POSTER'42'
CASE'REPORT:'GRANULOMATOUS'UVEITIS'AS'PRESENTATION'OF'
INTRAOCULAR'DIFFUSE'LARGE'BICELL'LYMPHOMA'–'A'DIAGNOSTIC'
CHALLENGE'
'
Rita!S.!Gomes1,!Sara!Duarte1,!Marília!Gomes1,2,!José!Carda1,2!and!Letícia!Ribeiro1!
!
(1)Hematology,! University! Hospital! Center! of! Coimbra,! Coimbra,! Portugal,! (2)Faculty! of! Medicine,!
University!of!Coimbra,!Coimbra,!Portugal!
!
INTRODUCTION!
Primary!diffuse!large!BJcell!lymphomas!(DLBCL)!of!the!central!nervous!system!(CNS)!include!
the! intraocular! lymphoma! (IOL),! which! can! be! subdivided! into! vitreoretinal! or! uveal!
subtypes,!based!on!the!involved!site.!In!primary!IOLJDLBCL,!eye!involvement!is!exclusive!and!
80J90%!of!patients!will!develop!bilateral!lesions.!Nevertheless,!diagnosis!and!management!
of!IOL!remains!a!challenge.!
CASE'REPORT!
A!66JyearJold!man!followed!in!Ophthalmology!Department!for!12!months!due!to!unilateral!
granulomatous! uveitis! and! treated! with! local! steroids.! Vitreous! aspiration! due! to! vision!
impairment! was! performed.! Immunophenotypic! analysis! was! compatible! with! DLBCL! and!
treatment! with! methotrexate! intravitreally! was! initiated.! Positron! emission! tomography!
(PET)! scan! did! not! reveal! extraocular! lesions,! however! it! showed! bilateral! ocular!
lymphomatous!uptake!confirmed!by!magnetic!resonance!imaging!(MRI).!Lumbar!puncture!
and!bone!marrow!biopsy!were!negative.!!
Upon!establishment!of!bilateral!primary!IOLJDLBCL!diagnosis,!patient!was!treated!according!
to! MATRix! protocol! omitting! thiotepa! (high! dose! methotrexate,! high! dose! cytarabine,!
rituximab)! combined! with! intravitreal! administration! of! methotrexate.! Complete! response!
was!achieved!after!4!cycles!as!assessed!by!MRI.!
Fifteen! months! later,! the! patient! presented! with! headache,! spatial! disorientation! and!
memory! loss.! MRI! scan! revealed! a! lesion! of! corpus! callosum,! with! 3.3x1.6! cm,! being! the!
biopsy! compatible! with! diffuse! large! B! cell! lymphoma.! No! other! lesions! outside! the! CNS!
were!detected.!The!patient!was!retreated!with!MATRix!regimen!omitting!thiotepa!(total!of!4!
cycles)! followed! by! consolidation! radiotherapy! (36Gy/18fr),! with! a! persistent! complete!
response!the!last!12!months.!!
CONCLUSION'!
Intraocular!lymphoma!is!a!very!rare!entity.!Unfortunately,!it!may!be!interpreted!as!an!ocular!
inflammatory! disease,! by! macroscopic! evaluation,! resulting! in! a! delayed! diagnosis! and!
treatment,! with! significant! impact! on! patient’s! morbidity! and! mortality.! Early! imaging!
evaluation!and!analysis!of!the!vitreous!humor!could!hasten!the!diagnosis.!
! !
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES