Limits...
Ocular pathology of uncommon hematologic malignancies: a case series.

Head JE, Shen D, Santiago-Maysonet M, Bishop RJ, Chan CC - J Med Case Rep (2007)

Bottom Line: In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course.Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Immunopathology Section, National Institutes of Health, Bethesda, MD, USA. chanc@nei.nih.gov.

ABSTRACT

Introduction: In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.

Case presentation: In the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.

Conclusion: While ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.

No MeSH data available.


Related in: MedlinePlus

Case 2. (A and B) Choroidal vessels are filled with atypical cells (arrows), which are CD68+. (C) A subretinal infiltrate of leukemic cells (arrows), admixed with hemorrhage, is also seen. (D) The subretinal infiltrate and choroidal vessels contain a significant number of CD68+ cells (arrows). R = retina, Ch = choroid. (A and C, hematoxylin & eosin; B and D, avidin-biotin-complex immunoperoxidase; A and B, original magnification × 100; C and D, original magnification × 200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2211492&req=5

Figure 2: Case 2. (A and B) Choroidal vessels are filled with atypical cells (arrows), which are CD68+. (C) A subretinal infiltrate of leukemic cells (arrows), admixed with hemorrhage, is also seen. (D) The subretinal infiltrate and choroidal vessels contain a significant number of CD68+ cells (arrows). R = retina, Ch = choroid. (A and C, hematoxylin & eosin; B and D, avidin-biotin-complex immunoperoxidase; A and B, original magnification × 100; C and D, original magnification × 200).

Mentions: A 51 year-old man with chronic myelomonocytic leukemia developed progressively worsening anemia, thrombocytopenia, and leukocytosis and subsequently expired. Post-mortem gross examination of the eyes was significant for multiple fresh and old retinal hemorrhages bilaterally. Microscopic examination revealed numerous atypical leukocytes within the choroidal vasculature (Figure 2A) and bilateral retinal hemorrhages, as well as a small focus of subretinal leukemic cells with admixed hemorrhage in the left eye (Figure 2C). The leukemic cells within the choroidal vasculature and in the subretinal lesion were strongly immunopositive for macrophage marker, CD68 (Figures 2B &2D). Molecular studies demonstrated negative IgH gene rearrangement and absence of EBV DNA.


Ocular pathology of uncommon hematologic malignancies: a case series.

Head JE, Shen D, Santiago-Maysonet M, Bishop RJ, Chan CC - J Med Case Rep (2007)

Case 2. (A and B) Choroidal vessels are filled with atypical cells (arrows), which are CD68+. (C) A subretinal infiltrate of leukemic cells (arrows), admixed with hemorrhage, is also seen. (D) The subretinal infiltrate and choroidal vessels contain a significant number of CD68+ cells (arrows). R = retina, Ch = choroid. (A and C, hematoxylin & eosin; B and D, avidin-biotin-complex immunoperoxidase; A and B, original magnification × 100; C and D, original magnification × 200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211492&req=5

Figure 2: Case 2. (A and B) Choroidal vessels are filled with atypical cells (arrows), which are CD68+. (C) A subretinal infiltrate of leukemic cells (arrows), admixed with hemorrhage, is also seen. (D) The subretinal infiltrate and choroidal vessels contain a significant number of CD68+ cells (arrows). R = retina, Ch = choroid. (A and C, hematoxylin & eosin; B and D, avidin-biotin-complex immunoperoxidase; A and B, original magnification × 100; C and D, original magnification × 200).
Mentions: A 51 year-old man with chronic myelomonocytic leukemia developed progressively worsening anemia, thrombocytopenia, and leukocytosis and subsequently expired. Post-mortem gross examination of the eyes was significant for multiple fresh and old retinal hemorrhages bilaterally. Microscopic examination revealed numerous atypical leukocytes within the choroidal vasculature (Figure 2A) and bilateral retinal hemorrhages, as well as a small focus of subretinal leukemic cells with admixed hemorrhage in the left eye (Figure 2C). The leukemic cells within the choroidal vasculature and in the subretinal lesion were strongly immunopositive for macrophage marker, CD68 (Figures 2B &2D). Molecular studies demonstrated negative IgH gene rearrangement and absence of EBV DNA.

Bottom Line: In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course.Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Immunopathology Section, National Institutes of Health, Bethesda, MD, USA. chanc@nei.nih.gov.

ABSTRACT

Introduction: In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.

Case presentation: In the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.

Conclusion: While ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.

No MeSH data available.


Related in: MedlinePlus