title: Vitreoretinal presentation of secondary large B-cell lymphoma in patients with systemic lymphoma.
abstract: OBJECTIVE
  Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma.
  
  
  OBJECTIVE
  To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma. DESIGN Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes. SETTING Mayo Clinic pathology database.
  
  
  METHODS
  Fifty-five patients with vitreous specimens available for review.
  
  
  METHODS
  Vitreous aspiration biopsy.
  
  
  METHODS
  Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL).
  
  
  RESULTS
  Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium.
  
  
  CONCLUSIONS
  Vitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomão
authors.forename: José S
authors.initials: JS
authors.lastname: Pulido
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: Irene
authors.initials: I
authors.lastname: Canal-Fontcuberta
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001918:Brachytherapy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003131:Combined Modality Therapy; D005134:Eye Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D016130:Immunophenotyping; D017403:In Situ Hybridization; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology* / Q000628:therapy; D016393:Lymphoma, B-Cell / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D019572:Retinal Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014821:Vitrectomy; D014822:Vitreous Body / Q000737:chemistry / Q000473:pathology*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins