Demonstration of identical clonal derivation in a case of "oculocerebral" lymphoma

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Abstract
A 51 year old systemically healthy man presented in March 2002 with an epileptic fit. Cranial magnetic resonance imaging demonstrated a mass with intensive contrast enhancement in the left fronto-parietal area. A stereotactic biopsy was performed, establishing the diagnosis of a high grade malignant B cell NHL (fig 1A). The neoplastic cells consisted of medium to large sized blasts and were orientated perivascularly. They demonstrated immunoreactivity for CD20, a monotypical expression of Ig-kappa, and a large growth fraction (Ki-67 antigen) of 90%. Staging procedures did not reveal any systemic lymphoma. Two cycles of high dose methotrexate chemotherapy (4 g/m2 intravenously per cycle) were commenced. The patient developed recurrent epileptic attacks, and repeat imaging studies demonstrated tumour size increase. The patient was treated with whole brain irradiation (total dosage, 45 Gy), resulting in complete remission for 14 months. In August 2003, the patient complained of “floaters” and a bilateral decrease in vision. On examination, the visual acuity (VA) was 20/25 and 20/32 in the right and left eyes, respectively. Funduscopy revealed bilateral dense cellular infiltrates in the vitreous.

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