American journal of ophthalmology case reports · 2026
Vitreoretinal lymphoma revealing Richter transformation.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Prabha Dibya, Raval Vishal, Mishra Dilip
Аннотация
PURPOSE: To report a rare case of Richter syndrome transformation presenting as diffuse large B-cell vitreoretinal lymphoma (DLBCL) in a patient with chronic lymphocytic leukemia (CLL).
OBSERVATIONS: A woman in her late fifties with 11q-mutated CLL in remission presented with bilateral, painless blurring of vision. The best-corrected visual acuity was 20/50 in the right eye and 20/80 in the left eye. Fundus examination revealed multiple hypopigmented yellowish subretinal lesions in both eyes. A presumed diagnosis of secondary vitreoretinal lymphoma/leukemic infiltration was made, and multiple intravitreal methotrexate injections were administered until complete regression of lesions and visual recovery. However, a year later, the left eye relapsed with a large placoid, yellowish subretinal infiltration. ^18F-FDG PET-CT scan revealed systemic lymphadenopathy. Subretinal and vitreous biopsy revealed CD20-and BCL2-positive large atypical lymphoid cells, confirming DLBCL, consistent with Richter transformation in the eye. Although lymph node and tonsillar biopsies showed no systemic involvement, the patient declined prophylactic high-dose methotrexate despite the elevated risk of systemic transformation.
CONCLUSION AND IMPORTANCE: Bilateral vitreoretinal lymphoma presenting as the first manifestation of Richter transformation is exceedingly rare. Early ophthalmic recognition, biopsy, and systemic staging are essential for avoiding diagnostic delays.
OBSERVATIONS: A woman in her late fifties with 11q-mutated CLL in remission presented with bilateral, painless blurring of vision. The best-corrected visual acuity was 20/50 in the right eye and 20/80 in the left eye. Fundus examination revealed multiple hypopigmented yellowish subretinal lesions in both eyes. A presumed diagnosis of secondary vitreoretinal lymphoma/leukemic infiltration was made, and multiple intravitreal methotrexate injections were administered until complete regression of lesions and visual recovery. However, a year later, the left eye relapsed with a large placoid, yellowish subretinal infiltration. ^18F-FDG PET-CT scan revealed systemic lymphadenopathy. Subretinal and vitreous biopsy revealed CD20-and BCL2-positive large atypical lymphoid cells, confirming DLBCL, consistent with Richter transformation in the eye. Although lymph node and tonsillar biopsies showed no systemic involvement, the patient declined prophylactic high-dose methotrexate despite the elevated risk of systemic transformation.
CONCLUSION AND IMPORTANCE: Bilateral vitreoretinal lymphoma presenting as the first manifestation of Richter transformation is exceedingly rare. Early ophthalmic recognition, biopsy, and systemic staging are essential for avoiding diagnostic delays.