Abstract
Purpose
To report two cases of primary vitreoretinal lymphoma (PVRL), which presented as intermediate and posterior uveitis.
Methods
Combined clinical assessment, multimodal imaging with spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, brain magnetic resonance imaging and vitreous and retinal biopsy. Case 1 was a 48-year-old woman who complained of visual loss in her right eye secondary to a diffuse vitreous opacification and multiple chorioretinal lesions. Case 2, a 74-year-old man, presented with low vision in his right eye due to a wide chorioretinal lesion at the posterior pole, vitreous opacification and posterior uveitis in both eyes.
Results
Diffuse large B cell lymphoma was histologically diagnosed in the cerebellum in the first case and in chorioretinal tissue in the second patient. Atypical lymphoid cells were detected and allowed to make a diagnosis of primary central nervous system lymphoma in case 1 and PVRL in case 2.
Conclusion
PVRL often masquerades ad intermediate or posterior uveitis. The management of the patients needed a team of pathologists, haematologists and ophthalmologists to achieve the correct diagnosis and choose the more appropriate therapy. Some peculiar characteristics on multimodal imaging, even in atypical cases of PVRL, should raise suspicious for PVRL and lead to a diagnostic vitrectomy and/or retinal biopsy.
References
Chan CC, Rubenstein JL, Coupland SE (2011) Primary vitreoretinal lymphoma: a report from an international primary central nervous system lymphoma collaborative group symposium. Oncologist 16(11):1589–1599
Fend F, Ferreri AJM, Coupland SE (2016) How we diagnose and treat vitreoretinal lymphoma. Br J Haematol 173:680–692
Hwang CS, Yeh S, Bergstrom CS (2014) Diagnostic vitrectomy for primary intraocular lymphoma: when, why, how? Int Ophthalmol Clin 54(2):155–171
Davis JL (2013) Intraocular lymphoma: a clinical perspective. Eye (Lond) 27(2):153–162
Grimm SA, McCannel CA, Omuro AMP et al (2008) Primary CNS lymphoma with intraocular involvement: international PCNSL collaborative group report. Neurology 71(17):1355–1360
Mantopoulos D, Cebulla CM (2015) Multimodal imaging of spontaneously shifting primary vitreoretinal lymphoma. Ocul Oncol Pathol 1(4):237–240
Shields CL, Manalac J, Das C (2015) Review of spectral domain enhanced depth imaging optical coherence tomography of tumors of the choroid. Indian J Ophthalmol 63(2):117–121
Say EAT, Shah SU, Ferenczy S et al (2011) Optical coherence tomography of retinal and choroidal tumors. J Ophthalmol 2011:385058
Egawa M, Mitamura Y, Hayashi Y et al (2014) Spectral-domain optical coherence tomographic and fundus autofluorescence findings in eyes with primary intraocular lymphoma. Clin Ophthalmol 8:335–341
Faia LJ, Chan CC (2009) Primary intraocular lymphoma. Arch Pathol Lab Med 133(8):1228–1232
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Morara, M., Foschi, F., Veronese, C. et al. Two cases of primary vitreoretinal lymphoma: a diagnostic challenge. Int Ophthalmol 38, 353–361 (2018). https://doi.org/10.1007/s10792-016-0422-1
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DOI: https://doi.org/10.1007/s10792-016-0422-1