白血病患儿造血干细胞移植后发生眼Kaposi肉瘤一例报告附文献复习

Acute leukemia child with ocular Kaposi＇ s sarcoma after hematopoietic stem cell transplantation ： a case report and literatures review

目的探讨白血病患儿造血干细胞移植后眼卡波西肉瘤（Kaposi’Ssarcoma，KS）的临床特征。方法回顾性分析1例HIV阴性急性淋巴细胞白血病（ALL）患儿非血缘相关外周血干细胞移植（PBSCT）后发生单眼角膜、结膜及巩膜Ks的临床资料。结果患儿为高危T细胞型ALL，接受PBSCT后7个月出现右眼视物模糊，缓慢进展为角结膜新生物。病理表现为毛细血管瘤样改变及异型性梭形细胞，结合典型免疫组化及原位杂交人类疱疹病毒8型（HHV8）阳性，诊断为右眼Ks。行角结膜巩膜肿物切除及角膜巩膜移植术，予抗病毒、抗感染、促修复、增强免疫力、预防角膜排斥等治疗，右眼保留且有手动视力，原发病未复发，未发生移植物抗宿主病。结论首次报告国内ALL患儿造血干细胞移植后发生与HIV感染无关眼KS。手术及生物治疗对眼KS是一种安全有效的方法。

Objective To summarize clinical features of eye Kaposis＇ sarcoma （ KS ） in leukemia child after peripheral blood stem cell transplantation （PBSCT）. Methods One 13 years-old child with acute lymphoblastic leukemia （ALL） and negative HIV test who developed KS restricted in right conjunctiva, cornea and sclera after successful allogeneic PBSCT was reviewed retrospectively. Results The child suffered from T cell type ALL. He received immunosuppressive treatment after PBSCT, and had once extensive herpes zoster restricted in skin. Seven months after PBSCT, he had blurred vision with right eye and slowly neoplasm formed in cornea and conjunctiva. Pathological examination confirmed KS with changes like capillary hemangioma, atypical fusifol^n cell, typical immunochemistry and positive immunofluorescent result of HHV8. He received excision of lump of cornea, conjunctiva, sclera and transplantation of cornea and sclera. Antiviral therapy was given together with anti-infection, prevention of cornea rejection and biotherapy. He kept right eye and hand-move eyesight, survived without GVHD or recurrence of ALL and KS. Conclusion This was the first ocular KS case in ALL child after PBSCT, without correlation with HIV infection. Complete excision combined with biotherapy was safe and effective for single ocular lesions.