Intraocular T-cell Lymphoma Research Articles

Intraocular Lymphoma in Dogs - Findings of Contrast Enhanced Ultrasound and ARFI Elastography

Background: Ocular lymphoma can affect the iris, conjunctiva, choroid, and retina and is mostly associated with multicentric disease. Elastography is an ultrasound technique that provides noninvasive, pain-free assessment of tissue stiffness. It has the ability to assess subtle changes throughout the organ as well as focal lesions. Microbubble contrast ultrasound enables the detection of incipient vascular flows, which are difficult to detect using traditional ultrasound methods. This study aimed to describe acoustic radiation force impulse (ARFI) elastography and microbubble contrast ultrasound findings in the eyes of two dogs diagnosed with intraocular T-cell lymphoma. Cases: Case 1. Physical examination revealed an exophytic mass in the left eye. Schirmer test revealed a secretion of 22 mm/min. Negative threat reflex, glare, direct pupillary light reflex, and consensual response were also noted. Biomicroscopy revealed hyperplasia of the third eyelid, overlapping with the affected eye. When the membrane was removed, moderate conjunctival hyperemia, mucoid secretion, and buphthalmia were observed. In addition, significant corneal edema was present, making it impossible to visualize the anterior chamber and perform fundus examination. The intraocular pressure, as measured with a rebound tonometer, was 39 mmHg. B-mode ultrasonography identified amorphous, hyperechoic, and heterogeneous structures throughout the anterior chamber, iris, and ciliary body. The elastogram showed that the mass had greenish tones and intermediate stiffness, and the mean SWV of the ciliary body and iris was 2 m/s. Contrast-enhanced ultrasound (CEUS) revealed vascularization of the neoformation region, with wash-in, peak, and wash-out values of 9.89 s, 24.56 s, and 107.87 s, respectively. Case 2. On physical examination, a change in the shape of the right pupil was observed. Schirmer test revealed a secretion of 20 mm/min, with negative threat, glare, and pupillary reflexes to direct and consensual light. Biomicroscopy revealed neoformation from 7 am to 11 am in the sclera, retina, and choroid complex, concomitant with dyscoria and conjunctival hyperemia. The intraocular pressure, as measured by rebound tonometry, was 33 mmHg. Fundoscopy revealed a mass in the temporal region and focal retinal detachment. No changes were observed in the contralateral eye. B-mode ultrasound revealed an increase in volume in the temporal region of the iris, ciliary body, and choroid with diffuse heterogeneity and partial retinal detachment. Elastographic examination revealed shades of green and yellow compatible with increased tissue stiffness. On quantitative examination, the mean SWVs of the ciliary body and iris were 3.14 m/s. On CEUS, the neoformation region presented wash-in, peak, and wash-out values of 8.67 s, 22.33 s, and 80.20 s. Discussion: B-mode ultrasonography established the tumor extent and evaluated echogenicity, verifying the involved ocular structures. The examination played an important role in the diagnosis as well as clinical management. ARFI elastography can detect small tissue changes, helping to define nodules and masses more reliably, in addition to allowing the verification of tissue stiffness. In both dogs, it was possible to verify that the masses presented greater rigidity than the adjacent tissues both qualitatively and quantitatively. In previous studies, it was found that cutaneous and breast lymphomas in humans were more rigid than adjacent tissues on elastography. This increase in rigidity and heterogeneity observed on elastograms can be explained by the extramedullary interactions of the matrix in T-cell lymphomas. Tumor growth is dependent on the blood supply, which was evaluated using CEUS in these cases. Furthermore, the ciliary body contrast filling times were longer than those described in normal dogs. Keywords: eye, surgery, diagnostic imaging, pain, veterinary ophthalmology, neoplasia. Título: Linfoma intraocular em cães - achados da ultrassonografia contrastada e elastografia ARFI Descritores: olho, cirurgia, diagnóstico por imagem, dor, oftlamologia veterinária, neoplasia.

Primary Intraocular T-cell Lymphoma

Primary Intraocular T-cell Lymphoma

Intraocular T-cell Lymphoma: Clinical Presentation, Diagnosis, Treatment, and Outcome

ABSTRACTPurpose: To report on the clinical data of seven patients with T-cell intraocular lymphoma (IOL).Methods: Retrospective case series.Results: Seven immunocompetent patients, 12 eyes, 6 women, with T-cell-IOL were included from five countries. Mean age was 53.5 years (range: 25–82). Four patients had systemic-ocular lymphoma, two had CNS-ocular lymphoma, and one had systemic-CNS- ocular lymphoma. Vitritis was the most frequent clinical sign, followed by anterior uveitis and serous retinal detachment. Cytopathologic examination was performed on all ocular specimens (vitreous in six and iris mass biopsy in one patient). Adjunctive diagnostic procedures included immunohistochemistry, molecular tests, and cytokine profiling of vitreous samples. Treatment modalities included systemic chemotherapy (five patients), intravitreal methotrexate (three patients), globe radiotherapy, and intrathecal chemotherapy. Mean survival from diagnosis was 21.7 months (range: 2–69). Two patients are still alive.Conclusions: T-cell IOL has variable clinical manifestations and prognosis. Systemic involvement, SRD, and vitreoretinal involvement were frequently observed.

Intraocular T-cell Lymphoma due to Mycosis Fungoides and Response to Intravitreal Methotrexate

Purpose: To report a case of mycosis fungoides with subsequent intraocular involvement and good response to intravitreal methotrexate.Design: Case report.Methods: Retrospective chart review.Results: This is a rare case of intraocular T-cell lymphoma due to mycosis fungoides, which responded to intravitreal methotrexate therapy in a previous vitrectomized eye.Conclusions: Intraocular T-cell lymphoma is a rare manifestation of mycosis fungoides and should be considered in the differential diagnosis of chronic uveitis in patients with this history. Intravitreal methotrexate may be an effective adjunctive treatment for this condition.

Intravitreal Methotrexate as Adjunctive, Palliative Therapy in Intraocular T-cell Lymphoma

Purpose: To report on the rapid and sustained effect following injection of intravitreal methotrexate (IVTMTX) in intraocular T-cell lymphoma.Design: Report of 2 cases.Methods: A young male with natural killer/T-cell lymphoma presented with infiltrative nodular iridocyclitis and received a single IVTMTX. An elderly female with peripheral T-cell lymphoma presented with a hypopyon, infiltrative iridocyclitis, and choroidal effusions and received 3 IVTMTX over 4 months.Results: Both patients responded well after the first injection, with resolution of signs within 1 week and improvement in vision.Conclusions: IVTMTX may be effective as a palliative, vision-restoring measure in patients with systemic T-cell lymphoma.

Cytofluorographic and molecular identification of a CD8-positive, TCR-alpha/beta-negative intraocular T cell lymphoma: a case report and review of the literature.

IntroductionCytofluorographic and molecular techniques are effective adjuncts in diagnosing intraocular lymphoma. Primary intraocular lymphoma is an uncommon entity predominantly of B cell origin and rarely with a T cell phenotype. The aim of the present paper is to report a case of a CD8-positive, TCR-α/β-negative intraocular T cell lymphoma and review the literature.Case presentationT cell neoplasia was detected based on flow cytometric demonstration of an abnormal T cell population and polymerase chain reactions for immunoglobulin and T-cell receptor rearrangements demonstrating evidence of monoclonality. Flow cytometry revealed a T cell population aberrantly expressing T-cell lineage markers. This T cell population expressed CD2, bright CD3, CD8, bright CD7, CD38, CD69, and variable CD25. T-cell receptor γ gene rearrangement studies demonstrated evidence of T-cell gene rearrangement confirming that the T cells were monoclonal.ConclusionWe herein report the rare case of a TCR α/β-negative CD8+ intraocular T-cell lymphoma suggestive of gamma/delta origin diagnosed by flow cytometry and polymerase chain reaction.

Ocular Manifestations of Adult T-cell Leukemia/Lymphoma: A Clinicopathologic Study

Adult T-cell leukemia/lymphoma (ATLL) is a recently described distinct clinicopathologic entity characterized by an extremely aggressive clinical course, a leukemic or lymphomatous proliferation of hyperlobulated peripheral T cells, and an association with infection by a retrovirus, human T-lymphotropic virus type I (HTLV-I). The authors present a patient with ATLL who initially had clinical features of severe uniocular intraocular inflammation, simulating acute retinal necrosis or herpetic retinitis, but results of histopathologic examination of the globe showed ATLL. A 38-year-old man had severe unilateral intraocular inflammation associated with widespread diffuse retinitis. Two weeks later, a focal retinitis with vasculitis developed nasal to the optic disc in the opposite eye. Shortly thereafter, mental disturbance developed, and the patient died less than 3 months after onset of the ocular symptoms. Results of postmortem examination showed atypical lymphocytic infiltration in the eyes, brain, and other systemic organs. Results of histopathologic and immunohistochemical studies showed that the atypical cells infiltrating the ocular tissues were ATLL cells. Patients infected with HTLV-I initially can have intraocular T-cell lymphoma that simulates acute retinal necrosis or herpetic retinitis.