Intraocular lymphoma: Difference between revisions

Jump to navigation Jump to search
Line 63: Line 63:
*Common complications of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref>
*Common complications of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref>
:*Radiation-induced retinopathy  
:*Radiation-induced retinopathy  
*Prognosis is generally poor, and the median survival rate of patients with intraocular lymphoma is approximately
:*Neovascular glaucoma
*Prognosis is generally good, and the 5-year survival for patients with intraocular lymphoma is between 65-80%.


== Diagnosis ==
== Diagnosis ==

Revision as of 13:02, 11 May 2016

WikiDoc Resources for Intraocular lymphoma

Articles

Most recent articles on Intraocular lymphoma

Most cited articles on Intraocular lymphoma

Review articles on Intraocular lymphoma

Articles on Intraocular lymphoma in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Intraocular lymphoma

Images of Intraocular lymphoma

Photos of Intraocular lymphoma

Podcasts & MP3s on Intraocular lymphoma

Videos on Intraocular lymphoma

Evidence Based Medicine

Cochrane Collaboration on Intraocular lymphoma

Bandolier on Intraocular lymphoma

TRIP on Intraocular lymphoma

Clinical Trials

Ongoing Trials on Intraocular lymphoma at Clinical Trials.gov

Trial results on Intraocular lymphoma

Clinical Trials on Intraocular lymphoma at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Intraocular lymphoma

NICE Guidance on Intraocular lymphoma

NHS PRODIGY Guidance

FDA on Intraocular lymphoma

CDC on Intraocular lymphoma

Books

Books on Intraocular lymphoma

News

Intraocular lymphoma in the news

Be alerted to news on Intraocular lymphoma

News trends on Intraocular lymphoma

Commentary

Blogs on Intraocular lymphoma

Definitions

Definitions of Intraocular lymphoma

Patient Resources / Community

Patient resources on Intraocular lymphoma

Discussion groups on Intraocular lymphoma

Patient Handouts on Intraocular lymphoma

Directions to Hospitals Treating Intraocular lymphoma

Risk calculators and risk factors for Intraocular lymphoma

Healthcare Provider Resources

Symptoms of Intraocular lymphoma

Causes & Risk Factors for Intraocular lymphoma

Diagnostic studies for Intraocular lymphoma

Treatment of Intraocular lymphoma

Continuing Medical Education (CME)

CME Programs on Intraocular lymphoma

International

Intraocular lymphoma en Espanol

Intraocular lymphoma en Francais

Business

Intraocular lymphoma in the Marketplace

Patents on Intraocular lymphoma

Experimental / Informatics

List of terms related to Intraocular lymphoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: PIOL

Overview

Intraocular lymphoma (also known as "PIOL") is a rare subtype of primary central nervous system lymphoma. Intraocular lymphoma may affect the eye secondarily from a metastasis from a non-ocular tumor or may arise within the eye primarily. According to the World Health Organization (WHO) classification, intraocular lymphomas are most commonly a diffuse large B-cell immunohistologic subtype of non-Hodgkin's lymphoma. The most common symptoms of intraocular lymphoma is blurred or decreased vision. In the majority of patients, central nervous system involvement, only accounts for 20% of primary central nervous system lymphomas. The median age at diagnosis among patients with intraocular lymphoma is between 50-60 years. The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption. On fluorescein angiography, findings may reveal "leopard spot" patterns due to sub-retinal pigment epithelium infiltrates that stain early and progressively or mottling of the sub-retinal pigment epithelium due to hyper- and hypo-fluorescent window defects. The initial therapy for patients with intraocular lymphoma is corticosteroids.[1]

Historical Perspective

  • Intraocular lymphoma was first discovered by Samuel Wilks, a British physician, in 1856.

Classification

  • According to the World Health Organization (WHO) classification, intraocular lymphomas are most commonly a diffuse large B-cell immunohistologic subtype of non-Hodgkin's lymphoma.
  • Primary central nervous system lymphoma may be classified into 5 subtypes:[1]
  • Primary cerebral lymphoma
  • Primary leptomeningeal lymphoma
  • Primary intraocular lymphoma
  • Primary spinal lymphoma
  • Neurolymphomatosis

Pathophysiology

  • Intraocular lymphoma is characterized as a secondary central nervous system lymphoma that mainly affects the optic nerve and the eye.[2]
  • The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption.[1]
  • Genes associated with the development of intraocular lymphoma, include:[2]
  • On gross pathology, characteristic findings of intraocular lymphoma, include:
  • No remarkable findings
  • On microscopic histopathological analysis, characteristic findings of intraocular lymphoma, include:[2]
  • Marginal zone (52%)
  • Follicular (23%)
  • Atypical lymphocytes (gold standard)

Causes

  • There are no established causes of intraocular lymphoma.

Differentiating Intraocular Lymphoma from Other Diseases

  • Intraocular lymphoma must be differentiated from other diseases that cause chronic loss of vision, or headaches, such as:
  • Ocular metastasis (most common)
  • Choroidal hemangioma
  • Vitrous lymphoma
  • Retrolental fibroplasia

Epidemiology and Demographics

  • The prevalence of intraocular lymphoma remains unknown.[1]

Age

  • Intraocular lymphoma is more commonly observed among patients aged 50 to 60 years old.[1]
  • Intraocular lymphoma is more commonly observed among middle aged adults.

Gender

  • Males are more commonly affected with intraocular lymphoma than females.[2]

Race

  • There is no racial predilection for intraocular lymphoma.

Risk Factors

  • Common risk factors in the development of intraocular lymphoma, include:[2]
  • Toxoplasma gondii infection

Natural History, Complications and Prognosis

  • The majority of patients with intraocular lymphoma are symptomatic at the time of diagnosis.
  • Early clinical features include symptoms of a non-resolving uveitis, and blurred vision.[1]
  • If left untreated, patients with intraocular lymphoma may progress to develop complete vision loss.
  • Common complications of intraocular lymphoma, include:[2]
  • Radiation-induced retinopathy
  • Neovascular glaucoma
  • Prognosis is generally good, and the 5-year survival for patients with intraocular lymphoma is between 65-80%.

Diagnosis

Symptoms

  • Symptoms of intraocular lymphoma may include the following:[1]
  • Burning of the eye
  • Redness of the eye
  • Blurred vision
  • Photophobia or sensitivity to light
  • Eye pain
  • Floaters (which are dark spots that float in the visual field)
  • Headache
  • Severe symptoms of intraocular lymphoma, may include:[1]

Physical Examination

  • Patients with intraocular lymphoma usually appear pale or malnourished.[1]
  • Physical examination may be remarkable for:
  • Decreased visual acuity (most common)
  • Irregular pupil
  • Increased lacrimation
  • Eye redness
  • Increased intraocular pressure

Laboratory Findings

  • There are no specific laboratory findings associated with intraocular lymphoma.[1]

Imaging Findings

  • Magnetic resonance image (MRI) is the imaging modality of choice for patients with intraocular lymphoma.[1]
  • On MRI, characteristic findings of intraocular lymphoma, include:[2]
  • Fat suppressed T2 and post-contrast T1 weighted images, with thin slice thickness and a reduced FOV is ideal, and should include the cavernous sinuses.
  • T1: isointense to muscle 8
  • T2: hyperintense to muscle, hypointense to fat
  • T1 C+ (GAD): enhancement present but variable

Treatment

Medical Therapy

  • The initial therapy for intraocular lymphoma is corticosteroids.[1]
  • Other medical therapies for intraocular lymphoma, may include:
  • Methotrexate
  • Intravitreal rituximab

Surgery

  • Surgery is the mainstay of therapy for intraocular lymphoma.

Prevention

  • There are no primary preventive measures available for intraocular lymphoma.[1]
  • Once diagnosed and successfully treated, patients with intraocular lymphoma are followed-up periodically every 3, 6, or 12 months.

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma