Iris Infiltration in Systemic Non-Hodgkins Lymphoma (NHL) as First Sign of Insufficient Chemotherapy
Berthold S.1, Kottler U. B.1, Frisch L.1, Radner H.2, Pfeiffer N.1
Johannes-Gutenberg University Mainz, 1Department of Ophthalmology; 2Department of Pathology
Purpose: Non-Hodgkins lymphoma affects the eye either as a primary tumor or metastatic. To our knowledge, only one case of infiltrations of the iris as an oculare relapse during systemic remission has been described in the literature so far.
Method: Case report with clinical, pathologic and radiographic findings.
Results: A 76-year-old female presented with ocular pain, hyphema with an overlying layer of leucocytes, hyperemia and temporal prominence of the iris and secondary glaucoma. Sonographically vitreous cells but no solid tumor were visible. Five months earlier a high malignant B-cell NHL in the inguinal region had been diagnosed. After finishing the systemic chemo therapy the disease was thought to be in remission. Magnetic resonance imaging showed a meningeal enhancement, presuming a lymphatic meningitis; repeated spinal punctures could not confirm a central nervous spread. As the anterior chamber aspirate showed no malignant cells, we performed an iris biopsy for confirmation of the diagnosis. Histopathologically, the biopsy specimen revealed infiltration with atypical lymphoid blastic cells. Orbital radiation was started (30 Gy). Three weeks later the patient developed a hemiplegia. A computerized tomography revealed a pro
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