1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Caitlin M Nickens Affiliation: Uniformed Services University

2. MedPix No: 11064 - History Pt Demographics: Age = 62 y.o. Gender = man 62 y.o. man c/o progressive visual problem in his left eye Downloaded by (-1)

3. MedPix No: 11064 - EXAM & LABS Visual symptoms:Decreased vision in his left eye to hand motions Normal vision, right eyeOphthalmic examination:Large yellow choroidal lesions and vitreous cells, left eye

4. CNS lymphoma, large B-cell type, retina and brain Bilateral frontal lobe lesions, producing a *butterfly* pattern. Downloaded by (-1)

5. CNS lymphoma, large B-cell type, retina and brain Bilateral frontal lobe lesions, producing a *butterfly* pattern. Downloaded by (-1)

6. CNS lymphoma, large B-cell type, retina and brain The eye was enucleated. There is a region of thickening of the retina in the posterior globe. Downloaded by (-1)

7. Retinal lymphoma, large B-cell type A patient with Retinal lymphoma. This close-up view showed the region of thickening of the retina in the posterior globe. Downloaded by (-1)

8. Retinal lymphoma, large B-cell type A patient with Retinal lymphoma. Patient had decreased vision in the right eye. This close-up view showed the region of thickening of the retina in the posterior globe. Downloaded by (-1)

9. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of thickening of the retina in the posterior globe is hyperchromatic. Downloaded by (-1)

10. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic. Downloaded by (-1)

11. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. Downloaded by (-1)

12. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. Downloaded by (-1)

13. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. Downloaded by (-1)

14. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic - showing a lesion with *small round blue cells* - characteristic of lymphoma. Downloaded by (-1)

15. CNS lymphoma, large B-cell type, retina and brain Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic - showing a lesion with *small round blue cells* - characteristic of lymphoma. Downloaded by (-1)

16. Retinal CNS lymphoma, Special stains Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. Downloaded by (-1)

17. FINDINGS T2W MR shows bilateral frontal lobe involvement from a *butterfly* lesion in the genu of the corpus callosum Enucleated eye - after vitrectomy w/silicone oil replacement - shows thickening of the posterior retina w/small round blue cells

18. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? *Butterfly Lesions* - Astrocytoma, primary CNS lymphoma - - Retinal *blue cell tumor* - - Retinal lymphoma - - Retinoblastoma - - Chronic (benign) choroidal inflammation - - Status-post vitrectomy - - Intraocular silicone oil - - Cataract - - Angle closure glaucoma -

19. Diagnosis: Retinal lymphoma, large B-cell type Dx Confirmed by: Diagnostic vitrectomy and histopathology

20. DISCUSSION