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Case Study: December 2015
History
A 55 year old female present with visual deterioration in the right eye for 3 weeks. The RVA was 6/36 and a variabley pigmented mass was seen encircling the optic disc at the posterior pole (Fig 1). The B-scan showed a choroidal hypo-echoic mass with extra-ocular extension. The favoured diagnosis was a uveal melanoma with orbital extension. A biopsy was offered but declined and an enucleation was carried out.
Questions
1. What do Figs 3,4,5 and 6 demonstrate?
2. What do Figs 7 and 8 show?
3. What is the diagnosis?
1. A diffuse intraocular mass with an extraocular component, composed of lymphoid cells and eosinophilic amorphous material that is apple green birifringent, confirming amyloid.
2. A diffuse mass of small lymphocytes positive for CD20 indicating a B-cell phenotype.
3. This is indolent B-cell lymphoma of the choroid (in this case MALToma) with amyloid production.
References
Ryan RJH, Sloan MJ, Collins ABExtranodal marginal zone lymphoma of mucosa associated lymphoid tissue with amyloid deposition Am. J. Clin. Pathol., 2012
Coupland SE, Foss HD, Hidayat A Extranodal marginal zone B cell lymphomas of the uvea: an analysis of 13 cases. J Pathol., 2002
