • 55 Tuo J, Shen D, Yang HH. et al. Distinct microRNA-155 expression in the vitreous of patients with primary vitreoretinal lymphoma and uveitis. Am J Ophthalmol 2014; 157: 728-734
    CrossrefPubMedGoogle Scholar
  • 56 Kakkassery V, Schroers R, Coupland SE. et al. Vitreous microRNA levels as diagnostic biomarkers for vitreoretinal lymphoma. Blood 2017; 129: 3130-3133
    CrossrefPubMedGoogle Scholar
  • 57 Bonzheim I, Giese S, Deuter C. et al. High frequency of MYD88 mutations in vitreoretinal B-cell lymphoma: a valuable tool to improve diagnostic yield of vitreous aspirates. Blood 2015; 126: 76-79
    CrossrefPubMedGoogle Scholar
  • 58 Berenbom A, Davila RM, Lin HS. et al. Treatment outcomes for primary intraocular lymphoma: implications for external beam radiotherapy. Eye (Lond) 2007; 21: 1198-1201
    CrossrefPubMedGoogle Scholar
  • 59 Peʼer J, Hochberg FH, Foster CS. Clinical review: treatment of vitreoretinal lymphoma. Ocul Immunol Inflamm 2009; 17: 299-306
    CrossrefPubMedGoogle Scholar
  • 60 Soussain C, Choquet S, Fourme E. et al. Intensive chemotherapy with thiotepa, busulfan and cyclophosphamide and hematopoietic stem cell rescue in relapsed or refractory primary central nervous system lymphoma and intraocular lymphoma: a retrospective study of 79 cases. Haematologica 2012; 97: 1751-1756
    CrossrefPubMedGoogle Scholar
  • 61 Grimm SA, McCannel CA, Omuro AM. et al. Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report. Neurology 2008; 71: 1355-1360
    CrossrefPubMedGoogle Scholar
  • 62 Nussenblatt RB, Chan CC, Wilson WH. et al. International Central Nervous System and Ocular Lymphoma Workshop: recommendations for the future. Ocul Immunol Inflamm 2006; 14: 139-144
    CrossrefPubMedGoogle Scholar