Blinding Bilateral Hyperviscosity Retinopathy in a 43-Year-Old Nigerian Male with Lymphoplasmacytic Lymphoma: A Case Report and Management Challenges (original) (raw)
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Retinal necrosis as the initial presentation of primary intraocular lymphoma
Nepalese Journal of Ophthalmology
A 72 years old female presented with bilateral painless progressive loss of vision over one year. She was diagnosed as non-resolving bilateral panuveitis. Her visual acuity in right eye was hand movement close to face and left eye was perception of light with inaccurate projection of rays. Bilateral anterior chamber had 1+ cells and flares. Vitreous cells had 1+ cells and haze in right eye but the left eye had 3+ vitreous cells and haze. Right eye fundus had multiple, discrete sub retinal yellowish deposits with subretinal haemorrhage and macular edema with perivascular infiltrates. In left eye, disc was just visible. The patient underwent diagnostic vitrectomy in left eye and undiluted vitreous sample on cytology showed reactive large lymphoid cells with necrotic background pattern suggestive of intraocular lymphoma. Patient underwent external beam radiotherapy and chemotherapy.
Vitreoretinal Presentation of Secondary Large B-Cell Lymphoma in Patients With Systemic Lymphoma
JAMA Ophthalmology, 2013
Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma. OBJECTIVE To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma. DESIGN Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes. SETTING Mayo Clinic pathology database. PARTICIPANTS Fifty-five patients with vitreous specimens available for review. EXPOSURES Vitreous aspiration biopsy. MAIN OUTCOME AND MEASURE Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL). RESULTS Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium. CONCLUSIONS AND RELEVANCE Vitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.
RETINAL Cases & Brief Reports, 2017
Purpose: To report the case of a patient whose retinal disease was found to be associated with a diffuse large B-cell lymphoma found 30 years after the apparent successful treatment of a classical Hodgkin lymphoma. Methods: Observational case report. Results: The authors describe the case of a 69-year-old man referred to their Department because of progressive, bilateral vision loss over the last few months. Deterioration in color vision and intense photophobia were also present. His bestcorrected visual acuity was 20/400 in the right eye (RE) and 20/800 in the left eye (LE). Slit lamp and fundus examination failed to show any abnormalities. Spectral domain optical coherence tomography (SD-OCT) detected diffuse attenuation of the ellipsoid layers in addition to a focal subfoveal defect in both eyes. Both fluorescein and indocyanine angiographies (FA and ICGA) were normal. Full flash electroretinogram (ERG) revealed bilateral cone rod dysfunction with decreased amplitudes of both a and b waves. Conclusion: Because of the late onset of the disease, poor visual acuity compared with a small macular anatomical lesion and a history of Hodgkin lymphoma 30 years ago, a neoplastic etiology was investigated. Poor performance status and chest pain led to a thoracic CT scan, which identified a massive mediastinal tumor. Serum analysis found an abnormal amount of antibody activity within the 40 kD region of Western blot of retina. The diagnosis of diffuse large B-cell lymphoma was established. Systemic examinations found a Stage IV non-Hodgkin lymphoma.
Yousef Alotaibi
Leukemia is a proliferative and malignant syndrome of hematopoietic stem cells of the bone marrow. The ocular manifestations could be used as predictors of leukemiaor they can be detected after confirming the diagnosis of leukemia. We report a case of 19 years old male presented with sudden painless decrease of vision of both eyes, left more than right, for 3 days associated with fatigue, headache, and palpation for 2 days duration. After diagnosis, the case suffered from acute lymphoid leukemia which was associated with some ophthalmic manifestations including multiple blots and flame shaped hemorrhage of the right eye, macular hemorrhage, cotton wall spot of the left eye and white centered hemorrhage of both eyes. OCT revealed left thickening of sensorial retinal consistent with macular hemorrhage. After conducting all investigations, the patient was confirmed to be suffering from acute lymphoid leukemia.
The diagnosis and treatment of primary vitreoretinal lymphoma: a review
International journal of retina and vitreous, 2018
To describe the recent diagnostic and treatment options for the most predominant form of primary vitreoretinal lymphoma (PVRL), namely diffuse large B cell lymphoma. This is mainly based on the experience at the Mayo Clinic as well as a partial review of the literature. MYD88 L265P mutation is seen in about 80% of cases; therefore, a polymerase chain reaction for this mutation helps in making the diagnosis that has been notoriously difficult to make. Local therapy using intravitreal methotrexate and rituximab has been very helpful in the treatment of the local disease. Systemic high-dose intravenous methotrexate is helpful in treating bilateral disease in conjunction with intravitreal therapy. Whether it is helpful in preventing or delaying the development of central nervous system lymphoma (CNSL) is still in dispute. If there is development of CNSL or recurrent ocular disease, alternatives to high-dose methotrexate under investigation include pomalidomide, stem cell transplantation...
Ocular Lymphoma: Clinical, Diagnostic, and Therapeutic Aspects
Ocular involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an in-traocular manifestation of systemic lymphoma. Lymphoma manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis , uveitis, multiple evanescent white dot syndrome, acute retinal necrosis, or herpetic retinitis. Accurate diagnosis depends on a high index of suspicion and frequently requires histopathological analysis of specimens, particularly vitreous biopsy, subretinal aspiration, or retinal biopsy with flow cy-tometry, polymerase chain reaction, or immunohistochemistry methods. Most of ocular lymphomas are of B lineage. Diagnosis is often complex and needs use of paraclinical evaluations. Treatment mainly consists of chemotherapy. It is important to review the ocular manifestations of lymphoma to assist oph-thalmologists in prompt diagnosis of ocular lymphoma. And it also helps oncologists to recognize the need for a complete oph-thalmic evaluation in the diagnosis, follow-up, and management of patients with lymphoma. Iran J Med Sci 2008; 33(4): 195-201. Keywords ● B cell lymphoma ● tumor ● lymphoma ● eye neoplasm ● intraocular
Ocular pathology of uncommon hematologic malignancies: a case series
Journal of Medical Case Reports, 2007
In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.
Cancer Associated Retinopathy in Non-Hodgkin’s Lymphoma
Global Journal of Hematology and Blood Transfusion, 2014
Cancer-associated retinopathy (CAR) is an uncommon paraneoplastic retinopathy usually associated with small cell lung carcinoma. To our knowledge, there is no previous report in the English literature of CAR syndrome occurring in lymphoma patients. We describe a rare case of CAR syndrome in a 62-year-old male with non-Hodgkin's lymphoma (NHL) treated with four doses of intravenous immunoglobulin.