Large B-cell lymphoma of the uvea: Histopathologic variants and clinicopathologic correlation

Ophthalmic Manifestations in Patients with Blood Malignancies

Ocular complications can occur in up to 90% of patients with blood malignancies. Such complications range from direct infiltration to local hemostatic imbalance and treatment-related toxicity. This narrative review is based on a systematic computerized search of the literature conducted until January 2024 and examines the common ocular complications associated with blood cancers. Ocular complications from primary disease include mass effects from ocular adnexal lymphomas and intraocular lymphomas, with B-cell lymphomas accounting for 95% of primary ocular presentations. Secondary disease involvement from systemic hematological malignancies can lead to a wide range of ocular manifestations, such as leukemic retinopathy. Furthermore, toxicity from antineoplastic therapies and ocular graft versus host disease (oGVHD) after hematopoietic stem cell transplantation present additional risks to ocular health. In conclusion, ocular complications in blood cancer patients are an integral part of patient management, requiring regular ophthalmic evaluations and close collaboration between oncologists and ophthalmologists. Advances in therapy and an increased focus on early symptom recognition are essential for preserving vision and enhancing patient quality of life.

Choroidal Lymphoma: Diagnostic Value of Combined Indocyanine Green Angiography and Optical Coherence Tomography

OBJECTIVE

To compare multimodal imaging findings in patients with choroidal lymphoma (CL).

METHODS

Multicenter retrospective observational case series. Multimodal imaging features of patients with CL were reviewed with particular attention to the patterns of choroidal infiltration on indocyanine green angiography (ICGA) and optical coherence tomography (OCT).

RESULTS

Eighteen eyes of 15 patients were included in this study. Average tumor thickness on ultrasonography was 2.6 mm (range, 1.2-5.7 mm). Choroidal infiltration on ICGA was characterized by multifocal, round areas (300-500 microns diameter) of hypocyanescence in all cases, whereas OCT at the same region disclosed diffuse choroidal infiltration. By OCT, the tumor surface contour was primarily placid (22%), dome-shaped (11%), or undulating (67%).

CONCLUSIONS

In this analysis of eyes with CL, ICGA demonstrated multifocal sub-millimeter regions of choroidal hypocyanescence whereas OCT documented diffuse choroidal infiltration. This incongruence could be a distinctive diagnostic feature of choroidal lymphoma, assisting with differentiation from other pathological entities.

Bilateral Multiple Retinal Detachments Associated with Diffuse Large B-Cell Lymphoma: Masquerading as Vogt-Koyanagi-Harada Disease

PURPOSE

We report a case of intraocular involvement in diffuse large B-cell lymphoma masquerading as Vogt-Koyanagi-Harada disease.

METHODS

A 48-year-old woman presented with blurred vision in both eyes, fever, and hearing disturbance and underwent a complete ophthalmologic and systemic evaluation.

RESULTS

Ophthalmologic examination showed bilateral exudative retinal detachment and signs of Vogt-Koyanagi-Harada disease. However, considering her generalized symptoms, systemic evaluation was performed before administering systemic steroid pulse therapy. In a systemic investigation, the patient was diagnosed with intraocular involvement in diffuse large B-cell lymphoma. After systemic chemotherapy, her bilateral visual acuity improved to 20/25 and the bilateral serous retinal detachment resolved.

CONCLUSION

In cases with prominent systemic symptoms, comprehensive systemic evaluation should be performed to rule out severe systemic conditions, such as malignancies.

Heterogeneity in the diagnosis of plasmablastic lymphoma, plasmablastic myeloma, and plasmablastic neoplasm: a scoping review

The diagnosis of plasmablastic lymphoma (PBL), plasmablastic myeloma (PBM), and plasmablastic neoplasm (PBN) may be arbitrary in some cases because these entities can be indistinct. We conducted this scoping review to investigate heterogeneity in diagnostic criteria used in previous studies and validate the diagnostic results of previous diagnostic algorithms and the algorithm we developed, which also includes diagnosis of PBN. Using the PRISMA Extension for Scoping Reviews, we analyzed literature published between September 2017 and April 2020. We identified a total of 163 cases (128 PBL, 32 PBM, and 3 PBN) from 77 case reports and 8 case series. We found that diagnostic criteria in the literature varied for PBL but were consistent for PBM. Our algorithm was the first attempt to include PBN in a complete structure. The results of the three diagnostic algorithms varied significantly. Hematologists and pathologists should pay more attention to the differential diagnosis of PBL, PBM, and PBN.

Ocular Oncology-Primary and Metastatic Malignancies

Several neoplastic processes can involve the eye, either primarily or secondary to a systemic malignancy. The most common primary tumors of the eye include conjunctival and uveal melanoma, retinoblastoma, conjunctival and intraocular lymphoma, and ocular surface squamous neoplasia. Metastatic spread from systemic malignancies, especially of the breast and lung, also can involve the eye. A combination of ophthalmologic examination, ancillary testing, and cytologic/histopathologic evaluation leads to accurate diagnosis. Management consists of surgery, radiotherapy, chemotherapy, and immunotherapy delivered in various forms.

Augenbefall und Systemerkrankung – periokuläre und intraokuläre Lymphome

Hintergrund

Das okuläre Lymphom wird anhand seiner anatomischen Lokalisation in die intraokulären und periokulären Lymphome eingeteilt. Intraokulär kann die Uvea mit ihren Strukturen betroffen sein oder die Retina in Verbindung mit dem Glaskörper. Die periokulären Lymphome treten in Orbita, Bindehaut, Tränenapparat oder Lid auf. Von großer Bedeutung ist die Unterscheidung zwischen primären Lymphomen der Region oder systemischem Befall. Über die letzten Jahrzehnte konnte in den westlichen Ländern eine konstant steigende Inzidenz okulärer Lymphome nachgewiesen werden.

Ziel

Dieser Beitrag soll einen Überblick über die vielfältigen Manifestationen, Diagnostik, Therapie sowie Prognose und Nachsorge geben.

Material und Methoden

Der Beitrag basiert auf einer selektiven Literaturrecherche über die MEDLINE-Datenbank zum Thema okuläre Lymphome sowie den persönlichen Erfahrungen der Autoren.

Ergebnisse

Je nach Lokalisation können die Symptome sehr unterschiedlich sein. Die Diagnose erfolgt über eine Probebiopsie und anschließende zytologische/histologische und ggf. molekularpathologische Untersuchung. Strahlentherapeutische sowie systemische Verfahren stellen die am häufigsten angewendeten Therapieverfahren dar. Die Prognose hängt sehr stark von der Lokalisation, dem Subtyp des Lymphoms sowie dem Ausmaß des Tumorbefalls ab.

Diskussion

Das okuläre Lymphom berührt in Diagnostik, Therapie und Nachsorge die Schnittstellen zwischen Ophthalmologie, (Hämato‑)Onkologie, Strahlentherapie, Neurologie, Neurochirurgie, Mund-Kiefer-Gesichts-Chirurgie, Hals-Nasen-Ohren-Heilkunde, Dermatologie, Radiologie, Pathologie und Psychoonkologie. Dabei spielt der Augenarzt als Eingangsarzt bei dieser Systemerkrankung eine wesentliche Rolle.

Intraocular Tumors: Angiographic Patterns

Intraocular tumors are primarily diagnosed clinically. However, ancillary tests such as fluorescein angiogram provides excellent visualization of retinal tumors while indocyanine green angiography reveals intrinsic vascular patterns of choroidal tumors. In this review, we contrast angiographic patterns of a variety of retinal, choroidal, and iris tumors.