Intraocular lymphoma as relapse after chemotherapy for primary breast diffuse large B-cell lymphoma

Abstract

A 68-year-old woman developed right breast pain and visited a hospital. A 2-cm mass was palpable in the areola at 9 o'clock and was visualized as a well-defined tumor shadow on ultrasound examination. Needle biopsy revealed large abnormal lymphoid cells in a diffuse pattern (Fig. 1A), which were positive for CD20 and CD5, and negative for CD3, CD10, and cyclin D1. The Ki67-labeling index was high at 60%. The pathological diagnosis was primary breast diffuse large B-cell lymphoma. Whole-body 2-[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography (PET) was normal except for high uptake in the right breast (SUVmax=19.26) and a 1-cm area in the axillary lymph node on the right side (SUVmax=2.01). She was in stage IA with a single risk factor (age) using the international prognostic index. Over 3 months, she underwent 6 courses of R-CHOP chemotherapy (rituximab: 375 mg/m 2 , cyclophosphamide: 750 mg/m 2 , doxorubicin: 50 mg/m 2 , vincristine: 1.4 mg/m 2 , and predniso-lone: 100 mg x 5 doses), combined with intrathecal injection of methotrexate (10 mg) and cytarabine (40 mg). She achieved complete remission. One year and 4 months later, she developed blurred vision in the right eye and visited an eye doctor. The best-corrected visual acuity was 0.6 in the right eye and 1.0 in the left eye. The intraocular pressure was 23 mmHg in the right eye and 17 mmHg in the left eye. She had previously undergone cataract surgery with intraocu-lar lens implantation in both eyes. The right eye had no aqueous inflammatory cells but had vitreous opacity with several yellowish thickened retinal lesions in the right eye (Fig. 2A, 2B, 2C). The left eye was normal. PET demonstrated no abnormal uptake. She underwent vitrectomy with Intraocular lymphoma as relapse after chemotherapy for primary breast diffuse large B-cell lymphoma Keywords: Intraocular lymphoma, breast lymphoma, vitrectomy, diffuse large B-cell lymphoma, intrathecal methotrexate Fig. 1. A. Hematoxylin-eosin staining of right breast needle biopsy specimen at the initial visit. Note the diffuse infiltration of large cells with irregular nuclei. B-D. Hematoxylin-eosin and immunostaining of paraffin-embedded sections of vitrectomy cell block from the right eye. Note the large cells positive for CD20 (C) admixed with small lymphocytes positive for CD3 (D). Bar = 100 μm in A, and bar = 50 μm in B-D.