A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma
Purpose: To report an unusual case of vitreoretinal lymphoma (VRL) in which a glaucoma drainage implant (GDI) likely functioned as a sanctuary site for relapsing disease. Observations: A 54-year-old female with recently diagnosed CNS diffuse large B-cell lymphoma (DLBCL) was referred for evaluation...
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Elsevier
2025-06-01
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| Series: | American Journal of Ophthalmology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993625000520 |
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| author | Debora H. Lee Jennifer Li-Wang Patricia Chevez-Barrios Amy C. Schefler |
| author_facet | Debora H. Lee Jennifer Li-Wang Patricia Chevez-Barrios Amy C. Schefler |
| author_sort | Debora H. Lee |
| collection | DOAJ |
| description | Purpose: To report an unusual case of vitreoretinal lymphoma (VRL) in which a glaucoma drainage implant (GDI) likely functioned as a sanctuary site for relapsing disease. Observations: A 54-year-old female with recently diagnosed CNS diffuse large B-cell lymphoma (DLBCL) was referred for evaluation of VRL. Ocular history at an outside center included a 4-year reported history of uveitis complicated by glaucoma and a GDI in the left eye (OS). Initial examination revealed keratic precipitates (KP), vitreous haze with clumps of white cells OS, and vitreous biopsy revealed DLBCL OS. Intravitreal methotrexate injections were initiated for primary VRL alongside systemic chemotherapy for CNS involvement with resolution of disease. One year later, the patient returned with 2+ anterior chamber (AC) and vitreous cells OS, and vitreous biopsy again revealed DLBCL OS. External radiation treatment was administered for recurrent VRL in the left eye, followed also by the right eye due to the high risk of fellow eye involvement. Autologous stem cell transplantation was then performed. Five months later, the patient returned with worsening KPs and new vitreous cells OS, and vitreous biopsy again revealed DLBCL OS. Enucleation was performed, and histopathology revealed DLBCL cells lining the GDI fibrous capsule, consistent with the GDI likely having served as a sanctuary site and source for continued local relapse. Conclusions and Importance: We report a case in which a GDI functioned as a probable sanctuary site for VRL. Sanctuary sites of malignancy should be considered in patients with pre-existing ocular hardware, particularly when recurrent relapses occur despite complete treatment. |
| format | Article |
| id | doaj-art-0c48d8bbf34044efa3f34486364bdddd |
| institution | DOAJ |
| issn | 2451-9936 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj-art-0c48d8bbf34044efa3f34486364bdddd2025-08-20T03:10:32ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362025-06-013810229910.1016/j.ajoc.2025.102299A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphomaDebora H. Lee0Jennifer Li-Wang1Patricia Chevez-Barrios2Amy C. Schefler3Ruiz Department of Ophthalmology and Visual Science, University of Texas Health Science Center, Houston, TX, USARetina Consultants of Texas, Houston, TX, USADepartment of Pathology and Genomic Medicine, Weill Cornell Medicine, Houston Methodist Hospital, USARuiz Department of Ophthalmology and Visual Science, University of Texas Health Science Center, Houston, TX, USA; Retina Consultants of Texas, Houston, TX, USA; Corresponding author. Retina Consultants of Texas 4460 Bissonnet Street, Suite 200, Bellaire, TX, 77401, USA.Purpose: To report an unusual case of vitreoretinal lymphoma (VRL) in which a glaucoma drainage implant (GDI) likely functioned as a sanctuary site for relapsing disease. Observations: A 54-year-old female with recently diagnosed CNS diffuse large B-cell lymphoma (DLBCL) was referred for evaluation of VRL. Ocular history at an outside center included a 4-year reported history of uveitis complicated by glaucoma and a GDI in the left eye (OS). Initial examination revealed keratic precipitates (KP), vitreous haze with clumps of white cells OS, and vitreous biopsy revealed DLBCL OS. Intravitreal methotrexate injections were initiated for primary VRL alongside systemic chemotherapy for CNS involvement with resolution of disease. One year later, the patient returned with 2+ anterior chamber (AC) and vitreous cells OS, and vitreous biopsy again revealed DLBCL OS. External radiation treatment was administered for recurrent VRL in the left eye, followed also by the right eye due to the high risk of fellow eye involvement. Autologous stem cell transplantation was then performed. Five months later, the patient returned with worsening KPs and new vitreous cells OS, and vitreous biopsy again revealed DLBCL OS. Enucleation was performed, and histopathology revealed DLBCL cells lining the GDI fibrous capsule, consistent with the GDI likely having served as a sanctuary site and source for continued local relapse. Conclusions and Importance: We report a case in which a GDI functioned as a probable sanctuary site for VRL. Sanctuary sites of malignancy should be considered in patients with pre-existing ocular hardware, particularly when recurrent relapses occur despite complete treatment.http://www.sciencedirect.com/science/article/pii/S2451993625000520Vitreoretinal lymphomaPrimary vitreoretinal lymphomaPrimary central nervous system lymphomaOcular variantDiffuse large B-cell lymphomaMasquerade syndrome |
| spellingShingle | Debora H. Lee Jennifer Li-Wang Patricia Chevez-Barrios Amy C. Schefler A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma American Journal of Ophthalmology Case Reports Vitreoretinal lymphoma Primary vitreoretinal lymphoma Primary central nervous system lymphoma Ocular variant Diffuse large B-cell lymphoma Masquerade syndrome |
| title | A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| title_full | A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| title_fullStr | A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| title_full_unstemmed | A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| title_short | A glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| title_sort | glaucoma drainage implant functioning as a sanctuary site for vitreoretinal lymphoma |
| topic | Vitreoretinal lymphoma Primary vitreoretinal lymphoma Primary central nervous system lymphoma Ocular variant Diffuse large B-cell lymphoma Masquerade syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S2451993625000520 |
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