J Korean Ophthalmol Soc.  2011 Jul;52(7):871-875. 10.3341/jkos.2011.52.7.871.

Presumed Intraocular Natural Killer/T-cell Lymphoma Combined with Nasal Lymphoma

• Jeong HS
• Park SH
• Lee JH
• Lee DY
• Nam DH

• KMID: 2214714
• DOI: http://doi.org/10.3341/jkos.2011.52.7.871

Abstract

PURPOSE
To report a case of presumed intraocular natural killer/T-cell lymphoma (NKTL).
CASE SUMMARY
A 61-year-old male presented with visual disturbance of the left eye for duration of 3 years. He had been treated with systemic chemotherapy and radiotherapy for nasal NKTL 1 year prior. Inflammatory reaction in the anterior chamber and vitreous opacity were observed in the left eye. The patient was diagnosed with uveitis in the left eye at a local clinic 3 years prior to visiting us. Because the patient did not respond to anti-inflammatory therapy, we performed diagnostic and therapeutic vitrectomy. Intraoperatively, vitreous opacity was thin sheet like in appearance. The vitreous specimen contained few lymphoid cells and was positive for Epstein Barr virus-encoded RNA (EBER). Systemic workups showed no metastasis to other organs. The patient was treated with systemic methotrexate chemotherapy and intravitreal methotrexate injected 3 times (once per week). During the 12-month follow-up period after the last intravitreal injection, the recurrence of lymphoma and related uveitis was not observed.

Keyword

Diagnostic vitrectomy; Intraocular natural killer/T-cell lymphoma

MeSH Terms

Anterior Chamber
Eye
Follow-Up Studies
Humans
Intravitreal Injections
Lymphocytes
Lymphoma
Male
Methotrexate
Middle Aged
Neoplasm Metastasis
Recurrence
RNA
Uveitis
Vitrectomy
Methotrexate
RNA

Figure

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  Figure 1. Nasal NK/T-cell lymphoma. H&E staining after endonasal biopsy showed infiltration of lymphoma cells. Immunohistochemical staining with cell markers was positive for CD3, 56, granzyme B, TIA-1, but showed no immunoreactivtiy against CD20. All images were captured at an original magnification of ×400.

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  Figure 2. Fundus photographs of the left eye at initial visit show dense vitreous infiltration.

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  Figure 3. Intraoperative photographs show thin sheet-like vitreous opacities.

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  Figure 4. Cytology from the vitreous shows a few atypical lymphoid cells with large polymorphic nuclei and scanty basophilic cytoplasm (A, Wright-Giemsa, original magnification of ×400), and Epstein Barr virus-encoded RNA (EBER) in situ hybridization revealed specific EBER transcripts in vitreous (B, original magnification of ×400).

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  Figure 5. Twelve months after vitrectomy and intravitreal methotrexate injections, fundus photograph shows preexisting optic atrophy and absence of recurrence of lymphoma.

Reference

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