류마티스 관절염 환자에서 발생한 안와 점막연관 림프조직형 림프종 1예
A Case of Orbital MALT Lymphoma in a Patient with Rheumatoid Arthritis
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목적: 자가면역질환 환자에서 림프종이 높은 빈도로 발생함이 알려졌으나 아직 국내에서 보고된 적이 없다. 저자들은 류마티스 관절염 환자에서 발생한 안와의 점막연관 림프조직형 림프종(Mucosa-associated lymphoid tissue [MALT] lymphoma) 1예를 보고하고자한다. 증례요약: 류마티스 관절염으로 진단받은 70세 남자 환자가 내과에서 경과관찰 중 3개월 전부터 발생한 우안 윗눈꺼풀 부종을 주소로내원하였다. 기저질환으로 당뇨와 고혈압이 있었고, 류마티스 관절염 치료를 위해 3년 전부터 타크로리무스(Tacrolimus)를 복용하고있었다. 우안 윗눈꺼풀 및 아래눈꺼풀 하안검에서 결절이 촉지되었고, 조영증강 안와 컴퓨터 단층촬영 검사에서 우안 눈물샘 아래에조영 증강되는 종괴 소견을 보여 절개 생검을 시행하였으며, 악성 점막연관 림프조직형 림프종(Low grade extranodal marginal zone B cell lymphoma of MALT)으로 진단되었다. 전신 전산화 단층촬영 및 전신 양전자방출단층촬영술에서 전신침범은 관찰되지 않아내과에서 경과관찰 중이다. 결론: 류마티스 관절염 등 자가면역 질환이 있는 환자에서 안와 종괴가 생기는 경우, 드물지만 점막연관 림프조직형 림프종(MALT lymphoma)의 가능성을 고려해야 한다.
Abstract
Purpose: To report a case of orbital mucosa-associated lymphoid tissue (MALT) lymphoma that occurred in a patient with rheumatoid arthritis (RA). Case summary: A 70-year-old male with alleged RA presented with a 3-month history of spontaneous and painless upper and lower eyelid swelling in the right eye. On initial examination, palpable nodules were observed at the right upper and lower eyelids and orbital computed tomography (CT) revealed a contrast-enhancing nodule just inferior to the lacrimal gland, thus an incisional biopsy was performed. The pathological report showed malignant orbital lymphoma (low grade extranodal marginal zone B cell lymphoma of MALT). Since distant metastases were not detected on whole-body CT and positron emission tomography, the patient was advised to keep previous medication and regular follow-up examinations. Conclusions: The possibility of MALT lymphoma should be considered as a differential diagnosis in patients with eyelid swelling and autoimmune diseases such as RA.
참고문헌 (25)
- Smedby KE., "Malignant lymphomas in autoimmunity and inflammation : a review of risks, risk factors, and lymphoma characteristics", Cancer Epidemiol Biomarkers Prev, 15, pp.2069~2077 (2006)
- Smedby KE., "Autoimmune and inflammatory disorders and risk of malignant lymphomas-an update", J Intern Med, 264, pp.514~527 (2008)
- Dias C., "Susceptibility of patients with rheumatic diseases to B-cell non-Hodgkin lymphoma", Nat Rev Rheumatol, 7, pp.360~368 (2011)
- Johnson TE., "Ocular-adnexal lymphoid tumors : a clinicopathologic and molecular genetic study of 77 patients", Ophthal Plast Reconstr Surg, 15, pp.171~179 (1999)
- Sullivan TJ., "Imaging features of ocular adnexal lymphoproliferative disease", Eye(Lond), 20, pp.1189~1195 (2006)
- Cho EY., "Clinicopathologic analysis of ocular adnexal lymphomas : extranodal marginal zone b-cell lymphoma constitutes the vast majority of ocular lymphomas among Koreans and affects younger patients", Am J Hematol, 73, pp.87~96 (2003)
- Jenkins C., "Histological features of ocular adnexal lymphoma(REAL classification)and their association with patient morbidity and survival", Br J Ophthalmol, 84, pp.907~913 (2000)
- 지준영, "안와 및 안부속기 악성림프종의 방사선치료", 대한안과학회지, 46(2), pp.3~3 (2005), 대한안과학회
- Cassidy DT., "Lacrimal gland orbital lobe cysts associated with MALT lymphoma and primary Sjögren's syndrome", Orbit, 24, pp.257~263 (2005)
- Nagaki Y., "Orbital lymphoma of mucosa-associated lymphoid tissue in a patient with rheumatoid arthritis", Jpn J Ophthalmol, 42, pp.223~226 (1998)
- Ko GT., "Hashimoto's thyroiditis, Sjogren's syndrome and orbital lymphoma", Postgrad Med J, 70, pp.448~451 (1994)
- Rasquin F., "Primary orbital lymphoma within the context of Sjögren's syndrome secondary to rheumatoid arthritis", Bull Soc Belge Ophtalmol, 254, pp.125~132 (1994)
- Ohshima K., "A case of lacrimal gland malignant lymphoma, associated with Sjögren's syndrome", Nihon Ganka Gakkai Zasshi, 95, pp.386~392 (1991)
- Stefanovic A., "Extranodal marginal zone lymphoma of the ocular adnexa", Blood, 114, pp.501~510 (2009)
- Baecklund E., "Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis", Arthritis Rheum, 54, pp.692~701 (2006)
- Baecklund E., "Lymphoma development in patients with autoimmune and inflammatory disorders--what are the driving forces?", Semin Cancer Biol, 24, pp.61~70 (2014)
- Carbone PP., "Report of the Committee on Hodgkin's Disease Staging Classification", Cancer Res, 31, pp.1860~1861 (1971)
- Liesegang TJ., "Ocular adnexal lymphoproliferative lesions", Mayo Clin Proc, 68, pp.1003~1010 (1993)
- Jaffe ES., "World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. A progress report", Am J Clin Pathol, 111(1 Suppl 1), pp.S8~S12 (1999)
- Voulgarelis M., "Malignant lymphoma in primary Sjögren's syndrome : a multicenter, retrospective, clinical study by the European Concerted Action on Sjögren's Syndrome", Arthritis Rheum, 42, pp.1765~1772 (1999)
- Theander E., "Lymphoma and other malignancies in primary Sjögren's syndrome : a cohort study on cancer incidence and lymphoma predictors", Ann Rheum Dis, 65, pp.796~803 (2006)
- Niemann CU., "B-cell receptor signaling as a driver of lymphoma development and evolution", Semin Cancer Biol, 23, pp.410~421 (2013)
- Ekström Smedby K., "Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes : a pooled analysis within the InterLymph Consortium", Blood, 111, pp.4029~4038 (2008)
- Stein SA., "Primary thyroid lymphoma : a clinical review", J Clin Endocrinol Metab, 98, pp.3131~3138 (2013)
- Hellgren K., "Do rheumatoid arthritis and lymphoma share risk factors? : a comparison of lymphoma and cancer risks before and after diagnosis of rheumatoid arthritis", Arthritis Rheum, 62, pp.1252~1258 (2010)