Korean J Ophthalmol.  2014 Feb;28(1):108-112. 10.3341/kjo.2014.28.1.108.

Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye

• Park CY
• Hwang SW
• Kim DY
• Huh HJ
• Oh JH

• KMID: 1792102
• DOI: http://doi.org/10.3341/kjo.2014.28.1.108

Abstract

A 36-year-old woman was diagnosed with anaplastic large cell lymphoma (ALCL) by excisional biopsy of a left frontal skin lesion. During the first cycle of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient complained of right ocular pain and inflammation. Cytologic examination using aqueous humor revealed atypical lymphocytes, suggesting intraocular ALCL involvement. Acute angle closure developed in the anterior chamber due to rapid progression of ALCL, causing pupillary block. Laser and surgical interventions were attempted but failed to relieve the pupillary block. Finally, radiation therapy resolved the pupillary block to restore the anterior chamber and normalize intraocular pressure. This is the first case in the English literature of ALCL involving the iris to cause acute secondary angle closure.

Keyword

Acute angle closure; Anaplastic large cell lymphoma; Eye; Radiotherapy

MeSH Terms

Adult
Anterior Eye Segment/*pathology
Biopsy
Diagnosis, Differential
Eye Neoplasms/*diagnosis
Female
Humans
Lymphoma, Large-Cell, Anaplastic/*diagnosis
Magnetic Resonance Imaging
*Neoplasm Invasiveness
Positron-Emission Tomography

Figure

• 

  Fig. 1 (A) Skin mass is visible in left frontal area. On microscopic examination, excisional biopsy reveals tissue heavily infiltrated by small lymphocytic cells (B) (H&E, ×40). Immunohistochemistry reveals infiltrating cells that strongly express CD3 (C) (×200) and anaplastic lymphoma kinase (D) (×200). (E) Slit lamp photograph of right eye on second visit. Significant inflammation with fibrin reaction is visible in anterior chamber. Subconjunctival hemorrhage is present. (F) Ocular ultrasonography demonstrates relatively clear posterior segment, suggesting that inflammation is localized in the anterior eye. (G) Cytospin smear shows atypical cells harboring a moderate amount of cytoplasm and eccentric kidney-shaped nuclei (Wright stain, ×1,000). (H) During treatment course, acute angle closure due to pupillary block by dense fibrin clots is noted. (I) Magnetic resonance imaging shows focal enhancement of the iris and ciliary body without posterior segment involvement. (J) Positron emission tomography scan shows increased fluorodeoxyglucose metabolism in the right eye surface, right thyroid, and uterine wall.

• 

  Fig. 2 Changes in silt lamp findings on days 6 (A), 9 (B), 11 (C), and 14 (D) after radiotherapy. Gradual regression of tumor material and fibrin reaction is noted.

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