Pink pseudohypopyon as a presenting feature of large B‐cell lymphoma

Abstract

AbstractPurpose To describe the clinicopathologic features of a patient who developed an anterior chamber (AC) infiltrate mimickina pink pseudohypopyon as a presenting feature of large B‐cell lymphoma.Methods The clinical and pathologic findings in a patient with AC infiltrates secondary to systemic B‐cell lymphoma are reviewed. Main outcome measurements were clinical observation and cytologic/flow cytometric examination of the infiltrate after AC aspiration.Results A 51‐year‐old woman was evaluated for decreased vision in her right eye. On examination, her visual acuity was 20/30 in the right eye (RE) and counting fingers in the left eye. Abnormalities were confined to the RE. Slit lamp examination revealed +1 AC cells with a pink pseudohypopyion occupying 40% of the AC. The iris was corrugated and had small new vessels in the stroma. An anterior chamber aspirate was performed, and 0.8 ml of fluid was obtained. The sample was formed by 32% of lymphocytes and 54% of neutrophils. B‐lymphocytes were predominant over T‐lymphocytes (91% and 8%, respectively). Cytologic examination showed scattered atypical mononuclear cells. Immunohistochemical stains were positive for CD19 in the atypical cells. Flow cytometric immunophenotyping revealed a clonal, kappa restricted population of B‐lymphocytes comprising 97% of the viable cells in the sample. These results were consistent with a large B‐cell extranodal lymphoma.Conclusion Anterior chamber/iris infiltration from systemic lymphoma is exceedingly rare, present in less than 10% of patients. Herein, we describe a patient with systemic lymphoma in whom the first manifestation was a pink pseudohypopyon.