gms | German Medical Science

Intraocular manifestations of lymphoma are divided into three major forms: a) "primary intraocular lymphoma", arising in the vitreous and retina; b) primary uveal lymphomas; and c) intraocular involvement of systemic lymphoma. The latter two forms usually involve the choroid, only rarely affecting the iris. The aim of the current paper is to report the clinical, and histopathological of two cases of iridal lymphoma.

A 42-year-old woman of otherwise good health presented with iris nodules. A 62-year-old man with known systemic Non-Hodgkin lymphoma (NHL) presented with decreased vision and diffuse iridal thickening. Iris biopsies were performed; these were examined using conventional histology and immunohistochemistry.

Histological examination of the iris biopsy of patient 1 demonstrated a dense atypical lymphocytic infiltrate consisting of blasts positive for the B-cell antigen CD20, and demonstrating a large growth fraction of 90%. The iris biopsy of patient 2 showed an infiltration of small B-lymphocytes with monotypical expression for the immunoglobulin heavy chain IgM. Patient 1 was treated with localised irradiation of 35 Gy, and was in complete remission at final follow-up. Tumour control was obtained in Patient 2 using percutaneous radiotherapy; the systemic lymphoma was treated using Rituximab.

The current cases describe rare lymphomatous manifestation in the iris: patient 1 demonstrating a primary tumour; patient 2, a secondary manifestation of a systemic NHL. Despite their rarity, ophthalmic pathologists should consider the diagnosis of both primary and secondary lymphomas when reviewing iridal biopsies.