Ocular manifestations of testicular lymphoma

Purposes The testes, brain and eye are considered immune‐privileged sites in which specific cell properties allow certain malignant cells to escape immune system destruction. Rarely such sites may develop B‐cell lymphoma. Testicular lymphoma is a rare disease, most common in elderly male patients, few clinical reports document the association between primary testicular lymphoma and eye disease. Methods We report a case of a 75 year old male patient who presented with signs and symptoms which mimicked primary intraocular lymphoma. Given this suspicion, the patient was referred to an ocular oncology unit where a chorioretinal biopsy was taken revealing inflammatory cells with no evidence of malignancy. Results A number of months later, the patient re‐presented with deteriorating ocular symptoms, a plan was made for vitrectomy with re‐biospy. At a similar time, the patient presented to his GP with a testicular swelling, imaging revealed a right testicular mass from which biopsies were taken. Histology confirmed diffuse large B cell lymphoma of the testicle, and subsequently the patient was found to have intracerebral disease. The patient unfortunately passed away before further ocular investigation or biopsy. Conclusion The presence of vitritis and retinal lesions suggestive of lymphoma in an elderly male patient should prompt investigation of the testes in addition to CNS. A high suspicion for intraocular lymphoma must be maintained with continued close follow up, as early symptoms may be non‐specific and initial vitreous biopsy negative for malignant cells.