首诊于神经眼科的血液系统肿瘤的临床及影像学特征

The clinical and imaging features of patients with hematologic system tumors who initially presented to neuro-ophthalmology department

目的分析首诊于神经眼科的血液系统肿瘤患者的临床及影像学特征。设计回顾性病例系列。研究对象2015年解放军总医院神经眼科诊治的3例以视神经病变为首发表现,最终病理确诊为血液系统肿瘤患者。方法回顾性分析患者的临床、影像、实验室检查及病理结果。主要指标临床表现、眼眶磁共振成像(MRI)、血液及脑脊液检测、骨髓及脑组织病理检查。结果3例患者年龄均>50岁,其中2例首发症状为视力下降,1例双眼一过性黑矇为首发症状。病理类型分别为弥漫大B细胞淋巴瘤、小B细胞型淋巴瘤、多发性骨髓瘤。眼眶MRI检查:2例淋巴瘤患者可见视神经增粗,伴不同程度强化;多发性骨髓瘤患者右侧视神经及视交叉呈长T2信号,未见明显强化。结论血液系统肿瘤以视神经病变首发极为少见,临床表现为类似视神经炎症状,血液检查及影像检查有利于辅助诊断,病理检查为确诊的金标准。

Objective To investigate the clinical and imaging features of patients with hematologic system tumors who initially presented to neuro-ophthalmology departmnt.Design Retrospective case series.Participants Three cases initially presented as optic neuropathy,which was confirmed as hematological malignancy finally.Method The data including clinical manifestations,imaging examinations,laboratory tests and pathological findings of the patients were retrospectively analyzed.Main Outcome Measures Clinical manifestations,magnetic resonance imaging（MRI） of brain or orbit,blood and cerebral spinal fluid（CSF） tests and pathological findings.Results The three patients were over 50 years of age.Two patients complained with vision loss,one patient complained with amaurosis fugax bilateral.Orbital MRI showed the optic nerve thickening and different degree of enhancement in two cases of lymphoma,and in-volvement of optic nerve and optic chiasm without obvious enhancement in multiple myeloma.All the patients underwent biopsy and the outcomes were confirmed by pathology.One case was diagnosed as diffuse large B cell lymphoma,one as small B cell lymphoma and the other case as multiple myeloma.Conclusion This study documented three extremely rare cases of hematologic tumors initially presented as optic neuropathy.Blood tests and imaging examinations are helpful to making the diagnosis.Pathological examination is the gold standard for diagnosis.