Maskeleyici Sendromlar ve Üveit; Klinik, Tanı ve Tedavi

“Maskeleyici sendrom” terimi ön kamarada, vitreusta veya ikisinde birlikte hücre bulunan ancak immun-aracılı üveitlerle ilişkisi bulunmayan tüm durumları tanımlamak için kullanılır. Her ne kadar maskeleyici sendromlar intraoküler yabancı cisim, retinitis pigmentosa, oküler iskemik sendrom, vb benign durumlarda oluşabilse de, malign maskeleyici sendromlar bu grup bozukluklar içerisinde en önemli olanlardır. Lenfoma ve lösemi gibi hematolojik malignensiler, sistemik tümörlerin oküler metastazları, paraneoplastik retinopatiler ve retinoblastom oküler inflamatuar hastalıkları taklit eden neoplastik maskeleyici sendromlardır. Bu hastalıkların tanı ve tedavisindeki gecikme ciddi morbidite ve mortalite ile sonuçlanabilir. 50 yaş üstünde kronik üveiti olan tüm hastaların dikkatli bir şekilde klinik değerlendirmesi ve detaylı yardımcı araştırmalar sistemik yayılım, altta yatan hastalığın kötüleşmesi ve mortaliteyi engellemek için çok önemlidir.

Masquerade Syndromes and Uveitis; Clinics, Diagnosis and Treatment

The term of “masquerade syndrome” is used to describe all conditions where the presence of cells either in anterior chamber, vitreous or both but unrelated to any immune-mediated uveitis entities. Although masquerade syndromes can be caused by benign conditions such as intraocular foreign body, retinitis pigmentosa, ocular ischemic syndrome, etc., malignant masquerade syndromes are the important ones in this group of disorders. Hematologic malignancies such as lymphoma and leukemia, ocular metastasis of systemic tumors, paraneoplastic retinopathies and retinoblastoma are neoplastic masquerade syndromes mimicking ocular inflammatory diseases. A delay in the diagnosis and treatment of these diseases can result in serious morbidity and mortality. Careful clinical examination and detailed ancillary investigation of all patients older than 50 years of age with chronic uveitis are crucial to prevent systemic dissemination, worsening of the causal disease and mortality. Keywords: Masquerade syndrome, lymphoma, leukemia, paraneoplastic retinopathy, cancer associated retinopathy, melanoma associated retinopathy

Kaynakça

1. Theodore FH. Conjunctival carcinoma masquerading as chronic conjunctivitis. Eye Ear Nose Throat Mo 1967;46:1419-1420. 2. Touhami S, Audo I, Terrada C, Gaudric A, LeHoang P, Touitou V, et al. Neoplasia and intraocular inflammation: from masquerade syndromes to immunotherapy-induced uveitis. Prog Retin Eye Res 2019 May 12. pii: S1350-9462(18)30074-0. doi: 10.1016/j.preteyeres.2019.05.002 3. Kıratlı H, Şekeroğlu MA. Maskeleyici sendromlar. Turkiye Klinikleri J Ophthalmol-Special Topics 2008;1(2):95-100. 4. Rothova A, Ooijman F, Kerkhoff F, Van der Lelij A, Lokhorst HM. Uveitis masquerade syndromes. Ophthalmology 2001;108(2):386-99. 5. Grange LK, Kouchouk A, Dalal MD, Vitale S, Nussenblatt RB, Chan CC, et al. Neoplastic masquerade syndromes in patients with uveitis. Am J Ophthalmol 2014;157(3):526-31. 6. Nussenblatt RB, Whitcup SM, Palestine AG. Masquerade syndromes. In:Nussenblatt RB, Whitcup SM, Palestin AG. Uveitis: Fundamentals and clinical practice. St Louis: Mosby, 1996:385-395. 7. Tang LJ, Gu CL, Zhang P. Intraocular lymphoma. Int J Ophthalmol 2017;10(8):1301-1307. 8. Tsai T, O’Brien JM. Masquerade syndromes: malignancies mimicking inflammation in the eye. Int Ophthalmol Clin 2002;42(1):115-31. 9. Abu Samra K, Oray M, Ebrahimiadib N, Lee S, Anesi S, Foster CS. Intraocular lymphoma: Descriptive data of 26 patients including clinico-pathologic features, vitreous findings, and treatment outcomes. Ocul Immunol Inflamm 2018;26(3):347-352. 10. Fardeau C, Lee CP, Merle-Beral H, Cassoux N, Bodaghi B, Davi F, et al. Retinal fluorescein, indocyanine green angiography, and optic coherence tomography in non-Hodgkin primary intraocular lymphoma. Am J Ophthalmol 2009;147(5):886-94. doi: 10.1016/j.ajo.2008.12.025 11. Whitcup SM, Stark-Vancs V, Wittes RE, Solomon D, Podgor MJ, Nussenblatt RB, et al. Association of interleukin 10 in the vitreous and cerebrospinal fluid and primary central nervous system lymphoma. Arch Ophthalmol 1997;115(9):1157-60. 12. Akpek EK, Maca SM, Christen WG, Foster CS. Elevated vitreous interleukin 10 level is not diagnostic of intraocular-central nervous system lymphoma. Ophthalmology 1999;106(12):2291-5. 13. Cassoux N, Giron A, Bodaghi B, Tran TH, Baudet S, Davy F, et al. IL10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma. Invest Ophthalmol Vis Sci 2007;48(7):3253-9. 14. Fisson S, Quakrim H, Touitou V, Baudet S, Ben Abdelwahed R, Donnou S, et al. Cytokine profile in human eyes: Contribution of a new cytokine combination for differential diagnosis between intraocular lymphoma or uveitis. PLoS One 2013;8(2):e52385. 15. Pochat-Cotilloux C, Bienvenu J, Nguyen AM, Ohanessian R, Ghesquieres H, Seve P, et al. Use of a threshold of interleukin-10 and IL-10/IL-6 ratio in ocular samples for the screening of vitreoretinal lymphoma. Retina 2018;38(4):773-781. 16. Costopoulos M, Touitou V, Golmard JL, Darugar A, Fisson S, Bonnemye P, et al. ISOLD: A new highly sensitive interleukin score for intraocular lymphoma diagnosis. Ophthalmology 2016;123(7):1626-8. doi: 10.1016/j. ophtha.2016.01.037 17. Hoang-Xuan K, Bessell E, Bromberg J, Hottinger AF, Preusser M, Ruda R, et al. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology. Lancet Oncol 2015;16(7):e322-32. 18. Batchelor TT, Kolak G, Ciordia R, Foster CS, Henson JW. High-dose methotrexate for intraocular lymphoma. Clin Cancer Res 2003;9(2):711-5. 19. Smith JR, Rosenbaum JT, Wilson DJ, Doolittle ND, Siegal T, Neuwelt EA, et al. Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement. Ophthalmology 2002;109(9):1709-16. 20. 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(1):50-5. 21. Kim MM, Dabaja BS, Medeiros J, Kim S, Allen P, Chevez-Barrios P, et al. Survival outcomes of primary intraocular lymphoma: A single institution experience. Am J Oncol 2016;39(2):109-13. 22. Grimm SA, Pulido JS, Jahnke K, Schiff D, Hall AJ, Shenkier TN, et al. Primary intraocular lymphoma: an International Primary Central Nervous System Lymphoma Collaborative Group report. Ann Oncol 2007;18(11):1851-5. 23. Ferreri AJ, Blay JY, Reni M, Pasini F, Spina M, Ambrosetti A, et al. Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience. J Clin Oncol 2003;21(2):266-72. 24. Bitirgen G, Belviranlı S, Caliskan U, Tokgoz H, Ozkagnici A, Zengin N. Ophthalmic manifestations in recently diagnosed childhood leukemia. Eur J Ophthalmol 2016;26(1):88-91. 25. Hafeez MU, Ali MH, Najib N, Ayub MH, Shafi K, Munir M, et al. Ophthalmic manifestations of acute leukemia. Cureus 2019;11(1):e3837. 26. Ayliffe W, Foster S, Marcoux P, Upton M, Finkelstein M, Kuperwaser M, et al. Relapsing acute myeloid leukemia manifesting as hypopyon uveitis. Am J Ophthalmol 1995;119(3):361-4. 27. Hegde SP, Ursekar AT, Chitale AA. Relapsing acute myeloid leukemia presenting as hypopyon uveitis. Indian J Ophthalmol 2011;59(5):391-3. 28. Konstantinidis L, Damato B. Intraocular metastases—A review. Asia Pac J Ophthalmol (Phila) 2017;6(2):208-214. 29. Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases. Ophthalmology 1997;104(8):1265-76. 30. Shields CL, Kaliki S, Crabtree GS, Peshtani A, Morton S, Anand RA, et al. Iris metastasis from systemic cancer in 104 patients: the 2014 Jerry A. Shields Lecture. Cornea 2015;34(1):42-8. 31. Akpınar S, Batıoğlu F. Paraneoplastik retinopati. Ret-Vit 1999;7(2):149- 155. 32. Kondo M, Sanuki R, Ueno S, Nishizawa Y, Hashimoto N, Ohguro H, et al. Identification of autoantibodies against TRPM1 in patients with paraneoplastic retinopathy associated with ON bipolar cell dysfunction. PLoS One 2011;6(5):e19911. 33. Klemp K, Kiilgaard JF, Heegaard S, Norgaard T, Andersen MK, Prause JU. Bilateral diffuse uveal melanocytic proliferation: Case report and literatüre review. Acta Ophthalmol 2017;95(5):439-445. 34. Rao R, Honavar SG. Retinoblastoma. Indian J Pediatr 2017;84(12):937- 944. doi: 10.1007/s12098-017-2395-0 35. Niu L, Zhang C, Meng F, Cai R, Bi Y, Wang Y, et al. Ocular juvenile xanthogranuloma. Optom Vis Sci 2015;92(6):e126-33. 36. Kubicka-Trzaska A, Romanowska-Dixon B. Non-malignant uveitis masquerade syndromes. Klin Oczna 2008;110(4-6):203-6. 37. Mahmoud A, Messaoud R, Abid F, Ksiaa I, Bouzayene M, Khairallah M. Anterior segment optical coherence tomography and retained vegetal işntraocular foreign body masquerading as chronic anterior uveitis. J Ophthalmic Inflamm Infect 2017;7(1):13.

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