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Primary Choroidal Lymphoma Diagnosed with 27-Gauge Pars Plana Vitrectomy Choroidal Biopsy
Andrew W Kam1,2, Justin Galvin3, Svetlana Cherepanoff4,5
1Royal North Shore Hospital, Sydney, New South Wales, Australia.
Insights
Diagnosing primary choroidal lymphoma is now safer and more effective using 27-gauge vitrectomy choroidal biopsy. This minimally invasive technique provides adequate tissue for accurate diagnosis and prognosis.
Area of Science:
- Ophthalmology
- Oncology
- Surgical Pathology
Background:
- Transvitreal fine-needle aspiration biopsy is standard for intraocular lymphoma but often yields insufficient tissue.
- Choroidal biopsy via vitrectomy offers a potentially more effective diagnostic approach.
- Smaller-gauge vitrectomy instruments minimize trauma and improve visual recovery.
Observation:
- A 72-year-old female presented with blurred vision due to a large choroidal mass.
- Imaging revealed a thickened choroid with retinal detachment and extrascleral nodules.
- Diagnosis was confirmed as extranodal marginal zone B-cell lymphoma via 27-gauge vitrectomy choroidal biopsy.
Findings:
- 27-gauge pars plana vitrectomy successfully obtained adequate tissue for histopathologic, immunohistochemical, and flow cytometry analysis.
- The patient was diagnosed with primary choroidal lymphoma, with no evidence of systemic disease.
- Treatment with radiotherapy led to disease resolution.
Implications:
- 27-gauge vitrectomy choroidal biopsy is a safe and effective method for diagnosing primary choroidal lymphoma.
- This technique can overcome the limitations of fine-needle aspiration, providing sufficient material for comprehensive analysis.
- Minimally invasive vitrectomy biopsy facilitates timely diagnosis and appropriate management of intraocular malignancies.
Background:
Currently, transvitreal fine-needle aspiration biopsy is the most widely used tissue biopsy technique in cases of suspected intraocular lymphoma due to its relative simplicity and low trauma. The small sample produced, however, may be inadequate for diagnostic and prognostic analyses due to mechanical artefacts, insufficient material, or sampling errors. Small case series have demonstrated choroidal biopsy via vitrectomy to be safe and effective. With smaller-gauge vitrectomy instruments, visual recovery is rapid, and post-operative inflammation and conjunctival scarring is minimised. Furthermore, smaller-gauge instrumentation does not appear to affect the diagnostic yield of biopsies for intraocular lymphoma in vitro. We report a case of primary choroidal lymphoma successfully diagnosed with 27-gauge pars plana vitrectomy choroidal biopsy.
Case Presentation:
A 72-year-old female presented with a 6-month history of painless blurred vision in her right eye. Fundus examination revealed a large pale choroidal mass centred on the posterior pole with overlying exudative retinal detachment. Enhanced depth imaging optical coherence tomography revealed a markedly thickened choroid with an undulating appearance. B-scan ultrasonography demonstrated diffuse, smooth thickening of the choroid, and retrobulbar extrascleral hypoechoic nodules. A 27-gauge pars plana vitrectomy was performed and choroidal biopsy taken. Histopathologic, immunohistochemical, and flow cytometry studies confirmed a diagnosis of extranodal marginal zone B-cell lymphoma. Systemic workup found no evidence of systemic lymphoma. As such, the patient was diagnosed with primary choroidal lymphoma. She underwent intensity-modulated external beam radiotherapy with subsequent resolution of disease.
Conclusions:
Primary choroidal lymphoma can be safely and effectively diagnosed via 27-gauge vitrectomy choroidal biopsy.
