Ophthalmic Manifestations, Cytology, Immunohistochemistry, and Molecular Analysis of Intraocular Metastatic T-Cell Lymphoma: Report of a Case and Review of the Literature

Abstract

We report a case of T-cell lymphoma metastatic to the eye, with an accompanying review of the literature. A 78-year-old white male with bilateral vitritis was diagnosed with primary cutaneous peripheral T-cell lymphoma unspecified, via vitreous biopsy. The tumor was found to be clonally related to the prior cutaneous malignancy using cytology, immunophenotyping, and molecular analysis. The vast majority of primary intraocular lymphomas are malignant B-cells, whereas intraocular T-cell lymphomas are uncommon. This case demonstrates the utility of immunophenotyping and molecular analysis with microdissection and polymerase chain reaction, as critical adjunctive studies, in patients presenting with a masquerade syndrome, and later diagnosed with T-cell intraocular lymphomas. Vitreo-retinal without uveal involvement in this case, similar to many ocular metastatic T-cell lymphomas reported in the literature, is particularly intriguing because the uvea, not retina, is the typical ocular tissue involvement in the majority of metastatic B-cell lymphomas.

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

“…Incomplete data from patients 1, 3, and 5 have already been reported. 21,26,28 but charts of these patients were retrieved and complementary data were collected and included in the present study.…”

“…Unlike metastatic B-cell IOL, which involves the uvea, metastatic T-cell IOL predominantly presents with vitreoretinal involvement. 26 The most frequently reported metastatic T-cell IOL is the cutaneous peripheral T-cell lymphoma (mainly the mycosis fungoides subtype), the NK-T cell lymphoma and the adult T-cell lymphoma/leukemia. The aim of this article is to report on the clinical features, diagnosis, treatment, and outcome of seven immunocompetent patients diagnosed with T-cell IOL.…”

Primary Intraocular Lymphoma

“…207 Systemic T-cell lymphoma with intraocular involvement shares some of the ocular clinical features of typical B-cell PIOL. 132,135 3. Historical aspects…”

“…72,104,135,136,176 Subretinal tumors may consist largely of necrotic tissue, and so specimens are ideally taken from the deeper part of the lesion, near the choriocapillaris, where viable lymphoma cells are most likely to be found. 52 Transcleral biopsy using a partial scleral thickness flap is described.…”

Papilledema as a diagnostic challenge — report of three cases

“…Primary involvements may appear in cases of glioma, optic nerve sheath meningeoma (ONSM), hemangioblastoma, and primary intraocular lymphoma [6][7][8]. Secondary involvements of the optic disc are rare and may appear in cases of lymphoma, leukemia, lung, breast, and renal carcinoma, signet-cell gastric carcinoma, and squamous cell carcinoma of the uterine cervix (8)(9)(10). Melanocytoma and ONSM may be primary and secondary [11][12][13].…”