原发性眼部淋巴瘤研究进展  

Advances in Primary Ocular Lymphoma

作　　者：刘旭玲[1] 马骏[1] 孙文文[1] 李鹏[1] 杨开颜[1] Xuling Liu;Jun Ma;Wenwen Sun;Peng Li;Kaiyan Yang(Department of Pathology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]温州医科大学附属第一医院病理科,325015

出　　处：《中华眼视光学与视觉科学杂志》2020年第2期87-93,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：原发性眼部淋巴瘤根据累及部位分为原发性眼内淋巴瘤(PIOL)和眼附属器淋巴瘤(POAL)。原发性玻璃体视网膜淋巴瘤(PVRL)是PIOL最常见的形式,是一种侵袭性B细胞恶性肿瘤,被认为是原发性中枢神经系统淋巴瘤(PCNSL)的一种亚型。因其眼部症状的非特异性而经常导致误诊。恶性细胞的细胞病理学/组织病理学鉴定是诊断PVRL的金标准。其他辅助检查,如光学相干断层扫描和眼底自发荧光已被应用于PVRL的诊断。细胞因子测量和B细胞克隆性以及突变分子的测定进一步提高了诊断的准确性。目前PVRL的治疗包括局部放疗,玻璃体内化疗(甲氨蝶呤和利妥昔单抗),根据是否累及非眼部组织选择是否进行全身化疗。眼眶淋巴瘤是POAL的主要形式,绝大多数起源于B细胞。组织病理学亚型和疾病的临床分期是预测预后及选择治疗的最佳指标。在治疗孤立性低级别淋巴瘤时,放射治疗是首选治疗方法。对于播散性和高度恶性淋巴瘤,应选择化疗或放疗联合化疗。Primary ocular lymphoma can be divided into primary intraocular lymphoma(PIOL)and ocular adnexal lymphoma(POAL)based on their location.Primary vitreoretinal lymphoma(PVRL)is the most common form of PIOL.It is an invasive B-cell malignant tumor and is considered to be a subtype of primary central nervous system lymphoma(PCNSL).Because of the non-specificity of ocular symptoms,it often leads to misdiagnosis.Cytopathological/histopathological identification of malignant cells is the gold standard for the diagnosis of PVRL.Other auxiliary examinations,such as optical coherence tomography and fundus autofluorescence,have been used in the diagnosis of PVRL.The measurement of cytokines and the clonality of B cells and the determination of mutant molecules further improve the accuracy of diagnosis.Current treatments for PVRL include local radiotherapy,intravitreal chemotherapy(methotrexate and rituximab),and systemic chemotherapy,depending on whether non-ocular tissues are involved.Orbital lymphoma is the main form of POAL,and the vast majority of orbital lymphoma originate from B cells.Histopathological subtypes and clinical stages of the disease are the best indicators for predicting prognosis and selecting treatment.Radiotherapy is the first choice in the treatment of isolated low-grade lymphoma.For disseminated and highly malignant lymphoma,chemotherapy with or without radiotherapy should be selected.

关 键 词：眼部淋巴瘤 原发性眼内淋巴瘤 原发性眼附属器淋巴瘤 

分 类 号：R73[医药卫生—肿瘤]