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Editor,—A 56 year old man was referred to the ocular oncology service with complaints of pain, redness, and blurring of vision in his left eye for the previous 2 months. He had no significant past ocular history. He was a known hypertensive with no known allergies.
On examination his visual acuity was 6/18 in the right eye and 6/6 in the left eye. There was 2 mm of relative exophthalmos on the right side. A pink subconjunctival patch was noticed in the superior quadrant (Fig 1). He had a shallow anterior chamber. Gonioscopy showed that anterior bowing of the iris closed 270 degrees of the angle. A YAG iridotomy was performed and pupils dilated for fundus evaluation. Funduscopy showed extensive peripheral elevation of the ciliary body and pars plana, which appeared to extend subretinally to the disc with an overlying retinal detachment in places (Fig 2) Ultrasound biomicroscopy along with B scan of the globe confirmed diffuse infiltration of the ciliary body and choroid (Fig 3A). Diffuse extension of this abnormal tissue behind he globe was also evident. The left eye was normal. A working diagnosis of benign reactive lymphoid hyperplasia was made and an incisional biopsy planned. The patient was subsequently admitted for an incisional biopsy and investigations to rule out systemic disease. No systemic evidence of lymphoma was found, however. Histopathology confirmed the diagnosis of well differentiated B cell lymphoma (diffuse large cell lymphoma (REAL classification)1) (Fig4).
A cytogenetic analysis was also performed as detailed previously.2 3 Only a partial analysis was possible, but from analysis of 12 divisions the karyotype was determined to be: 2 cells, 46 XY; 10 cells, 43–46 X-Y, add (1) (q?), add (6)(q?), −10, −14, +2mar.
The patient was subsequently started on 30 mg of prednisolone and was referred to the radiotherapy department where he received 30 Gy in 15 sessions over a 3 week period. Follow up at 4 months and further 3 months following the radiotherapy showed resolution of the mass. The patient has since been asymptomatic.
Characteristic cytogenetic abnormalities are known to be associated with certain types of lymphoma.4-6 In addition to classic translocation of chromosome 8 and 14 in Burkitt's lymphoma, other chromosome rearrangements are related to subsets of lymphoma.5 To our knowledge this is the first report of chromosome abnormalities in ocular lymphoma. We observed abnormalities frequently associated with non-Hodgkin's lymphoma (NHL), including rearrangements of chromosome 1 and 6, which are found in both B and T cell NHL, as is a loss of the Y chromosome.6 Trisomy of chromosome 12 was also observed in this ocular lymphoma, and has been linked with small lymphocytic or diffuse large cell B NHL,5 and from a study of diffuse large cell lymphomas of stomach, chromosome 12 was again found to be the most consistent abnormality.4 Although its too early to identify which abnormalities are specifically related to the development of this eye lymphoma, it is apparent that certain alterations are characteristic of lymphoma in general, suggesting that similarities exist between development of ocular and other lymphomas.