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Zhang L, Zhang T, Xu G, Zhang C, Qian J, Chang Q, Bi Y, Chen Q. Multipurpose ultrasonographic characteristics of primary uveal MALT lymphoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:2383-2394. [PMID: 36933009 DOI: 10.1007/s00417-022-05958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 03/19/2023] Open
Abstract
PURPOSE To investigate the ultrasonographic features in patients with primary uveal mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS Medical records of 12 patients (13 eyes) diagnosed with primary uveal MALT lymphoma between September 2014 and September 2021 were retrospectively reviewed. Ultrasonography, B-scan ultrasonography, color Doppler flow imaging, and ultrasound biomicroscopy findings were retrieved from the medical records. RESULTS Mean age of the included patients was 59.4 ± 8.6 years. Typical ultrasonographic features of the choroidal infiltrates were flat, diffuse, and thickened, with low and homogenous internal reflectivity and with rich arterial blood flow from posterior ciliary arterioles. The mean thickness of the choroidal infiltrates was 1.34 ± 0.68 mm (n = 13). Most of the affected eyes had posterior episcleral extensions, with a mean thickness of 1.66 ± 1.21 mm (n = 12). Typical crescent-like posterior episcleral extensions were detected in nine eyes (69.2%). In six eyes, the blood flow from the choroidal infiltrates communicated with the episcleral extensions. In the ciliary body, the mean thickness of the infiltrates was 1.08 ± 0.43 mm (n = 9), and seven eyes (77.8%) had 360° ring-like infiltrations. The initial best-corrected visual acuity (BCVA) was significantly correlated with the final BCVA after treatment (p < 0.001). CONCLUSION Multipurpose ultrasonographic imaging revealed the unique characteristics of the primary uveal MALT lymphoma and is helpful in the diagnosis of this rare disease.
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Affiliation(s)
- Lili Zhang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Chaoran Zhang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Jiang Qian
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Yingwen Bi
- Department of Pathology, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China.
| | - Qian Chen
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai Medical School, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, China.
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2
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Hussain Z, Khan J, Ali S. Impact of Therapy & Age in Choroidal Cancers: A Retrospective Cohort Analysis of 7722 Patients from a US National Database. Clin Ophthalmol 2021; 15:1763-1774. [PMID: 33953535 PMCID: PMC8090984 DOI: 10.2147/opth.s298700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Collectively, choroidal cancers represent a vast array of histopathologically diverse constituencies with profound repercussions related to mortality and metastasis. Prognosticated factors provide utility in determining clinical management and outcome propensities. To date, measures to collectively characterize choroidal cancers as a class are not impressive. This study aims to shed light on the affiliation of age and therapeutic modalities to survival in patients diagnosed with choroidal cancers. Methods Cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) program, a freely accessible population-based database, was executed from 1975 to 2016, a 41-year time window. Univariable and multivariable Cox regression assessed survival with age and various therapeutic modalities as primary independent variables. Adjustment for several demographical and clinical variables was performed. Results This cohort consisted of 7722 patients at the time of diagnosis. Multivariable Cox regression demonstrated increased cause-specific hazards of 71.8% for patients aged 75+ years (HR = 1.718, CI 1.155-2.555, p < 0.008) as compared to patients aged 0-24 years. 16.2% and 58.0% increases in cause-specific mortality were showcased in patients diagnosed with 8770/3: mixed epithelioid and spindle cell melanoma (HR = 1.16, p = 0.029) and 8771/3: epithelioid cell melanoma of the choroid (HR = 1.580, p < 0.001) compared to individuals diagnosed with 8720/3: malignant melanoma NOS of the choroid. Chemotherapy significantly influenced survival in patients with choroidal cancers compared to those who did not receive chemotherapy or had an unknown status (HR = 0.377, CI 0.292-0.486, p < 0.001). Conclusion Like most cancers, choroidal cancers showcase poor clinical trajectory with advanced age. Specific ICD-O-3 histological subtypes predispose to increased mortality. Therapeutic modalities such as radioactive implants and chemotherapeutic agents demonstrate decreased cause-specific mortality compared to alternative treatments. Altogether, nuanced influences of age and therapy are revealed when evaluating choroidal cancers as a class, irrespective of subtype.
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Affiliation(s)
- Zain Hussain
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jawad Khan
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Shaheer Ali
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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3
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Khanna RK, Vallet N, Fromont-Hankard G, Pisella PJ, Le Lez ML. Pseudo-panuveitis masquerade syndrome associated with an orbital and systemic MALT-type B-cell lymphoma. J Fr Ophtalmol 2018; 41:e125-e128. [PMID: 29567022 DOI: 10.1016/j.jfo.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/12/2017] [Accepted: 10/16/2017] [Indexed: 10/17/2022]
Affiliation(s)
- R K Khanna
- Service d'ophtalmologie, CHRU Bretonneau, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - N Vallet
- Service d'hématologie et thérapie cellulaire, CHRU Bretonneau, 37044 Tours, France
| | - G Fromont-Hankard
- Service d'anatomopathologie, CHRU Bretonneau, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P-J Pisella
- Service d'ophtalmologie, CHRU Bretonneau, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - M-L Le Lez
- Service d'ophtalmologie, CHRU Bretonneau, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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4
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Dirani A, Allaire G, Callejo S, Belair ML, Biernacki K, Corriveau C, Hammamji K. Choroidal extranodal marginal zone lymphoma diagnosed by full-thickness retinochoroidal biopsy: case report and review of the literature. Int Med Case Rep J 2017; 10:153-158. [PMID: 28496372 PMCID: PMC5422570 DOI: 10.2147/imcrj.s129171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The case of an 89-year-old man who was referred for a painless decrease of vision in his right eye (RE) is reported. Fundus examination of the RE showed an elevated amelanotic lesion located in the posterior pole with an adjacent focal round pigmented lesion. There was also a more peripheral amelanotic lesion extending from 6 to 9 o’clock clockwise inferotemporally. Uveitis workup and imaging studies of brain and orbits were normal. A retinochoroidal biopsy was done and showed the presence of choroidal extranodal marginal zone lymphoma. The patient was treated with external beam radiotherapy. This report presents a review of the literature of all reported cases of choroidal extranodal marginal zone lymphoma.
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Affiliation(s)
- Ali Dirani
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
| | - Guy Allaire
- Department of Pathology, University of Montreal.,Department of Pathology, University of Montreal Health Center (CHUM), Montreal, Canada
| | - Sonia Callejo
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
| | - Marie Lyne Belair
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
| | - Katarzyna Biernacki
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
| | - Christine Corriveau
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
| | - Karim Hammamji
- Department of Ophthalmology, University of Montreal.,Department of Ophthalmology, University of Montreal Health Center (CHUM)
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5
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Pelegrín L, Adán A, López-Guillermo A, Martinez A, Shields CL. An old disease in an atypical place. Surv Ophthalmol 2014; 59:660-3. [PMID: 25233826 DOI: 10.1016/j.survophthal.2014.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
A 72-year-old man presented with signs on uveítis. Biopsy of an iris lesion established the diagnosis of uveal MALT lymphoma with presumed choroidal involvement.
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Affiliation(s)
- Laura Pelegrín
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Antonio Martinez
- Department of Pathologic Anatomy, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
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6
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Aronow ME, Portell CA, Sweetenham JW, Singh AD. Uveal Lymphoma: Clinical Features, Diagnostic Studies, Treatment Selection, and Outcomes. Ophthalmology 2014; 121:334-341. [DOI: 10.1016/j.ophtha.2013.09.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/08/2013] [Accepted: 09/05/2013] [Indexed: 11/26/2022] Open
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Choroidal and adnexal extranodal marginal zone B-cell lymphoma: presentation, imaging findings, and therapeutic management in a series of nine cases. Eye (Lond) 2013; 27:828-35. [PMID: 23598677 DOI: 10.1038/eye.2013.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 03/07/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To describe the clinical and imaging presentation, pitfalls in the diagnosis of choroidal extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), as well as the therapeutic management and prognosis. METHODS A retrospective case review of nine choroidal MALT lymphomas was performed. Initial clinical presentation and imaging findings of these histologically confirmed cases of lymphoma were analyzed. Treatment methods, time to diagnosis, systemic work-up, and treatment prognosis were assessed. RESULTS Initial presentation was essentially blurred vision. The features described on examination were: anterior and posterior scleritis, iridocyclitis, choroidal infiltration, and exudative retinal detachment. Fluorescein and indocyanine green angiography as well as ultrasonography and optic coherence tomography provided arguments in favor of the diagnosis. Biopsy sites included conjunctiva, Tenon's capsule, deep scleral tissue, episclera, lacrimal gland, and choroid. Treatment mostly consisted of a combination of chemotherapy and radiotherapy. The mean time to diagnosis was 12 months. CONCLUSIONS Owing to the insidious onset of these tumors and their ability to simulate other conditions, the diagnosis is commonly delayed. The prognosis is generally good and treatment is effective in the case of localized lymphoma.
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Abstract
PURPOSE Lymphoma is the most common malignancy of the ocular adnexa. Most of the ocular adnexa lymphomas are non-Hodgkin B-cell lymphomas. The most common type of ocular adnexa lymphoma is primary extranodal marginal zone B-cell lymphoma of the MALT (mucosa-associated lymphoid tissue). Most of these neoplasms are primary extranodal lymphomas, although 10% to 32% are secondary tumors from disseminated disease. CASE REPORT A 58-year-old woman presented for a comprehensive examination, with the chief complaint of ocular discomfort in both eyes. Anterior segment examination revealed bilateral salmon-colored lesions of the inferior and superior conjunctivae. The patient was referred for systemic evaluation and histopathology of the conjunctival lesions. She was diagnosed as having marginal zone lymphoma of the MALT and underwent radiation therapy (RT). CONCLUSIONS Ocular lymphoma may present on routine examination or with mild symptoms. Although most commonly a primary extranodal neoplasm, the condition may be associated with disseminated lymphoma and requires thorough evaluation and staging of the disease for determination of appropriate treatment. The primary eye care provider plays an important role in the identification and staging of the disease, as well as managing complications from RT. It is also important to recognize that concurrent conditions requiring treatment with topical medications, such as glaucoma, may be complicated after treatment because of the inflammation and ocular surface irritation after RT. The necessity and benefit of the addition of intraocular pressure medications during that time should be measured on a case-by-case basis. Patients should be followed closely after treatment for relapse of disease and identification of complications from ocular RT.
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9
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Kinoshita Y, Takasu K, Adachi Y, Yuri T, Nagumo S, Shikata N. Retrospective cytological study of intraocular lymphoma using vitreous and intraocular perfusion fluid. Diagn Cytopathol 2012; 40:604-607. [PMID: 22707324 DOI: 10.1002/dc.21596] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 10/14/2010] [Indexed: 10/08/2023]
Abstract
Intraocular lymphoma (IOL) is an extremely rare tumor. We carried out a retrospective cytopathological study with vitreous and intraocular perfusion fluid obtained on conducting a pars plana vitrectomy in 18 cases of IOL. In the 18 cases, nine were patients of Kansai Medical University Takii Hospital from 1991 to 2007, and the other nine had already been reported by other hospitals. Most patients were male, and the average age at onset was 60.4-year-old. The main symptoms were vitreous opacity, amblyopia, and blurred vision. Cases of primary intraocular lymphoma numbered 8/15 (53%), while cases of infiltration of malignant lymphoma from the brain numbered 2/15 (13%). Although IOL contains various subtypes of lymphoma, the most frequent subtype is diffuse large B-cell type lymphoma. It has been reported that making a definite diagnosis of IOL is difficult because the clinical symptoms and examinations are similar to chronic uveitis, and so IOL is called "masquerade syndrome." Recently, serological and molecular pathological studies have been carried out in addition to morphological examination. However, a cytological diagnosis based on the clinical background and/or image findings is important for the diagnosis of IOL, because of the volume limit of the vitreous fluid and difficulty of obtaining specimens from the inside of the eyes.
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Affiliation(s)
- Yuichi Kinoshita
- Department of Cytopathology, Kansai Medical University Takii Hospital, Moriguchi, Osaka, Japan.
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10
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Tagami M, Nagai T, Sekimukai D, Hara R, Azumi A. Uveal extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type with concomitant extraocular lesions in a Japanese man. Jpn J Ophthalmol 2011; 55:585-587. [PMID: 21717179 DOI: 10.1007/s10384-011-0013-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 11/05/2010] [Indexed: 11/25/2022]
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/metabolism
- Bone Marrow Neoplasms/drug therapy
- Bone Marrow Neoplasms/metabolism
- Bone Marrow Neoplasms/pathology
- Choroid Neoplasms/drug therapy
- Choroid Neoplasms/metabolism
- Choroid Neoplasms/pathology
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/pathology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasm Invasiveness
- Paranasal Sinus Neoplasms/drug therapy
- Paranasal Sinus Neoplasms/metabolism
- Paranasal Sinus Neoplasms/pathology
- Positron-Emission Tomography
- Prednisolone/therapeutic use
- Retinal Detachment/diagnostic imaging
- Retinal Detachment/drug therapy
- Retinal Detachment/pathology
- Rituximab
- Sphenoid Sinus/pathology
- Tomography, X-Ray Computed
- Ultrasonography
- Vincristine/therapeutic use
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Affiliation(s)
- Mizuki Tagami
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takayuki Nagai
- Ophthalmology Department, Shinnittetsu Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan
| | - Daisuke Sekimukai
- Ophthalmology Department, Kobe Kaisei Hospital, 3-11-15 Shinoharakita-machi, Nada-ku, Kobe, 657-0068, Japan
| | - Rumiko Hara
- Ophthalmology Department, Kakogawa Municipal Hospital, 2000 Kitazaike, Kakogawa-cho, Kakogawa, 675-8501, Japan
| | - Atsushi Azumi
- Ophthalmology Department, Kobe Kaisei Hospital, 3-11-15 Shinoharakita-machi, Nada-ku, Kobe, 657-0068, Japan.
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Stacy RC, Jakobiec FA, Schoenfield L, Singh AD. Unifocal and multifocal reactive lymphoid hyperplasia vs follicular lymphoma of the ocular adnexa. Am J Ophthalmol 2010; 150:412-426.e1. [PMID: 20599186 DOI: 10.1016/j.ajo.2010.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/06/2010] [Accepted: 04/12/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To characterize the differentiating histopathologic and immunophenotypic features of reactive lymphoid hyperplasia (RLH) and follicular lymphoma of the ocular adnexa. DESIGN Retrospective case study with clinical follow-up and review of the literature. METHODS Clinical records of 9 cases of RLH and 6 cases of follicular lymphoma from 2 institutions were reviewed. Light microscopic evaluation and immunohistochemical stains including CD20, CD3, CD5, CD21, CD23, BCL-2, BCL-6, CD10, kappa, lambda, and Ki67 were used to distinguish the 2 categories. RESULTS RLH preferentially involved the conjunctiva, whereas follicular lymphoma had a propensity to involve the lacrimal gland. Microscopic analysis with immunohistochemical staining distinguished RLH from follicular lymphoma. BCL-2 was positive in follicular centers of follicular lymphoma but not in RLH. CD10 identified follicular center cells and Ki67 quantified cells in S-phase. CD21 and CD23 detected dendritic cell scaffoldings of indistinct germinal centers. None of the patients with RLH developed lymphoma during their clinical courses (up to 18 years). However, 3 patients with orbital, but not conjunctival, RLH developed immunohistochemically proven multifocal nonophthalmic supradiaphragmatic adnexal RLH (sites included lung, parotid, axillary nodes, and uvea). All 6 patients with follicular lymphoma had disseminated disease. CONCLUSIONS A correct diagnosis of RLH vs follicular lymphoma can be reliably established employing immunohistochemical methods. A heretofore undescribed "multifocal RLH" syndrome must be distinguished from follicular lymphoma. Conjunctival RLH can usually be managed surgically without radiotherapy, but "multifocal RLH" required systemic treatment in 2 of 3 patients. Follicular lymphoma requires systemic chemotherapy if discovered beyond stage 1E.
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Affiliation(s)
- Rebecca C Stacy
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Spectral-domain optical coherence tomography of conjunctival mucosa-associated lymphoid tissue lymphoma with presumed choroidal involvement. Graefes Arch Clin Exp Ophthalmol 2010; 248:1837-40. [PMID: 20532548 PMCID: PMC2974205 DOI: 10.1007/s00417-010-1427-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/23/2010] [Accepted: 05/24/2010] [Indexed: 11/10/2022] Open
Abstract
Background Conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma has been well-described, but rarely do these lesions demonstrate intraocular involvement. We report a case of conjunctival MALT lymphoma with intraocular involvement and novel spectral-domain ocular coherence tomography (SD-OCT) findings. Patient and methods A 75-year-old woman with biopsy-proven MALT lymphoma of the conjunctiva presented with ipsilateral yellowish diffuse choroidal infiltrates on fundoscopic examination. Choroidal involvement was documented clinically, on ultrasonography, on fluorescein angiography, and by SD-OCT. Treatment consisted of 3 weeks of oral doxycycline and six cycles of systemic chemotherapy with cyclophosphamide, vincristine, prednisone, and rituximab. Results There was no evidence of progression or recurrence of MALT lymphoma after 9 months of follow-up. Despite complete resolution of clinical findings, ultrasound, and fluorescein angiography, the choroidal lesions remained unchanged on SD-OCT. Discussion Choroidal involvement of conjunctival MALT is rare, and can be successfully treated. Persistence of irregularities on SD-OCT did not influence management in the presence of clinical improvement and resolution on ultrasonography and fluorescein angiography.
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13
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Central nervous system manifestations of marginal zone B-cell lymphoma. Ann Hematol 2010; 89:1003-9. [DOI: 10.1007/s00277-010-0976-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
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14
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Bhat PV, Jakobiec FA, Papaliodis G, Sobrin L. Primary T-cell lymphoma of the retina and cerebellum: immunophenotypic and gene rearrangement confirmation. Am J Ophthalmol 2009; 148:350-60. [PMID: 19477711 DOI: 10.1016/j.ajo.2009.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 01/25/2023]
Abstract
PURPOSE To document fully the first credible primary T-cell lymphoma of the retina and central nervous system in a 71-year-old man. DESIGN Interventional, retrospective report. METHODS Critical analysis of clinical history and findings, which included bilateral vitreitis with anterior chamber reaction, creamy intraretinal infiltrates, and retinal detachment; complete blood counts and other blood studies (anti-neutrophil cytoplasmic antibody [ANCA], angiotensin-converting enzyme levels, and Lyme and fluorescent treponemal antibody absorption titers); magnetic resonance imaging (MRI) scanning of the brain with total body computed tomographic and positron emission tomographic scanning; interleukin (IL) level determinations (IL-10 and IL-6); cytologic and electron microscopic evaluations; immunophenotyping of cells; and polymerase chain reaction studies for viral deoxyribonucleic acid and ribonucleic acid, and immunoglobulin heavy-chain, and T-cell receptor (TCR) gene rearrangements. RESULTS The first vitreous specimen was diagnosed mistakenly as cytologically reactive and contained elevated levels of IL-10 and IL-6 in a ratio of 7 to 1. T cells predominated on immunophenotypic analysis. Computed tomographic and positron emission tomographic whole body scanning showed negative results for lymphoma. An MRI scan of the brain eventually revealed a cerebellar lesion. A retinal biopsy harbored cytologically atypical pleomorphic cells that were almost all immunophenotypically T cells; polymerase chain reaction studies demonstrated a clonal TCR gene rearrangement. T-cell lymphocytes in the biopsy specimen of the cerebellum had an identical clonal TCR gene rearrangement. CONCLUSIONS This case unequivocally establishes that primary retinal T-cell lymphoma accompanied by central nervous system involvement can occur. Elevation in the IL-10 to IL-6 ratio in the face of inconclusive or confusing vitreous cytologic and immunophenotypic findings (a predominance of "reactive T cells with some atypicality") should lead to gene rearrangement studies on biopsies of involved tissues for the detection of T-cell clonality.
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