J Korean Ophthalmol Soc.  2015 Mar;56(3):458-462. 10.3341/jkos.2015.56.3.458.

Secondary Choroidal Lymphoma Associated with Systemic Choroidal Lymphoma

• Kang SH
• Kim BM
• Kim YY

• KMID: 2339056
• DOI: http://doi.org/10.3341/jkos.2015.56.3.458

Abstract

PURPOSE
To report a case of secondary choroidal lymphoma.
CASE SUMMARY
A 57-year-old female presented at our clinic with decreased vision in her right eye 1 month in duration. Slit-lamp examination showed vitreous cells in the right eye. Fundus examination of the right eye revealed an elevated yellowish mass-like lesion at the temporal area and multifocal yellowish patches at the choroidal level. The clinical impression was intraocular lymphoma. We performed diagnostic vitrectomy, but the result was negative. A systemic evaluation revealed enlarged cervical lymph nodes and lymph node biopsy showed diffuse large B-cell lymphoma. The patient was diagnosed as secondary choroidal lymphoma associated with systemic lymphoma and was treated with systemic chemotherapy and 4 injections of intravitreal methotrexate. The patient is scheduled for regular follow-ups.
CONCLUSIONS
Choroidal mass may be the initial presenting sign of systemic lymphoma, and an extensive systemic evaluation should be performed.

Keyword

Secondary choroidal lymphoma; Systemic lymphoma

MeSH Terms

Biopsy
Choroid*
Drug Therapy
Female
Follow-Up Studies
Humans
Intraocular Lymphoma
Lymph Nodes
Lymphoma*
Lymphoma, B-Cell
Methotrexate
Middle Aged
Vitrectomy
Methotrexate

Figure

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  Figure 1. (A) Fundus photograph reveals a yellowish, elevated choroidal mass in the temporal posterior pole of the right eye, measuring 4.0 × 8.0 disc diameter. Multifocal yellowish choroidal infiltrates are also found. (B) Ultrasonography of the right eye shows a smooth surface with acoustically hollow thickening of the choroid and low to moderate internal reflectivity. (C) Fluorescein angiography of the right eye shows blocked fluorescence corresponding to choroidal mass lesion and multiple punctate hyper-fluorescent lesions intermingling with hypofluorescent lesions at the level of retinal pigment epithelium.

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  Figure 2. (A) A vertical optical coherence tomography scan across the central macula (arrow) shows multiple nodular elevations of the retinal pigment epithelium. (B) A horizontal optical coherence tomography scan across the choroidal mass lesion (arrow) shows a dome-shaped large mass with overlying retinal pigment epithelium thinning occupying the choroid, pushing the retina into the vitreous cavity.

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  Figure 3. Positron emission tomography. Probably multiple malignant lesions on both the supraclavicular and neck lymph nodes (LNs), left axillary LNs, internal mammary LNs, car-diophrenic LNs, upper abdominal paraaortic LNs and right iliac LNs and spleen and bone involvements are shown.

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  Figure 4. (A) H-E stain showed a diffuse infiltration of atypical large lymphoid cells (×400). Immunohistochemical staining with cell markers is positive for (B) CD 20 (×400) and (C) Ki 67 (×200).

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  Figure 5. Two months after systemic chemotherapy and intravitreal methotrexate injection, fundus photograph shows marked tumor shrinkage and flat hyperpigmented areas corresponding to the previous choroidal infiltrates lesions.

Reference

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