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A Choroidal Lesion with Extrascleral Extension: A Case Report

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Title: A Choroidal Lesion with Extrascleral Extension: A Case Report

Authors: Christopher D. Conrady, MD, PhD1, Kirk Winward, MD,2 and Roger Harrie, MD1* 
1Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84112.  2Retina Associates of Utah, Murray, UT 84107
Date: 01/2018
Keywords/Main Subjects: extrascleral, lymphoma, choroid, tumor
Diagnosis/Differential Diagnosis: choroidal lymphoma with extrascleral extension
Brief Description of Case: We present the case of a 64-year-old male with a choroidal lesion noted to have extrascleral extension subsequently identified as an isolated low-grade B-cell lymphoma by fine needle aspiration.

Images:

Figure 1 64-year-old man with extrascleral extension of ocular lymphoma.

(a) Fundus examination of the right eye identified an ill-defined, amelanotic, choroidal lesion temporal to the macula. Dotted green line indicates approximate borders of lesion.  (b) Fluorescein angiogram identified a hyperflourescent mass with late leakage consistent with fundus examination.  Dotted green line indicates approximate tumor borders.  (c-d) A- and B-scan ultrasound identified a 3mm x 10mm x 10mm choroidal lesion with extrascleral extension [indicated by green arrow in (c) and blue arrow in (d)].  Lesion thickness further characterized by A-scan with yellow and green lines in (d).  (e) Fine needle aspiration of the lesion identified a low grade B-cell lymphoma.  Inset shows magnified cells of central box consistent with B lymphocytes.

Summary of Cases:

In conclusion, identifying extrascleral extension on A- and B-scan ultrasonography of a lesion helps narrow the differential diagnosis to choroidal lymphomas or melanomas and posterior scleritis.

References for further reading:

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  2. Coupland SE, Foss HD, Hidayat AA, Cockerham GC, Hummel M, Stein H. Extranodal marginal zone B cell lymphomas of the uvea: an analysis of 13 cases. J Pathol. Jul 2002;197(3):333-340.
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  4. Ryan SJ, Zimmerman LE, King FM. Reactive lymphoid hyperplasia. An unusual form of intraocular pseudotumor. Transactions – American Academy of Ophthalmology and Otolaryngology. American Academy of Ophthalmology and Otolaryngology. May-Jun 1972;76(3):652-671.
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  9. Aronow ME, Portell CA, Sweetenham JW, Singh AD. Uveal lymphoma: clinical features, diagnostic studies, treatment selection, and outcomes. Ophthalmology. Jan 2014;121(1):334-341.
  10. Jusufbegovic D, Kim V, Char DH. Primary uveal lymphoma with epibulbar extension masquerading as an intraocular inflammation. Can J Ophthalmol. Feb 2015;50(1):e24-26.
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  12. Singh AD, Seregard, S. Ocular Tumors. 2016;7:53-59.
  13. Hoffman PM, McKelvie P, Hall AJ, Stawell RJ, Santamaria JD. Intraocular lymphoma: a series of 14 patients with clinicopathological features and treatment outcomes. Eye (Lond). May 2003;17(4):513-521.

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