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Title: | Intravascular large B-cell lymphoma of the eye: Literature review and new findings |
Authors: | Roditi, Eduardo;Panicker, Shyam;Fung, Adrian T. |
WSLHD Author: | Roditi, Eduardo;Panicker, Shyam;Fung, Adrian T. |
Issue Date: | 2024 |
Citation: | Asia-Pacific Journal of Ophthalmology 13(2):100053, 2024 |
Abstract: | PURPOSE: Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare, aggressive, multi-system disease that can affect the eye. We describe the ophthalmic presentation, multimodal imaging and treatment response of uveal IVLBCL. METHODS: Review and case report. RESULTS: Twenty-five published cases of IVLBCL involving the eye including our own were identified. Of these, 15 patients (60%) had clinically-detectable intraocular involvement, 6 (24%) had extraocular ophthalmic involvement only and 4 (16%) had subclinical, undiagnosed intraocular involvement that was retrospectively detected on post-mortem ocular histopathology. The male to female ratio was 1.08:1 with a mean presenting age of 65.1 +/- 11.7 years (range 38-82 years). The majority of cases had bilateral involvement (21/25 patients, 84%). Extraocular manifestations included diplopia, ptosis and ophthalmoplegia. Intraocular manifestations included serous retinal detachment (13/28, 46%), retinal hemorrhages (9/28, 32%), vascular changes (9/28, 32%), retinal pigment epithelial changes (7/28, 25%), thickened choroid (6/28, 21%), vitritis (5/28, 17%), cotton-wool spots (3/28, 10%), and a subretinal lesion (1/28, 3%). Histopathological diagnosis was most commonly confirmed on post-mortem enucleation (8/25 patients, 32%), skin (6/25 patients, 24%) or brain biopsy (6/25 patients, 24%). CONCLUSION: The presence of intra-retinal hemorrhages, cotton wool spots and/or Roth spots help differentiate IVLBCL from other similarly presenting diseases such as central serous chorioretinopathy and Vogt-Koyanagi-Harada disease. New signs not previously described in IVLBCL include macular bacillary layer detachment and hypo-cyanescent spots on ultra-wide field indocyanine green angiography. The diagnosis is elusive and requires tissue biopsy, but systemic chemotherapy and rituximab can lead to rapid improvement of the eye. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/9687 |
DOI: | https://dx.doi.org/10.1016/j.apjo.2024.100053 |
Journal: | Asia-Pacific Journal of Ophthalmology |
Type: | Journal Article |
Study or Trial: | Review Case Reports |
Department: | Ophthalmology Haematology |
Facility: | Westmead |
Keywords: | Antineoplastic Combined Chemotherapy Protocols Eye Neoplasms Fluorescein Angiography Lymphoma, Large B-Cell, Diffuse Vascular Neoplasms |
Appears in Collections: | Westmead Hospital 2019 - 2024 |
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