Abstract
IntroductionIn general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.Case PresentationIn the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.ConclusionWhile ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.
Highlights
Ocular complications of hematologic malignancies such as leukemia are well documented
It is estimated that 50% or more of all leukemias manifest some form of ocular involvement [1,2]
Case 1 A 54 year-old man with a previous diagnosis of lymphomatoid granulomatosis (LYG) presented with a left conjunctival growth consisting of clusters of papillae with focal hemorrhages of several weeks' duration (Figure 1A), during which time the systemic disease was thought to be in remission
Summary
We describe several microscopic ocular pathologic findings associated with two relatively rare hematologic malignancies. These cases emphasize both the ability of these diseases to demonstrate ocular involvement as well as important clinical and subclinical findings that may be seen with each. (B, hematoxylin & eosin, original magnification × 100; B (inset), original magnification × 400; C, avidin-biotin-complex immunoperoxidase, original magnification × 200). (A and B) Choroidal vessels are filled with atypical cells (arrows), which are CD68+. Our pathologic findings support that a routine eye examination, when possible, should be encouraged for patients with hematologic malignancies
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