|Year : 1984 | Volume
| Issue : 2 | Page : 105-107
Lymphoma of choroid
SC Sen1, NC Pal2
1 Regional Institute of Ophthalmology, Medical College, Calcutta, India
2 Department of Pathology, B.S. Medical College, Bankura, India
S C Sen
Regional Institute of Ophthalmology, Medical College, Calcutta-700 073
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sen S C, Pal N C. Lymphoma of choroid. Indian J Ophthalmol 1984;32:105-7
Lymphoma of choroid is a condition of aggregation of lymphocytes in this tissue, which may occasionally appear unassociated with any blood dyscrasia, in the form a tumour which may remain isolated and benign. A primary lymphoma of choroid is an exceptional occurrence. Lymphosarcoma of choroid with invasive nature is more common and often associated with similar tumours elsewhere or it is associated with generalised manifestation of lymphatic diseases,. Reese recorded lymphomatous involvement of uvea in 8 cases out of 171 affecting the region of the eye (1 in 21), which included lymphomatous deposits in Iris. McGavic found only one intraocular involvement out of 21 ocular lymphomas. Heath's series of 67 ocular lymphomas, the globe was involved only in three. Primary lymphomatous involvement of choroid were reported earlier,,.
Because of very rare incidence, a case of lymphoma of choroid, probably of primary in nature is being reported.
| Case report|| |
S.C.D., 67 years male attended Eye O.P.D., with the complain of loss of vision in left eye for about two months.
On examination : Left eye-there was nothing abnormal externally except a moderately dilated pupil. Both direct and consensual light reflexes were sluggish. Vision counting fingers at 2 meters, not improving with glasses. There was early Immature Cataract of nuclear type. Tension was 35 mm. (Schiotz). There was no ciliary tenderness nor any sign of uevitis. i here was no proptosis nor any limitation of ocular movements. Ophthalmoscopial examination revealed detachment of Retina in the lower part, 3 to 4 disc diameters below optic disc and macula, extending from 9 O'clock to 3 O'clock meridians and extending towards lower periphery. No retinal tear or dialysis was detected. There was no abnormal pigmentation, no haemorrhage or exudate in the fundus.
Right eye : Nothing abnormal was observed
Systemic examination did not reveal any abnormality. Our provisional diagnosis was secondary glaucoma in left eye resulting from choroidal growth, probably metastesis from malignant growth elsewhere. In absence of any symptom, ba-meal X-ray of G.I. tract was not done. He was treated Medically for reduction of I.O.P. in left eye.
There was gradual deterioration of vision. Tension in the left eye remained uncolored.
After 9 months Fundus oculus could not be seen due to advanced immature cataract Transillumination test was not informative. Patient complained of occassional pain in the left eye, which was relieved with Tab. Diamox. He ignored medical advice.
Enucleation of the left eye was done under local anaesthesia after one year. After enucleation the bisected eye ball showed no visible growth inside the eye ball. Lens was cataractous, vitreous was fluid, but clear and cornea was hazy.
Post operative period was uneventful. There was no evidence of orbital metastasis.
Laboratory investigations showed Blood Hb-12.76 GM. W.B.C.-4,600 per c.mm. Neutrophil-60%, Lymphocyte-32, Monocyte2%, Eosinophil-6%, Platelets-adequate. E.S.R.-Ist hr. 52 mm. and 2nd hour-90 mm. Urine-Nothing abnormal, Blood Sugar-l 10 mg.%, X-ray chest-Lung emphysematous with left lateral scoliosis of Dorsolumbar spine. Bone marrow exam:- "It was hypercellular with erythropoid hyperplasia. Erythropoiesis is partially megaloblastic. Myeloid series of cells show shift to left. Plasma cells and lymphocytes were of increased number.
| Histopathological report|| |
Microscopically the features of a well differentiated lymphocytic lymphoma in choroid was revealed. The cells were monomorphic in appearance and differentiated. The nuclear pattern of the tumour cells showed absence of any variation or giant cell formation. The choroid was diffusely and densely infiltrated by tumour cells in association with focal aggregation at places with tendency to form follicular. pattern without definite germinal centre. [Figure - 1][Figure - 2]. Choroidal tissue was replaced to a great extent and it was thickened due to dense and diffuse infiltration with lymphocytes. Retina was detached. Other structures of the eye including sclera were free from. infiltration by the tumour cells.
| Discussion|| |
Clinically the case appeared to be one of detachment of retina with secondary glaucoma, probably due to metastatic growth in choroid. As there was no pigmentation of retina over the detachment area, we did not think of melanoma of choroid. On general examination, no systemic abnormality could be detected except emphysematous lungs with scoliosis and a few patches of depigmentation on face and trunk.
Well differentiated lymphocytic lymphomas in their initial stages are localised and circumscribed. Such lymphocytic infiltration of choroid closely simulate reactive lymphoid hyperplasia due to chronic inflammation resulting massive thickening by cellular infiltration wherein lymphocytes are accompanied by plasma cells. In this case, dense and diffuse infiltration with well differentiated lymphocytes resulting thickening and replacement of choroid with tendency to form follicle and absence of plasma cells led us to diagnose the case as lymphoma of choroid. As there was no evidence of systemic lymphatic disease, the lymphoma of choroid seems to be primary. "An isolated lymphoma may be the precursor of a generalised lymphomatous dissemination". This may progress into a generalised process if the patient survives long enough".
According to Cooks lymphoma of choroid may present clinically in four ways-1). Generalised uveitis; 2) Recurrent haemorrhages in choroid; 3) Retinal detachment and 4) Secondary glaucoma.
In this case there was no evidence of uveitis and choroidal haemorrhage, but the patient presented with retinal detachment and secondary glaucoma.
Cause of glaucoma in this case is difficult of explain, as involvement of angle of anterior chamber could not be detected, Intraocular haemorrhage or inflammation was also not operative, Obstructions of venous retina by involving venae vorticose and by increased permeability may be responsible for production of secondary glaucoma in this case.
| Summary|| |
A rare case of choroidal lymphoma, presenting initially as a case of detachment of retina with secondary glaucoma has been presented. The relevant literature has been compendiously reviewed.
| Acknowledgement|| |
We are grateful to the Surgeon-Superintendent, S.S.KM. Hospital Calcutta for his kind permission to publish this case.
| References|| |
Duke-Elder, S. and Parkins, E.S. 1966, Systemic Ophthalmology, Vol. IX Henry Kimpton, London, pp 813.
Reese, A.B. 1963, Tumours of the Eye, 2nd Ed., Harper & Row. New York, pp 469.
Marcus, H.C., 1963, Arch. Ophthalmol., 69:251.
McGavic, J.S., 1943, Arch. OphthalmoL, 30, 179193.
Heath, P.. 1949, Amer. J. Ophthalmol, 32:1213.
Cooper, E.L. and Ricker, J.L., 1951, Amer. J.Ophthalmol., 34:1153.
Cook. C., 1954, Br. J. Ophthalmol.. 38:182.
Givner, L, 1955, Amer. J. Ophthalmol., 39:29.
[Figure - 1], [Figure - 2]