Case Report: Ocular Manifestations and Treatments of Ciliary Body Involvement by Lymphoma

PurposeTo describe the ocular clinical features, histopathological findings, and treatment outcomes of lymphomas involving the ciliary body.MethodsWe demonstrate three cases of ciliary body involvement by lymphoma from 2013 to 2019 in Peking Union Medical College Hospital (PUMCH). All patients underwent examinations including best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscope, ultrasound biomicroscopy (UBM), and diagnostic vitrectomy. In addition, cytopathology, immunohistochemistry, gene rearrangement, cytometric immunophenotypic, or in-situ hybridization were used for determining the pathological type of lymphoma.ResultsThe patients were a 25-year-old man, a 52-year-old woman, and a 54-year-old man. Two patients had unilateral involvement, and one patient had bilateral involvement. All patients presented with anterior uveitis and elevated intraocular pressure. Ciliary body masses or infiltration were found in 3 patients. Two patients had diffuse large B-cell lymphoma and one patient had natural killer/T-cell lymphoma. All patients received 0.4 mg methotrexate intravitreal injections, and the ciliary body lesions regressed completely.ConclusionLymphomatous involvement of the ciliary body usually presents as an atypical anterior chamber reaction. Vitreous biopsy should be considered in these patients for diagnosis. Methotrexate intravitreal injection combine with chemotherapy or radiotherapy, might extend the survival time and preserve visual acuity for patients with ciliary body involvement by lymphoma.

Novel Mutations in a Lethal Case of Lymphomatous Adult T Cell Lymphoma with Cryptic Myocardial Involvement

The autopsy of a 65-year-old diabetic African American male revealed significant left myocardial involvement by adult T-cell leukemia/lymphoma (ATLL) despite normal pre-mortem fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT). Due to pre-existing diabetic cardiomyopathy with reduced ejection fraction (EF) and compatible imaging studies, cardiac lymphomatous involvement was not suspected. While peripheral blood was negative for leukemia, next-generation sequencing of a lymph node revealed at least eight novel mutations (AXIN1, R712Q, BARD1 R749K, CTNNB1 I315V, CUX1 P102T, DNMT3A S199R, FGFR2 S431L, LRP1B Y2560C and STAG2 I771M). These findings underscore a diagnostic pitfall in a rare lymphomatous variant of ATLL infiltrating myocardium and contribute to its molecular characterization.

Pyrexia of unknown origin: a rare presentation of primary ovarian lymphoma

It is very rare to have a lymphomatous involvement of ovary. Malignant lymphoma of ovary is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma with ovarian mass as an initial manifestation is a rare entity and may have varied presentations which can cause confusion to the physician and cause delay in diagnosis. Study presents a case of non-Hodgkin’s lymphoma where the initial presentation was fever with weight loss, and was evaluated as pyrexia of unknown origin. When no other cause of fever was identified PET-CT was done showing metabolically active uterine mass with no lymphadenopathy. Exploratory laparotomy was planned followed by hysterectomy with bilateral salpingo ophorectomy with omentectomy. Ovarian malignancy was detected intraoperatively, which was diagnosed as diffuse large B cell lymphoma, NHL double expresser phenotype on histopathology and IHC. Patient was started on chemotherapy and is doing fine.