ÖZET

Otuzdört yaşında erkek hastaya sol supraklavikuler lenfadenopati biyopsisi yapılarak diffüz, intermediate grade Hodg­kin dışı lenfoma tanısı kondu. Hasta evre II kabul edildi. IPI skoru iki idi. Hastaya altı kür CNOP(Endoksan, Mi­to­xantrone, Vincristine sülfat, Prednizolon) kemoterapisi verildi. Kemik iliği aspirasyon ve biyopsisi normaldi. Hasta re­misyona girdi, iki aylık kontrollere başlandı. Son kürden dokuz ay sonra hastada sol gözünde aşağı bakamama ve sol gözde çift görme şikayetleri ortaya çıktı. Göz muayenesinde sol gözde hafif proptozis mevcuttu. Bulbus o­kü­lü üste devrik, sol gözünün aşağı hareketi kısıtlı idi. Çekilen orbital ve kranial Manyetik Rezonans Gö­rün­tü­le­me’de(MRG) sol orbitada  bulbus okülünün inferior bölümünde, inferior rektus kasında diffüz kalınlaşma ve kont­ras­lan­mada artış görüldü. Kranial MRG normaldi. Sol orbital alt duvarındaki kitleden biyopsi yapıldı. İlk tanı ko­nu­lan pre­paratlarla birlikte karşılaştırıldı. Anaplastik büyük hücreli lenfoma (NULL hücre) infiltrasyonu olarak rapor e­dildi. Has­tanın boyun-toraks-batın bilgisayarlı tomografi tetkikleri normaldi. Lenfadenopati  tespit edilmedi. Hasta sa­dece sol orbital nüks lenfoma kabul edildi. Üç kür MİNE (Mesna, İfosfamid, Mitoksantron, Etoposid) kemoterapisi ve­rildi. Ar­dından radyoterapi uygulandı. Tekrar çekilen orbital MRG’de kitlenin tamamen kaybolduğu görüldü. Hasta ke­mo­sen­sitif nüks kabul edildi, yüksek doz kemoterapi ve otolog kök hücre nakil programına alındı..
Anahtar Kelimeler: Malign lenfoma, Nüks, Oküler adneksal lenfoma, T-NULL hücreli lenfoma

A Case with T-Null Cell Lymphoma Who Relapsed as Ocular Adnexal Lymphoma

SUMMARY

By applying left supraclavicular lymphadenopathy biopsy to a thirtyfour year old male patient, he was diagnosed as dif­fuse, intermediate grade Non-Hodgkin lymphoma. The patient was accepted as grade II. IPI score was two. Six cu­res of CNOP (Endoxan, Mitoxantrone, Vincristine sulphate, Prednisolone) chemotherapy was given to the pa­ti­ent. Bone marrow aspiration and biopsy were normal. Remission was achieved on the patient, and started to be cont­rolled once in two months. Nine months after the last cure, the patient complained about not only being able to mo­ve his left eye down but also diplopia in his left eye. Minimal propthosis was diagnosed in his left eye in exa­mi­na­tion. His bulbus oculi had superior deviation, and his left eye was limited to move down. In the orbital and cranial Mag­netic Resonance Imagine (MRI) examination of the left orbita, diffuse thickening and increase in the cont­ras­ting was diagnosed on the bulbus oculi inferior and inferior rectus muscle parts. Cranial MRI was normal. Biopsy was taken from the mass on the left orbital inferior wall. It was compared with the first diagnosed preparations and re­ported as anaplastic large cell lymphoma (null cell) infiltration. The neck-thorax-abdominal computerized to­mog­raphy results were normal. Lymphadenopathy was not observed. The patient was accepted as only left orbital relapsed lymphoma. Three cures of MINE (Mesna, Ifosfamide, Mitoxantrone, Etoposide) chemotherapy was given. Af­ter this radiotherapy was applied. The mass was observed to be disappeared completely in the repeated orbital MRI. The patient was considered as chemotherapy sensitive relapsed malign lymphoma and was taken to high do­se chemotherapy and autologous stem-cell transplantation program.
Key Words: Malign lymphoma, Relapsed, Ocular adnexal lymphoma, T-NULL cell lymphoma