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Dhodapkar RM, Spadaro JZ, Heng JS, Sinard JH, Lee YH, Habib LA, Pointdujour-Lim R. NK/T-cell Lymphoma With Orbital Involvement: A Case Report and Systematic Review of the Literature. Ophthalmic Plast Reconstr Surg 2023; 39:316-327. [PMID: 36692957 DOI: 10.1097/iop.0000000000002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To present the clinical course of a patient with recurrent NK/T-cell lymphoma (NKTL) involving the orbit and to review the literature on patients with NKTL involving the orbit. METHODS The PubMed database was searched for all cases of NKTL involving orbital, intraocular, or adnexal ocular structures. RESULTS Ninety-six patients were included in the final analysis. The mean age of diagnosis was 48.1 ± 16.8 years. The patients were 53/96 (55.2%) male and 43/96 (44.8%) female. Tumor location varied and included the orbit in 80/96 (83.3%), nasosinus in 56/96 (58.3%), uvea in 11/96 (11.5%), lacrimal gland in 9/96 (9.4%), lacrimal drainage system in 11/96 (11.5%), and conjunctiva in 7/96 (7.3%) cases. Management included surgical debulking in 29/96 (30.2%) cases, radiotherapy in 52/96 (54.2%) cases, and chemotherapy in 82/96 (85.4%) cases. Median survival was 6 months (95% CI: 5-9). Chemotherapy (hazard ratio = 0.80, 95% CI: 0.67-0.95, p = 0.013), radiotherapy (hazard ratio = 0.75, 95% CI: 0.64-0.87, p < 0.001), and orbital involvement being a recurrence of disease (hazard ratio = 0.79, 95% CI: 0.67-0.95, p = 0.009) were associated with improved survival. Advanced Ann Arbor stage (III-IV) at diagnosis (hazard ratio = 1.22, 95% CI: 1.08-1.38, p = 0.001), vision loss (hazard ratio = 1.18, 95% CI: 1.04-1.34, p = 0.009), proptosis (hazard ratio = 1.15, 95% CI: 1.01-1.30, p = 0.035) and periorbital swelling (hazard ratio = 1.15, 95% CI: 1.00-1.33, p = 0.048) were associated with poor survival. CONCLUSIONS NK/T-cell lymphoma involving the orbit, globe, or ocular adnexa heralds a poor prognosis where early diagnosis and therapy are critical. The use of radiotherapy and chemotherapy is associated with improved survival.
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Affiliation(s)
- Rahul M Dhodapkar
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - John H Sinard
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Larissa A Habib
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Wang L, Jia M, Zhang R, Casalino G, Chakravarthy U, Wang Y. Bilateral intraocular and lung involvements associated with Nasal NK/T-cell lymphoma. Eur J Ophthalmol 2023; 33:NP97-NP102. [PMID: 34986043 DOI: 10.1177/11206721211070930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND To report a rare case of nasal natural killer/T (NK/T) cell lymphoma with bilateral intraocular and lung metastasis and to further describe the clinical features of intraocular manifestations. CASE PRESENTATION A 54-year-old man presented with a 3-month history of left nasal congestion, and bilateral vision impairment of one week duration. Subsequent maxillary computed tomography (CT) and multiple biopsies confirmed the diagnosis of nasal NK/T-cell lymphoma. EBV-encoded small RNA (EBER) in situ hybridization revealed EBV infection. A comprehensive ophthalmic examination found lymphoma-associated retinopathy and choroidopathy, which presented as bilateral diverse patterns and retinal detachment. In addition, the chest CT showed multiple scattered nodules in both lungs, and soft-tissue mass in the left hilum with mediastinal and axillary lymphadenopathy. The condition of this patient deteriorated rapidly and he died shortly after diagnosis. CONCLUSIONS The rarity of secondary ocular NK/T-cell lymphoma makes it challenging to identify these tumors early. Both otolaryngologist and ophthalmologists should be aware of ocular involvement and other secondary manifestations of NK/T-cell lymphoma.
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Affiliation(s)
- Luping Wang
- 598329Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mei Jia
- Department of Pathology, 26455Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruxiang Zhang
- Department of Otolaryngology Head and Neck Surgery, 26455Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Usha Chakravarthy
- Department of Ophthalmology, Centre for Public Health, 227990Queen's University of Belfast, Belfast, UK
| | - Yanling Wang
- 598329Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Jing D, You D, Liu Z, Wang W. Primary Orbital Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type, without Nasal Involvement. J Clin Med 2022; 11:jcm11237010. [PMID: 36498585 PMCID: PMC9737387 DOI: 10.3390/jcm11237010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) usually occurs in the nose or the nasopharynx, but extranasal and disseminated disease can occur. In this disease, orbital involvement is more commonly seen, but without nasal involvement is rare. A 61-year-old woman was referred with a one-month history of a remarkably enlarging salmon-colored mass arising in the right inner canthus, with redness and painlessness. The motility of the right eye was limited in the medial direction, with external deviation of the eyeball. A magnetic resonance imaging (MRI) scan of the orbits showed a mass of irregular shape located in the right inner canthus, without any sinus involvement. A histopathological examination concluded a diagnosis of primary orbital extranodal natural killer/T-cell lymphoma, nasal type. Her orbital mass significantly reduced to near disappeared after chemotherapy. From the first visit to the present, the survival duration of this patient was more than 1 year. This patient was still alive with a high quality of life and with no systemic metastasis. Extranodal natural killer/T-cell lymphoma, nasal type may primarily arise in the orbit without nasal involvement. Early discovery, early biopsy and diagnosis and early appropriate treatment can successfully control tumors and improve prognosis.
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Affiliation(s)
- Dalan Jing
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Debo You
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
| | - Wei Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
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Chen B, Yang S, Su W. First observation of intraocular extranodal natural killer/T-cell lymphoma secondary to a retroperitoneal tumour: a case report and comparative review. BMC Ophthalmol 2022; 22:141. [PMID: 35346113 PMCID: PMC8962092 DOI: 10.1186/s12886-022-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vitreoretinal lymphomas are difficult to diagnose due to their insidious onset and inaccessible focal points. Natural killer/T-cell derived malignancies are rare as intraocular lymphomas and usually have a rapid progression and a poor prognosis. Therefore, it is essential to make a definite diagnosis, especially differentially with B-cell-derived lymphomas, which account for most cases of vitreoretinal lymphomas. Case presentation This case report describes a 55-year-old female reporting a 10-month history of painless decline in her vision of the right eye. Optical coherence tomography of the patient revealed hyperreflective nodules and irregular humps in the retinal pigment epithelium layer. The right vitreous was aspirated for diagnostic assessment, revealing an interleukin-10 level of 39.4 pg/mL and an interleukin-10/interleukin-6 ratio of 1.05. The right vitreous humor was positive for Epstein–Barr virus DNA. Upon a systemic examination, a high metabolic nodule was found in the retroperitoneal area and proven to be positive for Epstein–Barr virus-encoded mRNA, CD2, CD3ε, TIA-1, and Ki-67. Considering the homology of the two lesions, the patient was diagnosed with metastatic vitreoretinal lymphoma secondary to retroperitoneal extranodal natural killer/T-cell derived lymphoma. The patient received systemic chemotherapy and regular intravitreal injections of methotrexate. Her visual acuity of the right eye had improved from 20/125 to 20/32 at the latest follow-up. No new lesions were found. Conclusions A definitive diagnosis of vitreoretinal lymphoma is challenging. On some occasions in which pathological evidence is missing, the available examination results and clinical observations must be comprehensively considered. This study herein summarized pertinent pieces of literature and reports and reviewed available practicable methods to make a definitive diagnosis of intraocular extranodal natural killer/T-cell lymphoma, which was particularly distinct from the common diffuse large B-cell lymphomas.
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Affiliation(s)
- Binyao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China. .,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Mallal P, Ammanuel B, White R, Kennedy C, Cheah CY. Simultaneous intraocular and cutaneous extranodal NK/T-cell lymphoma refractory to multiple therapies including pembrolizumab. Clin Case Rep 2021; 9:e04194. [PMID: 34026185 PMCID: PMC8133067 DOI: 10.1002/ccr3.4194] [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: 09/29/2020] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 02/01/2023] Open
Abstract
Floaters or visual disturbance in a patient with ENKL should prompt evaluation for possible vitreoretinal involvement. Lymphoma with ocular involvement should be treated aggressively and in most cases heralds CNS involvement.
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Affiliation(s)
- Peter Mallal
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
| | - Benhur Ammanuel
- Department of Anatomical PathologyPathwest Laboratory MedicineNedlandsWAAustralia
| | - Rohen White
- Department of Radiation OncologySir Charles Gairdner HospitalNedlandsWAAustralia
| | | | - Chan Yoon Cheah
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory MedicineNedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
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Zhang J, Chen H, Lin W, Wu Z. Aggressive natural killer/T-cell lymphoma masquerading as acute orbital hemorrhage: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1081-1085. [PMID: 32509082 PMCID: PMC7270658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
Natural killer T-cell lymphoma (NKTCL) is a highly aggressive tumor that usually affects the nasal cavity and/or paranasal sinuses. Primary orbital NKTCL is extremely rare, with only a few cases reported in the literature. The clinical presentation of orbital involvement by NKTCL is atypical and usually misdiagnosed as orbital cellulitis or orbital pseudotumor. A 23-year-old male patient was admitted to our hospital complaining of severe eye pain and manifested as acute orbital hemorrhage. Isolated orbital natural killer T-cell lymphoma (NKTCL) was confirmed by biopsy. This patient's orbital NKTCL did not respond to CHOP (cyclophosphamide, epirubicin, vincristine, prednisone) chemotherapy, but shrank significantly after receiving 1 cycle of C-SMILE (chidamide, steroid, methotrexate, isophosphamide, L-pegaspargase, etoposide). However, he still died after 3 cycles of C-SMILE chemotherapy at a follow-up time of 4 months. Primary orbital NKTCL can present clinically as a rare acute orbital hemorrhage, and the disease is aggressive and has a poor prognosis.
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Affiliation(s)
- Jing Zhang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, ShenzhenNo. 18, Zetian Road, Futian District, Shenzhen 518040, Guangdong Province, China
| | - Hui Chen
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaChengdu 610072, China
| | - Wei Lin
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaChengdu 610072, China
| | - Zhengzheng Wu
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaChengdu 610072, China
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Kitahara T, Imamura S, Ohta M, Okoshi T, Kobori A, Miyakoshi A, Oichi Y, Toda H. Two cases of primary ocular adnexal lymphomas diagnosed after pre-biopsy corticosteroid treatment using polymerase chain reaction-based gene rearrangement analysis. Am J Ophthalmol Case Rep 2019; 15:100520. [PMID: 31372582 PMCID: PMC6658928 DOI: 10.1016/j.ajoc.2019.100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/14/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report the limited usefulness of polymerase chain reaction (PCR)-based immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangement analysis in diagnosing primary ocular adnexal lymphomas (OAL) treated with corticosteroids before biopsy. OBSERVATIONS This was a case series of two patients: a 47-year-old woman and a 43-year-old man, who both presented with impaired visual acuity and ophthalmoplegia of the involved eyes. Both patients had previously received non-diagnostic biopsy and had been subsequently treated with corticosteroids. The visual acuity and ophthalmoplegia progressively worsened after a variable duration of remission. Ocular magnetic resonance imaging revealed gadolinium-enhancing intra- and extraconal lesions. Systemic evaluations did not reveal any other lesions outside of the orbit. Differential diagnoses were lymphoproliferative disorders, including undiagnosed primary OALs, and idiopathic ocular inflammation. Both patients were exposed to repeated biopsies. The biopsied tissue demonstrated marked lymphocytolysis due to corticosteroid usage; therefore, histology and immunophenotype were non-diagnostic. EuroClonality/BIOMED-2 PCR-based gene rearrangement analyses detected genetic clonalities of Ig and TCR and suggested diagnoses of primary OALs of B-cell and T-cell origins, respectively. An OAL of B-cell origin was treated with radiotherapy; an OAL of a rare T-cell origin was treated with high-dose methotrexate-based chemotherapy and adjuvant radiotherapy. Both patients remained progression free for more than 36 months. CONCLUSIONS AND IMPORTANCE PCR-based gene rearrangement analysis can be of limited usefulness in suggesting a diagnosis of primary OAL in patients receiving pre-biopsy corticosteroid treatment. Identification of genetic clonality is of clinical importance to provide treatment options for undiagnosed OALs.
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Affiliation(s)
| | - Shin Imamura
- Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - Makoto Ohta
- Department of Pathology, Fukui Red Cross Hospital, Fukui, Japan
| | - Tadakazu Okoshi
- Department of Pathology, Fukui Red Cross Hospital, Fukui, Japan
| | - Akira Kobori
- Department of Ophthalmology, Fukui Red Cross Hospital, Fukui, Japan
| | | | - Yuki Oichi
- Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan
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Alqurashi L, Alqahtani A. Ocular Infiltration as the Only Relapse Sign of Atypical Lymphoma Under Chemotherapy: A Case Report. Cureus 2019; 11:e4049. [PMID: 31016077 PMCID: PMC6464489 DOI: 10.7759/cureus.4049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Among the variants of non-Hodgkin's lymphoma (NHL), peripheral T-cell lymphomas (PTCLs) are the least occurring. An aggressive subtype is the extranodal natural killer/T-cell lymphoma (ENKTCL) which commonly affects the nasal cavity. Ocular complications of the disease could arise due to anatomical adjacency yet it is seldom reported. We present the case of a 42-year-old male diagnosed with ENKTCL, nasal type stage IV-B with central nervous system involvement. The patient underwent three cycles of chemotherapy to which there was a complete response until relapse occurred in the form of progressive vision loss and right optic nerve infiltration. A diagnostic vitrectomy was performed, and vitreous fluid flow cytometry revealed the presence of natural killer (NK) cells. Ocular manifestations are rarely reported in the literature, yet this could be crucial to follow up on. A regular ophthalmological examination should be warranted for all cases of ENKTCL with the aim of detecting recurrence and prevention of vision loss.
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Affiliation(s)
- Lujain Alqurashi
- Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdullah Alqahtani
- Oncology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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Thompson AC, McCall CM, Proia AD. Beneath the Retinal Pigment Epithelium: Histopathologic Findings in Metastatic Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type. Ocul Oncol Pathol 2018; 4:388-394. [PMID: 30574492 DOI: 10.1159/000487268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/26/2018] [Indexed: 01/03/2023] Open
Abstract
Purpose To report a case of extranodal natural killer/T-cell lymphoma (ENKTCL), nasal type metastatic to the space beneath the retinal pigment epithelium (RPE) with coincident paraneoplastic lymphoma-associated retinopathy. Methods Findings of clinical and histopathologic examination are presented with differential diagnoses and a literature review. Case Report A 53-year-old man presented with bilateral blindness and had exudative retinal detachments overlying subretinal masses in both eyes. Flow cytometry of pericardial fluid revealed malignant T lymphocytes. After two cycles of chemotherapy, the patient was hospitalized and quickly expired. Autopsy revealed lymphoma involving the eyes, heart, right lung, and two subcarinal lymph nodes focally. Histopathologic examination of the eyes revealed intraocular metastases from ENKTCL, nasal type. Expression of CD3 and CD56, along with expression of Epstein-Barr virus by in situ hybridization, confirmed the diagnosis. Lymphomatous infiltrates were confined to the space beneath the neurosensory retina and between the RPE and the Bruch membrane, sparing the uveal tissue, similar to other metastatic T-cell lymphomas. Extensive RPE and photoreceptor loss in regions with and without underlying tumor was typical of a concurrent paraneoplastic lymphoma-associated retinopathy. Conclusion Patients diagnosed with ENKTCL should be evaluated by an ophthalmologist, as ophthalmic involvement portends a poor prognosis.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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