Diagnosis of choroidal lymphoma, difficulties and possibilities

Abstract

AbstractPurpose To describe a case of choroidal lymphomaMethods A 66 y old man presented with left vitritis; 3y before presentation a testicular large B‐cel lymphoma was detected and treated by 8x R‐CHOP and 4x intrathecal chemo. General and hematologic examination failed to indicate a recurrence; because of the negative vitreous biopsy, the hematologists decided to give no systemic treatment. The left eye lost slowly vision and had the aspect of diffuse uveal melanocytic proliferation (BDUMP). After 6 methotrexaat vitreal injections, the choroid remain flat with the image of BDUMP, then very fast, a tumour was growing in the choroid and an enucleation was unavoidableResults The first vitreous biopsy showed multiple cells with a majority of macrophages (CD68+, 75%), small mature T‐Lymphocytes (CD3+, 20%) and very few larger B‐lymfocytes (CD20+, 5%). A second vitreous biopsy after 2 years showed a very cellular sample with a majority of macrophages, and small T‐lymphocytes, there were no B‐lymphocytes. 3 months later a spectacular tumour growth in all parts of the uvea necessitated an enucleation. This confirmed the diagnosis of uveal large B‐cell lymphoma, with a Ki‐67 positivity of nearly 100%Conclusion Lymphoma in the eye is a difficult diagnostic problem