97th DOG Annual Meeting 1999

P521

OCULAR METASTASIS OF A HIGHLY MALIGNANT CENTROBLASTIC B-CELL-LYMPHOMA - DIAGNOSIS AND TREATMENT

J. Gabel, C. Y. Mardin, A. Jünemann


Background: The incidence of secondary cerebral lymphomas is 5 to 29 % of all systemic non-hodgkin-lymphomas. The choroid can be involved by metastasis.

Case report: A 46-year old male in reduced physical condition was referred to our department with suspected mycotic endophthalmitis in his right eye. Six month ago a highly malignant non hodgkin lymphoma was diagnosed by excisional biopsy of a submandibulary lymph node (centroblastic (Kiel Classification), diffuse with large cellbodies (REAL stadium III b)). Patient was treated with a polychemotherapy up to a remission of the disease. At the first presentation the visual acuity was finger count. A pseudohypopyon was seen up to the middle of the pupil. It consisted of large cells and blood. Retinal details could not be seen. Because of a secondary angle closure glaucoma intraocular pressure was 36 mmHg. Ultrasonographically (A and B-Scan) no cellulary infiltration of the vitreous could be observed. With Ultrasoundbiomicroscopy (UBM) a circulary solide infiltration of the iris and a diffuse infiltration of the anterior chamber was detected. Pars plicata of the ciliary body was partially involved and the angle was partially occluded. These findings supported the clinical disease of a ocular metastasis. The patient was sent to the department of internal medicine for general medicine staging and therapy. After the beginning of ocular radiation therapy a marked improvement was observed. After complete ocular radiation iris and ciliary body lesions disappeared clinically and in the UBM. Visual acuity increased to 12/20, intraocular pressure was without therapy within normal limits.

Conclusion: Diagnosis of a ocular metastasis of a non-hodgkin-lymphoma is a clinical diagnosis. Sonography is a helpful for differential diagnosis. Although the prognosis for the patients life is pure, quality of life could be improved by early ocular radiation therapy.

Department of Ophthalmology, University Erlangen-Nuernberg, Schwabachanlage 6, D- 91054 Erlangen

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