Choroidal Lymphoma Research Articles

Intraocular lymphoma

The course of intraocular lymphoma will be focused on the diagnosis and treatment of this sight‐ and life‐threatening disease. The clinical manifestation of vitreoretinal as well as choroidal lymphoma will be presented, and diagnostic methods of intraocular fluids and tissues will be discussed.

Choroidal Metastases and Choroidal Lymphoma

Since the choroid is one of the organs with the most blood supply in the body, primary and metastatic tumors are common in the choroid. While metastatic choroidal cancers are the most common tumors of the eye, choroidal lymphoma is rare. The most common cancers that metastasize to the choroid are breast cancer and lung cancer. Choroidal lymphomas can be primary or secondary. Primary lymphoma is unilateral, slow growing and mild course. However, secondary lymphomas are bilateral, rapidly developing and aggressive. Treatment and survival of patients; varies depending on the extent of the disease, the general condition of the patient and the localization of the disease. Most patients have a limited life expectancy, but recent advances in systemic therapy have significantly improved the survival of some patients. The purpose of this review is to summarize current knowledge on choroidal metastases and choroidal lymphomas, highlighting the latest findings in epidemiology, pathogenesis, diagnosis, and treatment.

Response of Bacillary Layer Detachment after Chemotherapy for Choroidal Lymphoma

Response of Bacillary Layer Detachment after Chemotherapy for Choroidal Lymphoma

Management of primary choroidal lymphoma presenting as extensive serous retinal detachment and salmon patch of bulbar conjunctiva: a case report

BackgroundWe describe the outcome of ultra-low-dose radiotherapy plus intravitreal methotrexate and rituximab injections for a patient with primary choroidal lymphoma who presented with nodular conjunctival salmon patches and extensive serous retinal detachment.Case presentationA 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, “seasick” appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose “boom-boom” radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.ConclusionUltra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.

Indolent Nonprogressive Multifocal Choroidal Lymphoid Lesions: A Clinical–Histopathological Correlation

To present the clinicopathologic correlation of indolent nonprogressive multifocal choroidal lesions, clinically presumed to be lymphoid in nature, using multimodal imaging and histopathological analysis of a donor eye. Case study and clinicopathological correlation. A 77-year-old man of Caucasian ancestry with indolent, nonprogressive, multifocal, choroidal infiltration of his right eye, presumed to be lymphocytic in nature based on the appearance of the lesions, was followed up for 19 years. Multimodal imaging, including fundus photography, B-scan ultrasonography, OCT, fluorescein angiography, and indocyanine green angiography, was performed throughout the 19 years of follow-up before the patient's death. The involved eye was preserved 21 hours postmortem and analyzed using standard histopathological and immunohistochemical techniques. Correlation of findings on multimodal imaging with histopathological and immunohistochemical findings in the involved eye. Clinical examination over the course of 19 years showed no deterioration in the visual acuity of the involved eye. Multimodal imaging revealed yellow-orange choroidal lesions that showed no appreciable progression during the 19 years of follow-up. These areas stained minimally on fluorescein angiography. Indocyanine green angiography revealed tortuous choroidal vessels and fluorescence blockage. Enhanced-depth imaging OCT revealed hyporeflective, homogenous choroidal thickening. Light microscopy, histopathology, and immunohistochemistry showed that the lesions were composed of small, mature-appearing B cells that spared the choriocapillaris. The findings were most consistent with extranodal marginal-zone lymphoma of the mucosa-associated lymphoid tissue (MALT). Indolent, nonprogressive, multifocal, choroidal lymphoid lesions in this patient remained confined to the choroid, as determined based on the clinical examination and imaging for almost 2 decades, with no clinical evidence of extension into the retina. Light microscopy, histopathology, and immunohistochemistry postmortem showed that the lesions were composed of small, mature-appearing B cells that spared the choriocapillaris. The findings were consistent with extranodal marginal-zone lymphoma of the MALT. This entity is distinct from more aggressive uveal and choroidal lymphomas and is expected to remain relatively stationary on long-term clinical follow-up, with a good visual prognosis.

Choroidal Lymphoma: Diagnostic Value of Combined Indocyanine Green Angiography and Optical Coherence Tomography

ABSTRACT Objective To compare multimodal imaging findings in patients with choroidal lymphoma (CL). Methods Multicenter retrospective observational case series. Multimodal imaging features of patients with CL were reviewed with particular attention to the patterns of choroidal infiltration on indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Results Eighteen eyes of 15 patients were included in this study. Average tumor thickness on ultrasonography was 2.6 mm (range, 1.2-5.7 mm). Choroidal infiltration on ICGA was characterized by multifocal, round areas (300-500 microns diameter) of hypocyanescence in all cases, whereas OCT at the same region disclosed diffuse choroidal infiltration. By OCT, the tumor surface contour was primarily placid (22%), dome-shaped (11%), or undulating (67%). Conclusions In this analysis of eyes with CL, ICGA demonstrated multifocal sub-millimeter regions of choroidal hypocyanescence whereas OCT documented diffuse choroidal infiltration. This incongruence could be a distinctive diagnostic feature of choroidal lymphoma, assisting with differentiation from other pathological entities.

Diagnostic retinal biopsy in the management of secondary non-CNS vitreoretinal lymphoma masquerading as viral retinitis: a case report

BackgroundIntraocular lymphoma accounts for fewer than 1% of intraocular tumors. When the posterior segment is involved, it can be further classified as vitreoretinal or choroidal lymphoma. Vitreoretinal lymphoma (VRL) can rarely masquerade as an infectious retinitis making diagnosis and management challenging.ResultsA 73-year-old woman with a history of non-central nervous system (CNS) involving diffuse large B-cell lymphoma (DLBCL) was referred for worsening blurry vision—visual acuity of count figures at 2 ft—in her right eye for 8 months. Dilated fundus examination of the right eye was significant for retinal whitening and dot-blot hemorrhages, which was concerning for a viral retinitis and guided initial management. Secondary intraocular lymphoma was also considered. The retinal disease continued to progress despite intravitreal and systemic antiviral therapy, and a diagnostic vitrectomy was inconclusive. A retinal biopsy was then performed, which showed DLBCL, confirming a diagnosis of secondary VRL. Three subsequent treatments with intravitreal methotrexate led to regression of the VRL.ConclusionsOur case highlights the utility of a retinal biopsy after an inconclusive diagnostic vitrectomy in a challenging scenario of VRL to establish a diagnosis and initiate successful treatment. A multidisciplinary team of providers was essential for diagnosis, comprehensive workup, medical and surgical management of the patient.

Boom-Boom Radiotherapy for Choroidal Lymphoma—Two Days and Done

Boom-Boom Radiotherapy for Choroidal Lymphoma—Two Days and Done

DIAGNOSING SARCOIDOSIS IN THE EYE OF THE STORM

SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a granulomatous disease that typically affects the lungs but can involve all organ systems to a different extent and degree. The diagnosis requires a step wise approach that includes identifying affected organs amenable for biopsy. Up to 30% of patients may present with extra-pulmonary manifestations of sarcoidosis and ocular involvement is seen in up to 25% of these cases. We discuss a case of difficult to diagnose sarcoidosis in a patient with difficult to control asthma that presented with choroidal lesions concerning for ocular lymphoma which prompted additional workup. CASE PRESENTATION: 68 year-old woman with past medical history of difficult-to-treat, severe asthma and obesity with mixed restrictive/obstructive pulmonary functions referred to our institution for a second opinion. She had a long history of asthma since early in childhood that became very difficult to control requiring multiple burst of steroids, use of biologics, and high dose inhaled steroids. She endorsed daily productive cough of white sputum and mild malaise. She denied any other respiratory symptoms. She had undergone an extensive work including serologies and two bronchoscopies with transbronchial and endobronchial biopsies. Chest CT revealed patchy, ill-defined bilateral tree-in-bud opacities without bronchiectasis. Routine exam by her ophthalmologist prompted referral to a regional oncologic ophthalmologist and she was given the presumptive diagnosis of choroidal lymphoma and recommended to undergo choroid biopsy. A PET scan was positive only in the tonsillar beds and biopsy revealed reactive lymphoid hyperplasia. After discussion with ophthalmology the differential diagnosis of choroidal lymphoma, it was decided to proceed to a cryobiopsy of the lung to exclude the possibility of sarcoidosis. She underwent a bronchoscopy and bronchioalveolar lavage revealed 69% lymphocytes with normal flow cytometry. Cryobiopsy revealed non-necrotizing granulomas in a lymphangitic distribution without interstitial inflammation or bronchiolitis. After excluding other causes of granulomatous diseases coupled with eye lesions, patient was diagnosed with systemic sarcoidosis. She was started on oral prednisone with improvement in her respiratory symptoms. DISCUSSION: Sarcoidosis can present with mixed obstructive and restrictive physiology and mimic or exacerbate asthma. It can also present with both anterior and posterior uveitis and is the presenting symptom in 5% of cases. Choroidal and retinal disease can exist without symptoms yet result in blindness. CONCLUSIONS: It is important to recognize this potential presentation of sarcoidosis to start prompt treatment and prevent late complications such as secondary glaucoma and impaired vision. Reference #1: Y. Jamilloux, L. Kodjikian, C. Broussolle, P. Sève. Sarcoidosis and uveitis. Autoimmun Rev. 2014 Aug;13(8):840-9. Epub 2014 Apr 3. Reference #2: B. Bodaghi, V. Touitou, C. Fardeau, C. Chapelon, P. LeHoang. Ocular sarcoidosis. Presse Med, 41 (6 Pt 2) (2012), pp. e349-e354 Reference #3: M. Drent, U. Costabel. European respiratory monograph 32: sarcoidosis. European Respiratory Society (2005) DISCLOSURES: No relevant relationships by Sarah Hackman, source=Web Response No relevant relationships by Jay Peters, source=Web Response No relevant relationships by Jorge Villalpando, source=Web Response

INDOLENT, NONPROGRESSIVE, MULTIFOCAL CHOROIDAL LESIONS

In 2012, four patients with multiple asymptomatic, indolent, unilateral, choroidal lesions were described. We suspected benign-behaving lymphocytes infiltrating the choroid. This article expands the number of patients and duration of follow-up and speculates further on the etiology. Although histopathologic confirmation of these lesions is still unknown, the natural course of these patients is excellent and should be distinguished from aggressive choroidal lymphoma. To qualify for the study, the patients had to meet the following criteria: 1) Patients collected had asymptomatic choroidal infiltrates as demonstrated in the figures; 2) absence of vitreous cells; 3) no evidence of concomitant systemic malignancy; 4) no systemic inflammatory diseases, including sarcoidosis; 5) no birdshot chorioretinopathy; 6) no conjunctival or orbital lesions; and 7) advanced multimodal imaging and clinical follow-up were performed. There were 11 eyes of 11 patients seen. Follow-up ranged from 4 months to 12 years and 1 month (mean 50.2 months; median 24 months). Systemic workup was unrevealing. No patients in this cohort developed systemic, conjunctival, orbital, or vitreoretinal lymphoma or inflammatory disease. No patients developed symptoms or vision loss. This entity is an indolent choroidal infiltrative disease. It resembles some cases of choroidal lymphoma and may represent an indolent lymphocytic infiltrate.

Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging

BackgroundHematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease.Case presentationA 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness.ConclusionsOur detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.

Choroidal lymphoma or something else?

Choroidal lymphoma or something else?

Primary vitreoretinal lymphoma

Primary vitreoretinal lymphoma (PVRL) is the most common intraocular lymphoma. It is ahigh grade malignant B‑cell lymphoma, which is thought to arise in the retina. It often infiltrates the central nervous system (CNS) and is therefore associated with apoor prognosis. The PVRL must be differentiated from other forms of intraocular lymphoma, such as the low-grade B‑cell lymphoma that rarely arises in the choroid. The choroidal lymphomas do not spread to the brain, they can be treated with low-dose external beam radiotherapy and the patients have agood prognosis. Since PVRL is arelatively rare tumor, there is little information with respect to its true incidence, to any geographical or ethnic variability and to the main risk factors apart from an association with immunosuppression, as aresult of HIV or Epstein-Barr virus infections. The treatment of PVRL is very variable between oncology centres and is also dependent on the unilaterality or bilaterality of disease and whether there is any concomitant CNS involvement. Further studies and research projects in this field are necessary in order to diagnose PVRL at an early stage and to develop new targeted individualized treatment.

OCT Angiography: Imaging of Choroidal and Retinal Tumors

Optical coherence tomography angiography (OCTA) is a new, noninvasive imaging modality used to assess the vasculature in chorioretinal disease. The purpose of this study was to describe OCTA findings in several chorioretinal tumors, specifically melanocytic tumors. We correlate these findings with clinical risk factors (RFs) for growth. This was a cross-sectional, comparative, observational study. We compiled a total of 79 cases consisting of the following: 55 choroidal nevi, 11 choroidal melanomas, 5 choroidal hemangiomas, 3 astrocytic hamartomas, 2 choroidal lymphomas, 1 choroidal metastases, 1 combined hamartoma of the retina and retinal pigment epithelium (RPE), and 1 choroidal osteoma. We performed OCTA of the 79 lesions to create images that were then analyzed by 3 different physicians. In addition to OCTA, we also used multi-imaging studies, including OCT, retinal color and autofluorescence fundus imaging, Doppler echography, and indocyanine/fluorescein angiography. The melanocytic lesions were divided into 6 different groups according on the number of clinical RFs present. We compared each group with the OCTA findings, seeking any correlation between OCTA findings and the number of RFs present. All layers of the OCTA were evaluated and described. In melanocytic lesions, 6 specific variables within the choriocapillaris layer were evaluated. We also studied the quality of the images, the presence of avascular areas within the lesion, heterogeneity of the choroidal plexus over the lesion, the presence of a neovascular membrane associated with the lesion, the definition of the lesion's borders, and the presence of a hyperreflective ring surrounding the lesion. Satisfactory imaging was obtained in 82.7% of the cases. Concordance κ indexes between the observers were satisfactory (0.768-0.958). For melanocytic lesions, the images of choroidal nevi were described mainly as heterogenic (61.4%) and hyperreflective (81.8%). Choroidal melanoma was mainly described as isoreflective or hyporeflective (62.5%) and associated with a hyperreflective ring (62.5%). The presence of a hyporeflective plexus within the tumor (P= 0.002) and the presence of a hyperreflective ring surrounding the lesion (P= 0.001) were associated with lesions with more RFs. General descriptive OCTA findings are made for nonmelanocytic tumors. OCTA is a very promising new technology that can be used in the study of posterior segment ocular tumors. When studying melanocytic tumors, the presence of a hyporeflective plexus or hyperreflective ring (in the choriocapillaris layer) surrounding the tumor is associated with a higher risk of malignancy. Larger studies are needed to corroborate these findings. However, we hope that these data can encourage more regular screening for those detected to be at high risk and, hence, reduce the risk of malignancies detected at a late stage.

EXTERNAL BEAM RADIATION FOR CHOROIDAL LYMPHOMA: Efficacy and Complications.

To determine the efficacy and safety of external beam radiation for treatment of choroidal lymphoma (CL). Retrospective case series. Twenty-five eyes of 24 patients with CL treated with external beam radiation. Review of medical records. Tumor control, visual acuity, and radiation complications. The mean age of the patients was 62 years (median, 65; range, 32-89 years). Only 2 patients (8%) had a history of systemic lymphoma. The most common symptom was painless blurred vision in 14 eyes (58%) and the mean duration of ocular symptoms was 12 months (median, 7; range, 1-36 months). Initial best-corrected visual acuity was 20/40 or better in 10 eyes (40%), 20/50 to 20/150 in 12 eyes (48%), and 20/200 or less in the other 3 eyes (12%). The fovea was involved by the CL in 16 eyes (64%). Mean tumor thickness was 3.1 mm (median, 3.0; range 1.1-6.3 mm). Anterior and posterior transscleral extension of CL were present in 15 (60%) and 14 eyes (56%), respectively. All patients, except 3 (13%), had some form of ocular biopsy confirming the diagnosis of ocular lymphoma. The mean total radiation dose was 2,867 cGy (median, 3,000; range, 1,200-3,600 cGy). At final examination, after a mean follow-up period of 58 months (median, 35; range, 13-228 months), 18 eyes (72%) showed complete regression of CL and 7 eyes (28%) showed partial regression. All eyes (100%) with initial serous retinal detachment (14 eyes), subfoveal fluid (8 eyes), and macular edema (5 eyes) achieved complete resolution of subretinal or intraretinal fluid after treatment. Recurrence of CL after initial partial response developed in only 1 eye (4%). Compared with the initial evaluation, final best-corrected visual acuity had increased in 11 (44%), was stable in 8 (32%), and had decreased in 6 eyes (24%). Only 2 eyes (8%) showed signs of mild nonproliferative retinopathy. In this study, external beam radiation was an effective and safe modality for treatment of CL, achieving long-term tumor regression in 96% and stable or improved vision in 76% after mean follow-up period of 6 years.

Primary choroidal lymphoma

The case of primary choroidal lymphoma was submitted. We described specific features that require the exception of choroidal lymphoma.

Case report of ring ciliary body and choroidal lymphoma

PurposeThe aim of the study was to analyze case of ring ciliary body and choroidal lymphoma.MethodsRetrospective analysis.Results54 years old man was sent in October 2014 to Department of Ophthalmology of the Jagiellonian University Medical College in Cracow with diagnosis of choroidal melanoma in left eye. Tumor was detected accidently. BCVA in both eyes was 1.0. Intraocular pressure in both eye was correct. In patients history stomach lymphoma treated in 1996 with radiotherapy and chemiotherapy. In fundus examination we found mass located temporally in choroid and cilary body. Ultrasound examination (USG and UBM) showed ciliary body and choroidal mass located between 2 and 7 clock hour (almost 180 degrees), thickness 8.2 mm, base 14.30 mm. The patient was qualified to biopsy of ciliary body and choroidal mass and I‐125 brachytherapy. During 2 weeks tumor enlarged, was located in 270–300 degrees and looks like ciliary body ring melanoma (thickness 9.0 mm, base 23.3 mm) with iris elevation and conjunctival edema. Enucleation of left eyeball was performed. Histopathological examination reveled neoplasma malignum probabiliter non epitheliale. Lypmoma malignum – marginal zone lymphoma. Immunohistochemical profile of tumor showed experesion CD20+, CD5‐, CD23‐, CD3‐, lack of expression lambda gains.ConclusionsLypmoma malignum – marginal zone lymphoma may occur like ciliary body and choroidal ring which should be considered in the differential diagnosis of intraocular tumors.

Primary Cilio-Choroidal Lymphoma with Epibulbar Extension

Shahana Mazumdar MS, DNB C 404 SomVihar Apartments R K Puram sector 12, New Delhi 110022 E-mail: shahana.mazumdar@gmail.com *Address for correspondence Primary intraocular lymphomas are rare malignancies and maybe either primary vitreore nal lymphomas or primary uveal lymphomas. Though primary vitreore nal lymphomas are increasingly being recognized, primary uveal lymphomas remain a very rare en ty. Amongst the primary uveal lymphomas, choroidal lymphomas are the commonest, followed by iris lymphomas and the least commonly reported are primary ciliary body lymphomas with only a couple of case reports.1,2 The ciliary body involvement is more commonly secondary to iridal or choroidal lymphomas.3-5 We are repor ng one such rare case of primary uveal lymphoma involving mainly the ciliary body with choroidal and epibulbar extension. This diagnosis was possible with the use of ultrasound biomicroscopy (UBM) and episcleral biopsy. The pa ent underwent Image Guided Radiotherapy (IGRT) with complete regression of the tumor and no recurrence or systemic lymphoma 2 years post treatment. It is important to recognize this en ty as it can mimic condi ons with graver prognosis such as a melanoma. Primary uveal lymphomas have a more benign course and respond drama cally to radiotherapy.

Diagnostik und Therapie der choroidalen Lymphome

Choroidal lymphoma is a rare disease and can be classified into primary and secondary choroidal lymphomas. Primary choroidal lymphoma is a low-grade extranodal marginal zone B-cell lymphoma and secondary choroidal lymphomas present ocular manifestations of disseminated systemic lymphomas. Typical clinical features of choroidal lymphoma are multifocal, yellow-whitish choroidal infiltrates. The vitreous body is usually clear and cell-free. Choroidal lymphoma has a tendency to extend through the sclera. In contrast to primary choroidal lymphoma, which is more often unilateral, does not show signs of anterior segment involvement and has a slow progression, secondary choroidal lymphoma is more often bilateral, has a rapidly progressive course with anterior segment and vitreous involvement and belongs to the high-grade lymphomas. The definitive diagnosis of choroidal lymphoma can only be confirmed by histopathological examination of biopsy tissue. The choroidal biopsy is the gold standard in the diagnostics of choroidal lymphoma. To date, no standardized treatment for choroidal lymphoma has been established. The treatment modalities include external beam radiotherapy, immunotherapy with rituximab and chemotherapy. The prognosis for survival of primary choroidal lymphoma is usually good. The prognosis of secondary choroidal lymphoma depends on the malignancy grade of systemic lymphoma.

Secondary Choroidal Lymphoma Associated with Systemic Choroidal Lymphoma

Purpose: To report a case of secondary choroidal lymphoma. Case summary: A 57-year-old female presented at our clinic with decreased vision in her right eye 1 month in duration. Slit-lamp examination showed vitreous cells in the right eye. Fundus examination of the right eye revealed an elevated yellowish mass-like lesion at the temporal area and multifocal yellowish patches at the choroidal level. The clinical impression was intraocular lymphoma. We performed diagnostic vitrectomy, but the result was negative. A systemic evaluation revealed enlarged cervical lymph nodes and lymph node biopsy showed diffuse large B-cell lymphoma. The patient was diagnosed as secondary choroidal lymphoma associated with systemic lymphoma and was treated with systemic chemotherapy and 4 injections of intravitreal methotrexate. The patient is scheduled for regular follow-ups. Conclusions: Choroidal mass may be the initial presenting sign of systemic lymphoma, and an extensive systemic evaluation should be performed. J Korean Ophthalmol Soc 2015;56(3):458-462