Primary central nervous system lymphoma (PCNSL) is a rare subtype of non‐Hodgkin lymphoma confined to the brain, spinal cord, meninges, intraocular compartment, and cranial nerves. Intraocular lymphoma (IOL) is a rare subtype of PCNSL. Intravitreal involvement by a PCNSL is an infrequent but potentially fatal event. The role of vitreous cytology in diagnosing IOLs is vital but has been sporadically described in the literature due to its variable sensitivity. Herein, we present a case of PCNSL, who primarily presented with ocular symptoms and could be accurately diagnosed based on vitreous cytology and subsequently confirmed on stereotactic brain biopsy.
Hepatic cystic lesions are commonly seen in radiology and can occur due to infective or neoplastic causes. It is imperative to determine the precise nature of these hepatic cysts owing to significant therapeutic and prognostic differences. Hepatic metastases from gastrointestinal neuroendocrine tumors (NETs) mostly present as solid hypervascular lesions. Cystic presentation of the metastatic NETs is extremely rare. A 64-year-old woman presented with an abdominal lump of 3 months duration and high-grade fever from the last 2 days. An ultrasound abdomen revealed multiple hypoechoic liver lesions suggestive of liver abscesses. An ultrasound-guided fineneedle aspiration (FNA) from the cystic liver lesions revealed a NET confirmed by immunocytochemistry. The Ki-67 index was 5%; hence, a final diagnosis of metastatic NET, grade 2, was given with advice to work up for localizing the primary tumor. Subsequently, a contrast-enhanced computerized tomography of the abdomen revealed a polypoidal lesion in the proximal jejunum, which showed intense expression on the whole-body DOTANOC scan (SUVmax-76.5), indicating it to be the likely primary tumor along with somatostatin receptor-expressing multiple lymph nodes and hypodense liver lesions. Thus, a final diagnosis of a jejunal NET with abdominal lymph node and liver metastases was made. The present report highlights the importance of FNA as a reliable modality in diagnosing metastatic NETs presenting as unusual cystic hepatic metastases masquerading as liver abscesses. Additionally, the cell block helps confirm the cytologic diagnosis and enables upfront tumor grading, thereby helping in prognostication and therapeutic decision-making.
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