MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Caitlin M NickensAffiliation: Uniformed Services University

MedPix No: 11064 - HistoryPt Demographics: Age = 62 y.o. Gender = man62 y.o. man c/o progressive visual problem in his left eye

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MedPix No: 11064 - EXAM & LABSVisual symptoms:Decreased vision in his left eye to hand motions Normal vision, right eyeOphthalmic examination:Large yellow choroidal lesions and vitreous cells, left eye

CNS lymphoma, large B-cell type, retina and brain

Bilateral frontal lobe lesions, producing a *butterfly* pattern.

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CNS lymphoma, large B-cell type, retina and brain

Bilateral frontal lobe lesions, producing a *butterfly* pattern.

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CNS lymphoma, large B-cell type, retina and brain

The eye was enucleated. There is a region of thickening of the retina in the posterior globe.

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Retinal lymphoma, large B-cell type

A patient with Retinal lymphoma. This close-up view showed the region of thickening of the retina in the posterior globe.

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Retinal lymphoma, large B-cell type

A patient with Retinal lymphoma. Patient had decreased vision in the right eye. This close-up view showed the region of thickening of the retina in the posterior globe.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of thickening of the retina in the posterior globe is hyperchromatic.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic - showing a lesion with *small round blue cells* - characteristic of lymphoma.

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CNS lymphoma, large B-cell type, retina and brain

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic - showing a lesion with *small round blue cells* - characteristic of lymphoma.

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Retinal CNS lymphoma, Special stains

Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye.

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FINDINGS T2W MR shows bilateral frontal lobe involvement from a *butterfly* lesion in the genu of the corpus callosum Enucleated eye - after vitrectomy w/silicone oil replacement - shows thickening of the posterior retina w/small round blue cells

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis? *Butterfly Lesions* - Astrocytoma, primary CNS lymphoma- - Retinal *blue cell tumor*- - Retinal lymphoma- - Retinoblastoma- - Chronic (benign) choroidal inflammation- - Status-post vitrectomy- - Intraocular silicone oil- - Cataract- - Angle closure glaucoma-

Diagnosis: Retinal lymphoma, large B-cell typeDx Confirmed by: Diagnostic vitrectomy and histopathology

DISCUSSION