Presumed Ocular Relapse of Diffuse Large B Cell Uterine Lymphoma Presenting Only as Vitritis after Continuous and Complete Remission

Abstract

Purpose: To report an ocular relapse of diffuse large B cell uterine lymphoma. Case summary: A 51-year-old woman with diffuse large B cell uterine lymphoma reached and maintained complete remission for four consecutive years at six re-staging evaluations after six cycles of cyclophosphamide, hydroxyl-daunorubicin, oncovin, and prednisone chemotherapy. Late ocular relapse of diffuse large B cell lymphoma may simply present as cells in the vitreous cavity without any systemic involvement. Diagnostic vitrectomy was performed, and the cytopathologic exam showed monoclonal B cell origin lymphoma. The patient was given a repeat course of intravitreal methotrexate injections and six cycles of high-dose methotrexate and Ara-C intravenously. Despite the chemotherapy, brain involvement was detected 26 months after the diagnosis. However, the patient remains alive after 48 months. Conclusions: In selected patients with intraocular lymphoma, having a high degree of clinical suspicion is the most important factor required to make the diagnosis; diagnostic vitrectomy is useful for both diagnostic and therapeutic purposes.