0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Clinical Sciences

Vitreoretinal Presentation of Secondary Large B-Cell Lymphoma in Patients With Systemic Lymphoma

Diva R. Salomão, MD1,2; José S. Pulido, MD1; Patrick B. Johnston, MD, PhD3; Irene Canal-Fontcuberta, MD1; Andrew L. Feldman, MD2
[+] Author Affiliations
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
3Department of Hematology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2013;131(9):1151-1158. doi:10.1001/jamaophthalmol.2013.334.
Text Size: A A A
Published online

Importance  Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma.

Objective  To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma.

Design  Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes.

Setting  Mayo Clinic pathology database.

Participants  Fifty-five patients with vitreous specimens available for review.

Exposures  Vitreous aspiration biopsy.

Main Outcome and Measure  Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL).

Results  Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium.

Conclusions and Relevance  Vitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Flowchart Depicting the Selection of Study Patients and Specimens
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Patient 1, With a Diagnosis of Large B-Cell Lymphoma

A, Slitlamp examination reveals the presence of vitreous aggregates. B, From the vitreous aspiration biopsy sample, a cytospin preparation shows large atypical lymphocytes with a high ratio of nuclei to cytoplasm and scant cytoplasm (Diff-Quick stain, original magnification ×600). C, The cell block shows a cellular specimen composed mostly of large atypical lymphocytes with prominent nucleoli (hematoxylin-eosin, original magnification ×600). D, Staining of these cells was positive for CD20 (anti-CD20, original magnification ×600). E, The cervical lymph node biopsy specimen reveals large B-cell lymphoma (hematoxylin-eosin, original magnification ×600). F, Optical coherence tomography reveals subretinal and retinal infiltrates.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Patient 3, With a Diagnosis of Chronic Lymphocytic Leukemia

A, Fundus photograph shows vitreous haziness. B, Optical coherence tomography reveals irregularities at the retinal pigment epithelium layer. C, The vitreous aspiration biopsy sample shows a cellular specimen represented by large atypical lymphocytes with prominent nucleoli (hematoxylin-eosin, original magnification ×600). Inset highlights the prominent nucleoli (original magnification ×1000). D, Staining of the cells was positive for CD20 (anti-CD20, original magnification ×600).

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();