Clinically Suspected Choroidal Lymphoma Arising from Indolent Nonprogressive Multifocal Choroidal Lesions: A Case...

Indolent nonprogressive multifocal choroidal lesions (INMCL) are benign choroidal lymphoid entities characterized by stable, multifocal, non-inflammatory lesions composed of mature B-cell infiltrates. This report describes a case of INMCL with macula lesions and serous retinal detachment (SRD) that was presumed to have transformed into clinically suspected choroidal lymphoma and was successfully treated with external beam radiotherapy.

Single observational case report.

A man in his 60s was found to have unilateral, multifocal yellowish-white choroidal lesions, consistent with INMCL, in the left eye during a routine examination. Seven years later, the patient noted visual disturbance and metamorphopsia in the same eye, although the lesions remained asymptomatic with a best-corrected visual acuity (BCVA) of 20/16 in the left eye until year X. At that time, the yellowish-white lesions enlarged towards the macula and were accompanied by SRD. SS-OCT revealed choroidal thickening with expanded hyporeflective spaces, and multimodal imaging suggested malignant transformation to choroidal low-grade malignant lymphoma. External beam radiotherapy of 24 Gy in 12 fractions was administered to the left eye, leading to complete resolution of SRD and normalization of choroidal thickness without recurrence during follow up. Laser speckle flowgraphy demonstrated marginal recovery of choroidal circulatory disorders.

Although INMCL is regarded as a benign nonprogressive choroidal lymphoid disease, this case suggests that some lesions may represent a possible evolution of choroidal lymphoma. Careful follow up and prompt consideration of radiotherapy in cases of progression and symptom onset may provide excellent anatomical and functional outcomes.