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.

Figure 1

Fundus photograph showing vitreous haze OS and early angiograph showing no retinal or choroidal lesions OU

Figure 2

Figure 2A: Cytology of the vitreous specimen revealed many atypical, large lymphoid cells, with large, round, irregular nuclei, visible nucleoli and basophilic cytoplasm (Giemsa, original magnification, x640). Figure 2B: Immunohistochemistry showed that most atypical cells were CD3 positive (avidin-biotin-complex immunoperoxidase, original magnification, x200). Figure 2C: The skin biopsy showed a marked infiltration of atypical polymorphic lymphoid cells, involving the dermis and the epidermal and dermal junction (hematoxylin & eosin, original magnification, x100). Figure 2D: The atypical lymphoid cells (vitreous and skin) obtained by microdissection were subjected to polymerase chain reaction amplification and detected clonal TCR-γ gene rearrangement.