Background: Primary intraocular lymphoma (PIOL) is a subset of the central nervous system lymphoma and rarely metastasizes to other organs. Here we report a case of PIOL in which a testicular lesion was discovered during treatment with intravitreal injection of methotrexate (MTX).
Case: The patient was a 59-year-old man who was diagnosed with corticosteroid-resistant uveitis of the bilateral eyes and was referred to our hospital in September 2013. In the first examination, visual acuity was 1.2 in the right eye and 1.0 in the left eye, and diffuse vitreous clouding was observed in both eyes. There were no abnormalities on chest computed tomography (CT), head magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT. In February 2014, although cytodiagnosis by vitreous biopsy of the right eye showed class IIIb, the interleukin (IL)-10/IL-6 ratio was >1, which led to the diagnosis of PIOL. Local treatment with intravitreal injection of MTX into the right eye was initiated after intrathecal injection of MTX. However, PET-CT showed abnormal accumulation in the left testicle in October 2015. The testicular lesion was also diagnosed as diffuse large B-cell lymphoma following left inguinal orchiectomy (biopsy) in February 2016. Systemic chemotherapy, irradiation of the remaining testicle, and additional intravitreal injection of MTX were performed. To date, there has been no metastasis to the remaining testicle or any other regions, or exacerbation of the eye condition.
Conclusion: We encountered a very rare case of the accidental discovery of a testicular lesion during treatment of PIOL. Routine systemic examination may be necessary, even during treatment of eye lesions.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 121: 761-767, 2017.