Iris Involvement in Natural Killer/T-cell Lymphoma

Bilateral iris mass as the first manifestation of NK cell lymphoma: A case report

INTRODUCTION

Natural killer (NK) cell lymphoma is a progressive non-Hodgkin's lymphoma with rare prevalence. Intraocular involvement of NK cell lymphoma is very rare, with only case reports to date.

CASE PRESENTATION

Here, we report a case of intraocular involvement of NK cell lymphoma which was presented with bilateral uveitis, iris mass, and diffuse infiltration into the center nerve system (CNS), skin, and possibly myocardium.

CONCLUSIONS

Iris mass and uveitis which is not responsive to steroids may be ocular manifestations of intraocular lymphoma, such as NK cell lymphoma. Ophthalmological and systemic examinations should be required for early diagnosis and treatment.

Iris lymphoma-a systematic guide for diagnosis and treatment

Iris lymphomas are rare malignant neoplasms arising either as primary tumors in the iris or as secondary tumors involving the iris. We summarize previously published data and make recommendations for work-up strategies for cases of suspected iris lymphoma. Our objective is to provide a structured overview of the typical clinical symptoms and signs, the pathologic, ophthalmic, as well as hematologic work-up for diagnosis, treatment, and follow-up of iris lymphomas and offer a flowchart on how to diagnose and treat these tumors.

Iris involvement by lymphoma: a review of 13 cases

BACKGROUND

To describe the clinical and histopathological features of lymphomas involving the iris.

DESIGN

Retrospective, descriptive study.

PARTICIPANTS

Fourteen eyes of 13 patients.

METHODS

Review of medical records.

MAIN OUTCOME MEASURES

Clinical and histopathological findings.

RESULTS

Median patient age was 58 years (range, 25-76 years). Seven patients had known systemic lymphoma of which five were of large B-cell type. Symptoms included blurred vision (8/14), eye redness (3/14) and eye pain (2/14). Four eyes had secondary elevated intraocular pressure. Anterior segment findings included anterior chamber cells (14/14 eyes), keratic precipitates (11/14 eyes), congestion of conjunctival/episcleral blood vessels (9/14), hyphaema (7/14), conjunctival/anterior epibulbar lymphoma (6/14), tumour-induced pseudohypopyon (4/14) and corneal oedema (3/14). Of 12 eyes with adequate view of iris details, clinically detectable iris thickening or visible mass was noted in all (12/12). There was concomitant involvement of ciliary body (8/14), choroid (5/14) and orbit (2/14). All patients had biopsy of conjunctiva, episclera, iris or ciliary body, confirming the diagnosis of lymphoma. Histopathological or cytopathological evaluation of iris or ciliary body showed high-grade lymphoma in 9/11 eyes in which it was performed. Five patients did not have long-term follow up and, of the other eight patients, three died from complications of systemic lymphoma during follow up ranging from 1 to 44 months.

CONCLUSION

Lymphomatous involvement of the iris should be considered in the differential diagnosis of corticosteroid-resistant uveitis in middle-aged and elderly patients. Iris lymphoma tends to be high grade and usually develops in patients with known aggressive systemic lymphoma.