Background: This article presents the case of a patient who experienced a monoclonal proliferation of CD8⁺T cells without lung cancer cells in the vitreous specimen after he underwent vitreous biopsy for vitreous opacities.
Case: A 78-year-old male was diagnosed with squamous cell lung carcinoma with epidermal growth factor receptor (EGFR) gene mutation, classified as T4N2M1 (StageIV), by his previous physician in April 20XX-2. He underwent several series of chemotherapy but had a progressive disease. He presented to a nearby ophthalmology with the chief complaint of blurred vision in the left eye in May 20XX. He was diagnosed with iridocyclitis of the left eye and treatment with steroid eye drops was initiated. Vitreous opacities developed in the left eye and steroid therapy was initiated in June 20XX. However, due to the exacerbation of the vitreous opacities, he visited our department for the first time in September 20XX. He underwent vitreous biopsy for diagnostic purpose because of suspicion of choroidal metastasis. A cellular specimen was represented mostly by atypical lymphoid cells with irregular nucleus in the vitreous specimen using smear preparation; however, lung cancer cells were not detected. Infiltration of CD8⁺T cells was observed in slides derived from the vitrectomy cell block, but no lung cancer cells were detected. A clonal gene rearrangement of the T cell receptor gene were detected in DNA derived from the vitreous. However, lung cancer tumor markers, carcinoembryonic antigen (CEA) and CYFRA21-1, were not detected in the vitreous humor. Greyish-white elevated subretinal lesions emerged in the choroids in January 20XX+1. Because of increased levels of CYFRA21-1 in the aqueous humor and adrenal metastasis on abdominal computed tomography scan, choroidal metastasis was considered.
Conclusion: The vitreous opacity in this case was most likely due to a monoclonal proliferation of CD8⁺T cells in response to tumor cells, which occurred after choroidal metastasis from lung cancer.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 92-99, 2023.