PMC3913975_01
(A) Skin mass is visible in left frontal area. On microscopic examination, excisional biopsy reveals tissue heavily infiltrated by small lymphocytic cells (B) (H&E, x40). Immunohistochemistry reveals infiltrating cells that strongly express CD3 (C) (x200) and anaplastic lymphoma kinase (D) (x200). (E) Slit lamp photograph of right eye on second visit. Significant inflammation with fibrin reaction is visible in anterior chamber. Subconjunctival hemorrhage is present. (F) Ocular ultrasonography demonstrates relatively clear posterior segment, suggesting that inflammation is localized in the anterior eye. (G) Cytospin smear shows atypical cells harboring a moderate amount of cytoplasm and eccentric kidney-shaped nuclei (Wright stain, x1,000). (H) During treatment course, acute angle closure due to pupillary block by dense fibrin clots is noted. (I) Magnetic resonance imaging shows focal enhancement of the iris and ciliary body without posterior segment involvement. (J) Positron emission tomography scan shows increased fluorodeoxyglucose metabolism in the right eye surface, right thyroid, and uterine wall.
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F1
A 36-year-old woman presented with multiple facial masses in the left submandibular and forehead area (Fig. 1A). Incisional biopsy of the forehead lesion revealed ALCL with positivity for CD30, CD3, and ALK (Fig. 1B-1D). On the second visit after 2 days, the patient's right eye demonstrated severe inflammatory reaction with dense fibrin clots around the pupillary margin in the anterior chamber with significant corneal edema (Fig. 1E). No fundus details were observed and ocular ultrasonography revealed a relatively clear posterior segment (Fig. 1F). A cytospin smear of aqueous humor aspiration revealed atypical lymphocytes (Fig. 1G). On the next day of aqueous humor culture, acute angle closure developed (intraocular pressure rose to 40 mmHg) due to pupillary block by dense fibrin (Fig. 1H). MRI showed focal enhancement of the iris, ciliary body, and anterior chamber without posterior segment involvement (Fig. 1I). A PET scan revealed increased fluorodeoxyglucose (FDG) metabolism in the right eye, right thyroid, and uterine wall (Fig. 1J).
Changes in silt lamp findings on days 6 (A), 9 (B), 11 (C), and 14 (D) after radiotherapy. Gradual regression of tumor material and fibrin reaction is noted.
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F2
After 30 Gy of radiation therapy in total, the patient's best-corrected visual acuity was restored to 20 / 25 with an IOP of 11 mmHg without glaucoma medication (Fig. 2).