Journal List > J Korean Ophthalmol Soc > v.51(2) > 1008744

Lee and Kim: A Case of Primary Intraocular Lymphoma Confirmed by Endoretinal Biopsy

Abstract

Purpose

To report one case of primary intraocular lymphoma confirmed by endoretinal biopsy and clinical experience.

Case summary:

A 65 year-old man complaining of persistent decreased visual acuity was referred to our hospital. Biomicroscopic examination showed bilateral vitreous cells and small round yellowish inflammatory lesions at the level of the retinal pigment epithelial cells. The disc of the left eye was pale in color. Fluorescein angiographic examination of the left eye showed intermingling round hyperfluorescent and hypofluorescent lesions. We performed diagnostic vitrectomy due to unresponsiveness to oral steroid therapy, but the result was negative. We finally performed an endoretinal biopsy, which showed tumor cells with H&E staining and strong immunoreactivities against CD 20 and CD 79a indicating the presence of B cells. We diagnosed this case as primary intraocular lymphoma and performed multiple- cycle chemotherapy with high-dose methotrexate. The ocular signs and symptoms were improved after chemotherapy.

Conclusions

Endoretinal biopsy could be another diagnostic tool for confirming suspected primary intraocular lymphoma in cases showing negative results with diagnostic pars plana vitrectomy and cytology.

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Figure 1.
Multiple round hyperfluorescent lesions intermingling with hypofluorescent lesion at the level of retinal pigment epithelium at left fluorescein angiogram.
jkos-51-297f1.tif
Figure 2.
Fluorescein angiogram of right eye showing multiple white hyperfluorescent dots temporal to macular area at the level of retinal pigment epithelium.
jkos-51-297f2.tif
Figure 3.
Cytologic examination showed no lymphoma cells. H&E staining after endoretinal biopsy showed infil- tration of large lymphoma cells (*400). Immunohistochemical staining with cell marker showed strong immunorea- ctivity against CD 20, 79a, Ki 67 but no immunoreactivtiy against CD 5 meaning B cells with high proliferation rate.
jkos-51-297f3.tif
Figure 4.
Fluorescein angiogram and fundus photographic finding of right eye after 13 months chemotherapy. The previous round hyperfluorescein dots disappeared and the right eye showed mild pigmentary change at the level of retinal pigment epithelium.
jkos-51-297f4.tif
Figure 5.
Brain MRI showed patchy parenchymal enhancement in the dentate nucleus area of cerebellar hemisphere (left arrow) and nodular enhancement in the left parietal lobe (right arrow) suggesting CNS lymphoma.
jkos-51-297f5.tif
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