Ophthalmic Manifestations of Hodgkin Lymphoma: A Review

Abstract

<b><i>Background:</i></b> Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL. <b><i>Summary:</i></b> Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy. <b><i>Key Message:</i></b> Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.

Vogt-Koyanagi-Harada disease developed during chemotherapy for Hodgkin lymphoma: a case report

“…Possible causes of the development of VKH disease, other than autoimmune diseases, include paraneoplastic syndrome, masquerade syndrome, infection, and drug-related causes [ 9 ]. In the present case, paraneoplastic syndrome could not be ruled out as a possible cause because serum autoantibody testing for retinal antibodies was not performed.…”

Unmasking an unusual presentation of Hodgkin’s lymphoma masquerading as ocular inflammation: a case report

“…However, the visual prognosis varied considerably, primarily depending on the extent of initial involvement [ 9 ]. Therefore, a regular follow-up and adaptation of systemic treatment of HL along with local ophthalmic treatment may facilitate complete regression of symptoms, better preservation of vision and may prevent permanent damage to the affect part of the eye [ 21 ]. Likewise, in our patient, collaboration with internal medicine and oncology teams led to a prompt examination and a timely diagnosis that allowed halting of the progression of the panuveitis most probably being a paraneoplastic symptom of HL.…”

Ocular Manifestations in Hematological Disorders

“…As yet, there is scant literature regarding the association of both nystagmus and Hodgkin's lymphoma [16]. Ophthalmic manifestations in systemic lymphoma may be the result of direct infiltration invading the optic nerve or the vitreoretinal, corneal or conjunctival inflammation, paraneoplastic retinopathy, or drug-induced lesions [17]. Moreover, locations of ophthalmic lymphomas might be intraocular or adnexal.…”