Orbitalni limfom udružen sa Gravesovom bolesti

  • Zoran Hajduković Clinic for Endocrinology, Military Medical Academy, Belgrade; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Snežana Kuzmić-Janković Clinic for Endocrinology, Military Medical Academy, Belgrade
  • Tamara Kljaković-Avramović Clinic for Ophthalmology, Military Medical Academy, Belgrade
  • Leposava Sekulović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute of Radiology, Military Medical Academy, Belgrade
  • Ljiljana Tukić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Haematology, Military Medical Academy, Belgrade
DOI: https://doi.org/10.2298/2804
Ključne reči: exophthalmos||, ||egzoftalmus, diagnosis, differential||, ||dijagnoza, diferencijalna, graves disease||, ||gušavost, egzoftalmička, histological techniques||, ||histološke tehnike,

Sažetak


Uvod. Zbog ispoljavanja bilateralnog egzoftalmusa i periorbitalnih edema udruženih sa hipertireoidizmom najčešće se inicijalno postavlja sumnja na Gravesovu oftalmopatiju. Ipak, Gravesova orbitopatija kod 20% bolesnika može prethoditi ispoljavanju hipertireoidizma i predstavljati diferncijalnodijagnostički problem, naročito ako je unilateralna. Takođe, i pored primene intenzivne farmakološke terapije, kod 3% bolesnika sa Gavesovom orbitopatijom može doći do progresije bolesti koja u ozbiljnim slučajevaima zahteva zračnu ili operativnu terapiju. Prikazan je bolesnik sa Gravesovom bolešću, inicijalno ispoljenom bilateralnom orbitopatijom sa progresivnim pogoršanjem unilateralnog egzoftalmusa, uzrokovanog B-ćelijskim nehočkinskim, limfomom orbite marginalne zone. Prikaz bolesnika. Kod bolesnika, starog 64 godine, sa 3-godišnjom evolucijom bilateralne Gravesove orbitopatije i hipertireoze, predominantno levostrano unilateralno ispoljilo se pogoršanje egzoftalmusa, rezistentno na primenjenu glukokortikoidnu terapiju, zbog čega je učinjena levostrana dekompresija orbite. Godinu dana nakon operativnog lečenja ponovo se razvio značajan egzoftalumos levog oka, što je pobudilo sumnju na drugu etiologiju. Ultrazvučni pregled orbite ukazao je na primarni limfom orbite, što je CT skenom i biopsijom tumorskog tkiva potvrđeno. Detaljna ispitivanja ukazala su na B-ćelijski nehočkinski limfom marginalne zone, proširenog IV – B-b CS, IPI 3 (infiltracija koštane srži: m+orbita+). Nakon primenjene polihemioterapije i radijacione terapije orbite ostvarena je kompletna remisija bolesti. Zaključak. Mada Gravesova bolest jeste najčešći razlog bilateralne orbitopatije progresivno pogoršanje orbitopatije zahteva detaljnu analizu u cilju isključivanja drugih ređih etiologija.

 

Biografija autora

Snežana Kuzmić-Janković, Clinic for Endocrinology, Military Medical Academy, Belgrade
+381-63-8307-544

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Objavljeno
2015/04/23
Broj časopisa
Vol. 71 Br. 5 (2014)
Rubrika
Prikaz bolesnika