[Primary intraocular lymphoma with unusual clinical presentation and poor outcome].
BACKGROUND
Primary intraocular lymphoma is a distinct subset of primary non-Hodgkin's lymphoma of the CNS. In general, the primary non-Hodgkin's lymphoma of the CNS is rare, accounting for 1 % of all non-Hodgkin's lymphomas and less than 1 % of all intraocular tumors.


METHODS
A 70-year-old man was hospitalized in June 2002 because of acute loss of vision on his left eye. A severe vitreous hemorrhage was observed. Ultrasound showed solid subretinal lesions at the posterior fundus. Diagnostic vitreous surgery including a biopsy was performed. An intraocular malignant B-cell lymphoma was determined by immunohistochemistry. General screening revealed no further manifestations of the lymphoma.


RESULTS
The patient initially refused any therapy until a painful secondary neovascular glaucoma with complete loss of visual function developed, thus prompting us to perform an enucleation. The following immunohistochemical examination confirmed the initial diagnosis. A chemotherapy with high-dose methotrexate and leucovorin rescue was initiated.


CONCLUSIONS
Primary intraocular lymphoma can present as diffuse uveitis refractory to corticosteroids. Diagnosis can be difficult and is often delayed.
Pache
M
M
Universitäts-Augenklinik Basel, Mittlere Str. 91, 4012 Basel, Schweiz.
Kain
H
H
Buess
M
M
Flammer
J
J
Meyer
P
P
D000368:Aged; D001706:Biopsy; D001766:Blindness / Q000209:etiology*; D016570:Bruch Membrane / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002829:Choroid / Q000473:pathology; D002830:Choroid Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D015353:Eye Enucleation; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009896:Optic Atrophy / Q000473:pathology; D011379:Prognosis; D012160:Retina / Q000473:pathology; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology; D014823:Vitreous Hemorrhage / Q000175:diagnosis / Q000473:pathology / Q000601:surgery
D002955:Leucovorin; D008727:Methotrexate