GENERALIZED IMMUNOCYTOMA PRESENTING WITH INTRAVITREAL INFILTRATION
U. Sengler, C. Althaus, A. Kersten, J. Stammem
Ocular involvement in generalized lymphoma often means infiltration of the orbit, the lacrimal gland or the conjunctiva with malignant cells. We present a patient with intravitreal leukocyte infiltration as initial sign of a generalized immunocytoma.
Case report: The 76-year-old patient complaining of a decrease of vision in the right eye for 4 weeks was referred with the presumptive diagnosis of vitreous bleeding. The right eye showed keratic precipitates, mild signs of intraocular inflammation in the anterior chamber (flare+, cells-) and dense cellular opacities in the vitreous. The pupillary margin of both eyes was marked with small cysts. Under topical steroids the inflammatory signs of the anterior chamber decreased while the vitreous opacities remained unchanged. The patient developed vertigo, ataxia and nausea and was examined medically and neurologically. Immune-electrophoresis showed a monoclonal spike of IgA without secondary immune deficiency. The bone marrow histology corresponded to hyperplastic changes without signs of plasma cell infiltration, no osteolytic lesions could be radiographically demonstrated. NMR scans disclosed several large cerebral lesions. A slight intravitreal infiltration also slowly developed in the left eye. A diagnostic and therapeutic pars-plana-vitrectomy was performed. From the vitreous sample the diagnosis of a lymphoma of low grade malignancy could be established. Cytological evaluation of the cerebrospinal fluid confirmed the diagnosis of a lympho-plasmocytoid immunocytoma. Due to the cerebral involvement a radiation therapy with x-ray of these lesions was started. Under this treatment the lesions decreased promptly and the neurological status improved partially. The vitreous infiltration of the left eye did not change. Conclusion: An immunocytoma can at first present as an intravitreal infiltration without the occurrence of other symptoms of sytemic generalization. Cytologic evaluation of a vitreous sample allows to establish the diagnosis .
Eye Clinic, Heinrich-Heine-University, Moorenstr. 5, D-40225Düsseldorf