Thursday, March 16, 2017

Retinal biopsy from an elderly woman with suspected ocular lymphoma

The patient had multiple foci of markedly thickened retina on exam. Ophthomologists were able to obtain a relatively large retinal biopsy. We did not find lymphoma in this case, and infections of many sorts were ruled out. But the ophthalmologists wanted an opinion as to whether retinal vasculitis was present. I wonder whether the threshold for calling vasculitis in the retina should be lower than in other tissues. Your input in the comments section would be greatly appreciated.

Low power view

Medium power showing diffuse edema

Arterioles with focus of intramural inflammatory infiltrate on right side of right vessel


jd said...

Sure doesn't look like vasculitis to me.

Brian E. Moore, MD, MEd said...

I agree, jd. Not classic for vasculitis. Whatever it is that's going on, it's a zebra.

charles eberhart said...

I do not see any specific pathology. It does not look like vasculitis to me. The edema is also much less pronounced than we see in diabetic retinopathy or other common retinal diseases causing vascular problems. With respect to the DLBCL issue, the few globes I have looked at from patients with that disease do not have the same type of perivascular lymphoid cells as one sees in the brain. Indeed, the retinal involvement has been quite patchy, and is sometimes dwarfed by sub-RPE tumor deposits.

Brian E. Moore, MD, MEd said...

Thanks for those insightful comments, Charles. Much appreciated.