scholarly journals Diagnostic retinal biopsy in the management of secondary non-CNS vitreoretinal lymphoma masquerading as viral retinitis: a case report

Author(s):  
Aditya Rali ◽  
Lucy T. Xu ◽  
Caroline Craven ◽  
Jonathon B. Cohen ◽  
Steven Yeh ◽  
...  

Abstract Background Intraocular lymphoma accounts for fewer than 1% of intraocular tumors. When the posterior segment is involved, it can be further classified as vitreoretinal or choroidal lymphoma. Vitreoretinal lymphoma (VRL) can rarely masquerade as an infectious retinitis making diagnosis and management challenging. Results A 73-year-old woman with a history of non-central nervous system (CNS) involving diffuse large B-cell lymphoma (DLBCL) was referred for worsening blurry vision—visual acuity of count figures at 2 ft—in her right eye for 8 months. Dilated fundus examination of the right eye was significant for retinal whitening and dot-blot hemorrhages, which was concerning for a viral retinitis and guided initial management. Secondary intraocular lymphoma was also considered. The retinal disease continued to progress despite intravitreal and systemic antiviral therapy, and a diagnostic vitrectomy was inconclusive. A retinal biopsy was then performed, which showed DLBCL, confirming a diagnosis of secondary VRL. Three subsequent treatments with intravitreal methotrexate led to regression of the VRL. Conclusions Our case highlights the utility of a retinal biopsy after an inconclusive diagnostic vitrectomy in a challenging scenario of VRL to establish a diagnosis and initiate successful treatment. A multidisciplinary team of providers was essential for diagnosis, comprehensive workup, medical and surgical management of the patient.

2021 ◽  
pp. 1-5
Author(s):  
Karishma Habbu ◽  
Roshan George ◽  
Miguel Materin

<b><i>Purpose:</i></b> This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). <b><i>Methods:</i></b> We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. <b><i>Results:</i></b> A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. <b><i>Conclusion:</i></b> Relapsed PBL can present as bilateral VRL.


2021 ◽  
Author(s):  
Seyedeh Maryam Hosseini ◽  
Mojtaba Abrishami ◽  
Elham Barashki ◽  
Ghodsieh Zamani

Abstract Purpose: Herein, we report a case of primary intraocular lymphoma (PIOL) with the first presentation of bilateral Epstein-Barr virus (EBV)-associated panuveitis and retinitis.Case presentation: A 69-year-old male was referred with a three-day history of blurred vision and pain and redness in his left eye following cataract surgery. Ophthalmic examination revealed panuveitis, vitritis, and necrotizing retinitis with retinal hemorrhage. A month later, the right eye was also involved. Initially, the clinical diagnosis of acute retinal necrosis was made based on clinical manifestation; however, the partial response to intravenous and intravitreal antiviral treatment in the left eye and involvement of the right eye resulted in further investigation of masquerade syndromes. Polymerase chain reaction-based analysis of vitreous sample was positive for EBV, and cytological evaluation was compatible with the diagnosis of B-cell lymphoma. A significant improvement was observed following serial intravitreal rituximab and methotrexate injections. The central nervous system and lungs were involved after 6 months, and the patient expired despite treatment with systemic chemotherapy. Conclusion: There may be an association between EBV panuveitis and primary intraocular B-cell lymphoma.


2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher B. Toomey ◽  
Andrew Gross ◽  
Jeffrey Lee ◽  
Doran B. Spencer

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.


2017 ◽  
Vol 26 (2) ◽  
pp. 157-160
Author(s):  
Erik Reinertsen ◽  
Stewart G. Neill ◽  
Kambiz Nael ◽  
Daniel J. Brat ◽  
Costas G. Hadjipanayis

We report a case of fibrous meningioma with tyrosine-rich crystalloid in the frontal lobe of a middle-aged woman. The patient presented with a history of several years of worsening headaches and blurry vision, which progressed to include syncopal episodes and right-sided weakness. Imaging demonstrated a dural-based extra-axial mass arising from the right orbital roof and extending superiorly along the right frontal convexity causing right-to-left midline shift. The patient underwent a craniotomy and operative resection. Tumor architecture and cytology was similar to that of a Schwannian neoplasm, with spindled cells arranged in a fascicular architecture and displaying focal nuclear palisading. Immunohistochemical stains confirmed a diagnosis of fibrous meningioma. Light microscopy demonstrated extracellular deposits of eosinophilic crystalline material parallel to the spindled tumor cells, reminiscent of “tyrosine-rich” crystals described in salivary gland neoplasms. This is the third meningioma featuring tyrosine-rich crystalloid reported in the literature; we also summarize the previous 2 reports.


2020 ◽  
Vol 13 (1) ◽  
pp. e233136
Author(s):  
Hatim Batawi ◽  
Jonathan A Micieli

A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie’s tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.


2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S84-S85
Author(s):  
S Ayub ◽  
Z Al-Duwal ◽  
D Sellers ◽  
A Rosenberg

Abstract Introduction/Objective Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement. Methods First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases. Results Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared. Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10. Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases. Conclusion Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.


Author(s):  
Hasan Nabil Al Houri ◽  
Tagrid Younes Ahmad ◽  
Sarah Zaher Adden ◽  
Wisam Hikmat Assad ◽  
Ammar Raiy

T-Cell Rich B-Cell Lymphoma (TCRBCL) is relatively a new entity, lately classified as a morphologic variant of Diffuse Large B-cell lymphomas (DLBCL). It consists (1-3) % of all B-cell lymphomas. The rate is far less when describing cases of primary splenic involvement with TCRBCL. Pathologically, TCRBCL is described as a limited number of scattered, large, atypical b-cells embedded in a background of abundant t-cells and frequently histiocytes. The similarity of this malignancy with other types makes it difficult to distinguish between them. Thus, it needs expertise in both clinical and pathological fields to make the right diagnosis. Here, we present a case of an adult male patient whose first presentation and previous medical history of renal colic misguided the initial diagnosis and suggested another colic episode as the underlying ailment. However, further physical, radiological and histopathological investigations uncovered the presence of primary TCRBCL within spleen with no involvement of other sites. Moreover, unusual pathologic finding of CD3 positivity was proved by immunohistochemistry.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Reda Issa ◽  
Stephen A. M. DeSouza

Abstract Background It has been disputed whether Lyme is a true causative agent in posterior uveitis or an incidental finding. Case presentation This report presents a case of a 33-year-old Caucasian female with a remote history of Lyme disease who presented with blurry vision in the right eye. Exam and imaging revealed a right active chorioretinitis and positive Lyme serology. The patient was systemically treated with prednisone and antibiotics. Symptoms initially improved, but she later developed a localized choriocapillaritis in the left eye. Steroids and antibiotics were restarted many times with fluctuating course of the disease. The patient was then started on chronic steroid-sparing immunosuppression, which has controlled the condition without recurrence. Conclusions The current report presents a unique case of recurrent bilateral chorioretinitis with positive Lyme serology and raises the question of the existence of true Lyme-associated uveitis.


2019 ◽  
Vol 9 (3) ◽  
pp. 516-519
Author(s):  
Satoshi Kakutani ◽  
Yasuhiro Takahashi ◽  
Ma. Regina Paula Valencia ◽  
Hirohiko Kakizaki

Purpose: To report a Japanese patient with diffuse large B-cell lymphoma (DLBCL) in the lacrimal sac. Methods: This is a case report of a 52-year-old Japanese woman who presented with a 3-month history of epiphora on the right side and a 1-month history of swelling on the right medial canthal area. Lacrimal sac irrigation showed patency of the lacrimal drainage system. Imaging studies revealed a lacrimal sac mass with involvement of the nasolacrimal duct. Results: Histopathology and immunohistochemistry of the biopsy specimen revealed DLBCL. Systemic workup revealed no other lesion. The patient received 6 cycles of R-CHOP regimen. After completion of the 5th cycle of R-CHOP, all of the symptoms had resolved. Conclusion: We report a case of DLBCL in the lacrimal sac, which is the most common type of lacrimal sac lymphoma in Japan. Since DLBCL is one of the aggressive types of lymphoma, Japanese patients with lacrimal sac lymphoma tend to have a poor prognosis.


2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S73-S74
Author(s):  
V Kumar ◽  
H Sonani ◽  
T Patel ◽  
J Lam

Abstract Introduction/Objective The primary Non-Hodgkin lymphoma of the breast is a very rare entity, which comprises only less than 0.5% of all breast malignancies. The follicular lymphoma of the breast is still rarer as the most common type is diffuse large B cell lymphoma (DLBCL). We are reporting two cases of follicular lymphoma of the breast. Methods/Case Report Case 1: A 67-year-old female with a history of low-grade follicular lymphoma of the lacrimal gland and cervical lymph node was presented with 1.7 cm irregular soft tissue mass in the upper inner quadrant of left breast identified on CT scan. Microscopic examination showed diffuse infiltration of medium-sized lymphocytes with focal follicular architecture. These lymphocytes were positive for CD20, CD10, BCL2, BCL6, and Ki67 (10%); while negative for CD5, CD3, cyclin D1, and EBER. These findings are consistent with low-grade follicular lymphoma. Subsequently, a biopsy of the right breast mass revealed similar findings. The patient was followed up with a PET scan every six months and doing well. Case 2: A 52-year-old female with a history of low-grade follicular lymphoma of the right hard/soft palate junction was presented with bilateral breast masses identified on mammography. The biopsy was performed and microscopic examination showed vaguely follicular architecture with small to medium-sized lymphocyte infiltration. The flow cytometric analysis revealed CD10 positive B cell population with kappa light chain restriction. Fluorescence in situ hybridization (FISH) analysis showed 96% of cells with BCL2 and BCL6 rearrangement. These findings were consistent with low-grade follicular lymphoma. The patient was started on chemotherapy with good outcomes. Results (if a Case Study enter NA) N/A Conclusion By reviewing two cases, we emphasize the rarity of follicular lymphoma in the breast. The most important differential diagnosis is extranodal marginal zone lymphoma and DLBCL. In absence of flow cytometric analysis FISH analysis for BCL-2 rearrangement or other molecular analysis is key to diagnose follicular lymphoma.


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