Intraocular lymphoma: Difference between revisions
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==Overview== | ==Overview== | ||
'''Intraocular lymphoma''' is a rare subtype of primary central nervous system lymphoma. Intraocular lymphoma may affect the eye secondarily from metastasis from a non-ocular tumor or may arise within the eye primarily. According to the World Health Organization (WHO) classification, intraocular lymphomas are most commonly a diffuse large B-cell immunohistologic subtype of [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]]. The most common symptoms of intraocular lymphoma are blurred or decreased vision. In the majority of patients, [[central nervous system]] involvement only accounts for 20% of primary central nervous system lymphomas. The median age at diagnosis among patients with intraocular lymphoma is between 50-60 years. The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption. On fluorescein angiography, findings may reveal "leopard spot" patterns due to sub-retinal pigment epithelium infiltrates that stain early and progressively or mottling of the sub-retinal pigment epithelium due to hyper- and hypo-fluorescent window defects. The initial therapy for patients with intraocular lymphoma is corticosteroids. | '''Intraocular lymphoma''' is a rare subtype of [[primary central nervous system lymphoma]]. Intraocular lymphoma may affect the eye secondarily from [[metastasis]] from a non-[[ocular]] tumor or may arise within the eye primarily. According to the [[World Health Organization]] (WHO) classification, intraocular lymphomas are most commonly a [[Diffuse large B cell lymphoma|diffuse large B-cell]] immunohistologic subtype of [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]]. The most common symptoms of intraocular lymphoma are [[Blurred vision|blurred]] or decreased vision. In the majority of patients, [[central nervous system]] involvement only accounts for 20% of [[Primary central nervous system lymphoma|primary central nervous system lymphomas]]. The median age at diagnosis among patients with intraocular lymphoma is between 50-60 years. The [[pathogenesis]] of intraocular lymphoma is characterized by the affection of the sub-[[retinal pigment epithelium]], which is normally involved in the light absorption. On fluorescein angiography, findings may reveal "leopard spot" patterns due to sub-[[retinal pigment epithelium]] infiltrates that [[stain]] early and progressively or [[mottling]] of the sub-[[retinal pigment epithelium]] due to hyper- and hypo-[[fluorescent]] window defects. The initial therapy for patients with intraocular lymphoma is [[Corticosteroid|corticosteroids]]. | ||
==Historical Perspective== | ==Historical Perspective== | ||
| Line 14: | Line 14: | ||
Intraocular lymphoma may be classified according to its location into 2 subtypes:<ref name="CouplandDamato2008">{{cite journal|last1=Coupland|first1=Sarah E|last2=Damato|first2=Bertil|title=Understanding intraocular lymphomas|journal=Clinical & Experimental Ophthalmology|volume=36|issue=6|year=2008|pages=564–578|issn=14426404|doi=10.1111/j.1442-9071.2008.01843.x}}</ref> | Intraocular lymphoma may be classified according to its location into 2 subtypes:<ref name="CouplandDamato2008">{{cite journal|last1=Coupland|first1=Sarah E|last2=Damato|first2=Bertil|title=Understanding intraocular lymphomas|journal=Clinical & Experimental Ophthalmology|volume=36|issue=6|year=2008|pages=564–578|issn=14426404|doi=10.1111/j.1442-9071.2008.01843.x}}</ref> | ||
* Retinal | *[[Retinal]] | ||
**Retinal | **Retinal | ||
**Vitreoretinal | **Vitreoretinal | ||
**Vitreal | **[[Vitreous|Vitreal]] | ||
* Uveal | *[[Uvea (anatomy)|Uveal]] | ||
**Iridal | **[[Iris|Iridal]] | ||
**Ciliary | **[[Ciliary Muscle|Ciliary]] | ||
**Choroidal | **[[Choroidal]] | ||
| Line 40: | Line 37: | ||
==Pathophysiology== | ==Pathophysiology== | ||
* Intraocular lymphoma arises from B cell, which are normally involved in immune system. | * Intraocular lymphoma arises from [[B cell]], which are normally involved in [[immune system]]. | ||
*Intraocular lymphoma can be either primary or secondary central nervous system lymphoma (oculocerebral lymphoma) that mainly affects the [[optic nerve]] and the eye.<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | *Intraocular lymphoma can be either [[Primary central nervous system lymphoma|primary]] or secondary central nervous system lymphoma (oculocerebral lymphoma) that mainly affects the [[optic nerve]] and the eye.<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | ||
*The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref> | *The [[pathogenesis]] of intraocular lymphoma is characterized by the affection of the sub-[[retinal pigment epithelium]], which is normally involved in the light absorption.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref> | ||
*Genes associated with the development of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | *[[Gene|Genes]] associated with the development of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | ||
:*[[C-myc|C-MYC gene]] | :*[[C-myc|C-MYC gene]] | ||
| Line 51: | Line 48: | ||
*On microscopic histopathological analysis, characteristic findings of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | *On microscopic histopathological analysis, characteristic findings of intraocular lymphoma, include:<ref name="wiki">Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma</ref> | ||
:*Marginal zone (52%) | :*[[Marginal zone]] (52%) | ||
:*Follicular (23%) | :*Follicular (23%) | ||
:*Atypical lymphocytes (gold standard) | :*[[Atypical lymphocytes]] ([[Gold standard (test)|gold standard]]) | ||
:*Elevated interleukin [[IL-10]] | :*Elevated interleukin [[IL-10]]. According to the [[World Health Organization]] (WHO) classification, intraocular lymphomas are most commonly a [[Diffuse large B-cell lymphoma|diffuse large B-cell]] immunohistologic subtype of [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]].<ref name="PIOL" /> | ||
==Causes== | ==Causes== | ||
| Line 60: | Line 57: | ||
==Differentiating Intraocular Lymphoma from Other Diseases== | ==Differentiating Intraocular Lymphoma from Other Diseases== | ||
*Intraocular lymphoma must be differentiated from other diseases that cause chronic loss of vision, or headaches, such as:<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref><ref name="SenBodaghi2009">{{cite journal|last1=Sen|first1=H. Nida|last2=Bodaghi|first2=Bahram|last3=Hoang|first3=Phuc Le|last4=Nussenblatt|first4=Robert|title=Primary Intraocular Lymphoma: Diagnosis and Differential Diagnosis|journal=Ocular Immunology and Inflammation|volume=17|issue=3|year=2009|pages=133–141|issn=0927-3948|doi=10.1080/09273940903108544}}</ref> | *Intraocular lymphoma must be differentiated from other diseases that cause chronic [[loss of vision]], or [[headaches]], such as:<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref><ref name="SenBodaghi2009">{{cite journal|last1=Sen|first1=H. Nida|last2=Bodaghi|first2=Bahram|last3=Hoang|first3=Phuc Le|last4=Nussenblatt|first4=Robert|title=Primary Intraocular Lymphoma: Diagnosis and Differential Diagnosis|journal=Ocular Immunology and Inflammation|volume=17|issue=3|year=2009|pages=133–141|issn=0927-3948|doi=10.1080/09273940903108544}}</ref> | ||
:* Pigmented [[nevi]] | :* Ocular [[metastasis]] (most common) | ||
:* [[Congenital]] [[hypertrophy]] of the [[retinal pigment epithelium]] | :*Pigmented [[nevi]] | ||
:*[[Congenital]] [[hypertrophy]] of the [[retinal pigment epithelium]] | |||
:* Optic disc melanocytoma | :* Optic disc melanocytoma | ||
:* [[Hypertrophy]] of the [[retinal pigment epithelium]] | :*[[Hypertrophy]] of the [[retinal pigment epithelium]] | ||
:* [[Hyperplasia]] of [[retinal pigment epithelium]] | :*[[Hyperplasia]] of [[retinal pigment epithelium]] | ||
:* [[Choroidal]] [[hemangioma]] | :*[[Choroidal]] [[hemangioma]] | ||
:* [[Choroidal]] [[metastasis]] | :*[[Choroidal]] [[metastasis]] | ||
:* [[Choroidal]] [[osteoma]] | :*[[Choroidal]] [[osteoma]] | ||
:* Peripheral [[exudative]] hemorrhagic chorioretinopathy | :* Peripheral [[exudative]] hemorrhagic chorioretinopathy | ||
:* [[Choroidal]] [[hemorrhage]] | :*[[Choroidal]] [[hemorrhage]] | ||
:* Hemorrhagic detachment of [[retina]] and [[retinal pigment epithelium]] | :* Hemorrhagic detachment of [[retina]] and [[retinal pigment epithelium]] | ||
:* [[Posterior]] [[nodular]] [[scleritis]] | :*[[Posterior]] [[nodular]] [[scleritis]] | ||
:* Intraocular [[leiomyoma]] | :* Intraocular [[leiomyoma]] | ||
:* [[Adenoma]] of [[retinal pigment epithelium]] | :*[[Adenoma]] of [[retinal pigment epithelium]] | ||
:* [[Retinoblastoma]] | :*[[Retinoblastoma]] | ||
:* Uveal [[metastases]] | :* Uveal [[metastases]] | ||
:* [[Choroidal]] detachment | :*[[Choroidal]] detachment | ||
:* [[Choroidal]] [[cyst]] | :*[[Choroidal]] [[cyst]] | ||
:* Uveal [[neurofibroma]] | :* Uveal [[neurofibroma]] | ||
:* Uveal [[schwannoma]] | :* Uveal [[schwannoma]] | ||
:*Choroidal hemangioma | :*Choroidal hemangioma | ||
:*Vitrous lymphoma | :*Vitrous lymphoma | ||
| Line 91: | Line 88: | ||
=== Prevalence === | === Prevalence === | ||
* The prevalence of intraocular lymphoma remains unknown.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref><ref name="MochizukiSingh2009">{{cite journal|last1=Mochizuki|first1=Manabu|last2=Singh|first2=Arun D.|title=Epidemiology and Clinical Features of Intraocular Lymphoma|journal=Ocular Immunology and Inflammation|volume=17|issue=2|year=2009|pages=69–72|issn=0927-3948|doi=10.1080/09273940902957305}}</ref> | * The [[prevalence]] of intraocular lymphoma remains unknown.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref><ref name="MochizukiSingh2009">{{cite journal|last1=Mochizuki|first1=Manabu|last2=Singh|first2=Arun D.|title=Epidemiology and Clinical Features of Intraocular Lymphoma|journal=Ocular Immunology and Inflammation|volume=17|issue=2|year=2009|pages=69–72|issn=0927-3948|doi=10.1080/09273940902957305}}</ref> | ||
===Age=== | ===Age=== | ||
| Line 100: | Line 97: | ||
===Race=== | ===Race=== | ||
*There is no racial predilection for intraocular lymphoma. | *There is no [[racial]] predilection for intraocular lymphoma. | ||
==Risk Factors== | ==Risk Factors== | ||
*Common risk factors in the development of intraocular lymphoma, include:<ref name="ShenHerbort2001">{{cite journal|last1=Shen|first1=De Fen|last2=Herbort|first2=Carl P|last3=Tuaillon|first3=Nadine|last4=Buggage|first4=Ronald R|last5=Egwuagu|first5=Charles E|last6=Chan|first6=Chi-Chao|title=Detection of Toxoplasma Gondii DNA in Primary Intraocular B-Cell Lymphoma|journal=Modern Pathology|volume=14|issue=10|year=2001|pages=995–999|issn=0893-3952|doi=10.1038/modpathol.3880424}}</ref><ref name="pmid14971583">{{cite journal |vauthors=Chan CC |title=Molecular pathology of primary intraocular lymphoma |journal=Trans Am Ophthalmol Soc |volume=101 |issue= |pages=275–92 |date=2003 |pmid=14971583 |pmc=1358994 |doi= |url=}}</ref> | *Common [[risk factors]] in the development of intraocular lymphoma, include:<ref name="ShenHerbort2001">{{cite journal|last1=Shen|first1=De Fen|last2=Herbort|first2=Carl P|last3=Tuaillon|first3=Nadine|last4=Buggage|first4=Ronald R|last5=Egwuagu|first5=Charles E|last6=Chan|first6=Chi-Chao|title=Detection of Toxoplasma Gondii DNA in Primary Intraocular B-Cell Lymphoma|journal=Modern Pathology|volume=14|issue=10|year=2001|pages=995–999|issn=0893-3952|doi=10.1038/modpathol.3880424}}</ref><ref name="pmid14971583">{{cite journal |vauthors=Chan CC |title=Molecular pathology of primary intraocular lymphoma |journal=Trans Am Ophthalmol Soc |volume=101 |issue= |pages=275–92 |date=2003 |pmid=14971583 |pmc=1358994 |doi= |url=}}</ref> | ||
:*Toxoplasma gondii infection | :*[[Toxoplasma gondii]] infection | ||
:*EBV infection | :*[[EBV infection]] | ||
:*HHV8 infection | :*HHV8 infection | ||
== Natural History, Complications and Prognosis== | == Natural History, Complications and Prognosis== | ||
*The majority of patients with intraocular lymphoma are symptomatic at the time of diagnosis. | *The majority of patients with intraocular lymphoma are [[symptomatic]] at the time of diagnosis. | ||
*Early clinical features include symptoms of a non-resolving uveitis, and blurred vision.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref> | *Early clinical features include symptoms of a non-resolving uveitis, and blurred vision.<ref name="PIOL">Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15</ref> | ||
*If left untreated, patients with intraocular lymphoma may progress to develop complete vision loss. | *If left untreated, patients with intraocular lymphoma may progress to develop complete vision loss. | ||
Latest revision as of 14:15, 18 September 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: PIOL; Ocular Lymphoma; Primary central nervous system ocular lymphoma
Overview
Intraocular lymphoma is a rare subtype of primary central nervous system lymphoma. Intraocular lymphoma may affect the eye secondarily from metastasis from a non-ocular tumor or may arise within the eye primarily. According to the World Health Organization (WHO) classification, intraocular lymphomas are most commonly a diffuse large B-cell immunohistologic subtype of non-Hodgkin's lymphoma. The most common symptoms of intraocular lymphoma are blurred or decreased vision. In the majority of patients, central nervous system involvement only accounts for 20% of primary central nervous system lymphomas. The median age at diagnosis among patients with intraocular lymphoma is between 50-60 years. The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption. On fluorescein angiography, findings may reveal "leopard spot" patterns due to sub-retinal pigment epithelium infiltrates that stain early and progressively or mottling of the sub-retinal pigment epithelium due to hyper- and hypo-fluorescent window defects. The initial therapy for patients with intraocular lymphoma is corticosteroids.
Historical Perspective
- Intraocular lymphoma was first discovered by Samuel Wilks, a British physician, in 1856.[1]
Classification
Intraocular lymphoma may be classified according to its location into 2 subtypes:[2]
| Intraocular lymphoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Retinal | Uveal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Retinal | Vitreoretinal | Vitreal | Iridal | Ciliary | Choroidal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary | Secondary | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
- Intraocular lymphoma arises from B cell, which are normally involved in immune system.
- Intraocular lymphoma can be either primary or secondary central nervous system lymphoma (oculocerebral lymphoma) that mainly affects the optic nerve and the eye.[3]
- The pathogenesis of intraocular lymphoma is characterized by the affection of the sub-retinal pigment epithelium, which is normally involved in the light absorption.[4]
- Genes associated with the development of intraocular lymphoma, include:[3]
- On microscopic histopathological analysis, characteristic findings of intraocular lymphoma, include:[3]
- Marginal zone (52%)
- Follicular (23%)
- Atypical lymphocytes (gold standard)
- Elevated interleukin IL-10. According to the World Health Organization (WHO) classification, intraocular lymphomas are most commonly a diffuse large B-cell immunohistologic subtype of non-Hodgkin's lymphoma.[4]
Causes
- There are no established causes of intraocular lymphoma.
Differentiating Intraocular Lymphoma from Other Diseases
- Intraocular lymphoma must be differentiated from other diseases that cause chronic loss of vision, or headaches, such as:[4][5]
- Ocular metastasis (most common)
- Pigmented nevi
- Congenital hypertrophy of the retinal pigment epithelium
- Optic disc melanocytoma
- Hypertrophy of the retinal pigment epithelium
- Hyperplasia of retinal pigment epithelium
- Choroidal hemangioma
- Choroidal metastasis
- Choroidal osteoma
- Peripheral exudative hemorrhagic chorioretinopathy
- Choroidal hemorrhage
- Hemorrhagic detachment of retina and retinal pigment epithelium
- Posterior nodular scleritis
- Intraocular leiomyoma
- Adenoma of retinal pigment epithelium
- Retinoblastoma
- Uveal metastases
- Choroidal detachment
- Choroidal cyst
- Uveal neurofibroma
- Uveal schwannoma
- Choroidal hemangioma
- Vitrous lymphoma
- Retrolental fibroplasia
Epidemiology and Demographics
Prevalence
- The prevalence of intraocular lymphoma remains unknown.[4][6]
Age
- Intraocular lymphoma is more commonly observed among patients aged 50 to 60 years old.
Gender
- Males are more commonly affected with intraocular lymphoma than females.
Race
- There is no racial predilection for intraocular lymphoma.
Risk Factors
- Common risk factors in the development of intraocular lymphoma, include:[7][8]
- Toxoplasma gondii infection
- EBV infection
- HHV8 infection
Natural History, Complications and Prognosis
- The majority of patients with intraocular lymphoma are symptomatic at the time of diagnosis.
- Early clinical features include symptoms of a non-resolving uveitis, and blurred vision.[4]
- If left untreated, patients with intraocular lymphoma may progress to develop complete vision loss.
- Common complications of intraocular lymphoma, include:[3]
- Blindness
- Radiation-induced retinopathy
- Neovascular glaucoma
- Prognosis is generally good, and the 5-year survival for patients with intraocular lymphoma is between 65-80%.[3]
Diagnosis
History and Symptoms
- Burning of the eye
- Redness of the eye
- Visual field defect
- Blurred vision
- Photophobia or sensitivity to light
- Eye pain
- Floaters
- Headache
Physical Examination
- Patients with intraocular lymphoma usually appear pale or malnourished.[4]
- Physical examination may be remarkable for:
- Decreased visual acuity (most common)
- Irregular pupil
- Increased lacrimation
- Eye redness
- Increased intraocular pressure
Laboratory Findings
- There are no specific laboratory findings associated with intraocular lymphoma.
Imaging Findings
- Magnetic resonance image (MRI) is the imaging modality of choice for patients with intraocular lymphoma.[4]
- On MRI, characteristic findings of intraocular lymphoma, include:[3]
- Fat suppressed T2 and post-contrast T1 weighted images, with thin slice thickness and a reduced FOV is ideal, and should include the cavernous sinuses.
- T1: isointense to muscle 8
- T2: hyperintense to muscle, hypointense to fat
- T1 C+ (GAD): enhancement present but variable
Treatment
Medical Therapy
- The initial therapy for intraocular lymphoma is corticosteroids.[4]
- Other medical therapies for intraocular lymphoma, may include:[4]
- Methotrexate
- Intravitreal rituximab
- Localized external beam radiation therapy (EBRT)
Surgery
- Surgery is the mainstay of therapy for intraocular lymphoma.
Primary Prevention
- There are no primary preventive measures available for intraocular lymphoma.[4]
- Once diagnosed and successfully treated, patients with intraocular lymphoma are followed-up periodically every 3, 6, or 12 months.
- The average relapse rate among patients with intraocular lymphoma is 2 years.[4]
Secondary Prevention
References
- ↑ Ahmed S, Shahid RK, Sison CP, Fuchs A, Mehrotra B. Orbital lymphomas: a clinicopathologic study of a rare disease. Am J Med Sci. 2006 Feb. 331(2):79-83.
- ↑ Coupland, Sarah E; Damato, Bertil (2008). "Understanding intraocular lymphomas". Clinical & Experimental Ophthalmology. 36 (6): 564–578. doi:10.1111/j.1442-9071.2008.01843.x. ISSN 1442-6404.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Intraocular lymphoma. Wikipedia. https://en.wikipedia.org/wiki/Intraocular_lymphoma
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 Hanson JA, Alexandru D and Bota DA: The evaluation and treatment of primary intraocular lymphoma. journal of Cancer Therapeutics and Research 2013, 2:15 http://dx.doi.org/10.7243/2049-7962-2-15
- ↑ Sen, H. Nida; Bodaghi, Bahram; Hoang, Phuc Le; Nussenblatt, Robert (2009). "Primary Intraocular Lymphoma: Diagnosis and Differential Diagnosis". Ocular Immunology and Inflammation. 17 (3): 133–141. doi:10.1080/09273940903108544. ISSN 0927-3948.
- ↑ Mochizuki, Manabu; Singh, Arun D. (2009). "Epidemiology and Clinical Features of Intraocular Lymphoma". Ocular Immunology and Inflammation. 17 (2): 69–72. doi:10.1080/09273940902957305. ISSN 0927-3948.
- ↑ Shen, De Fen; Herbort, Carl P; Tuaillon, Nadine; Buggage, Ronald R; Egwuagu, Charles E; Chan, Chi-Chao (2001). "Detection of Toxoplasma Gondii DNA in Primary Intraocular B-Cell Lymphoma". Modern Pathology. 14 (10): 995–999. doi:10.1038/modpathol.3880424. ISSN 0893-3952.
- ↑ Chan CC (2003). "Molecular pathology of primary intraocular lymphoma". Trans Am Ophthalmol Soc. 101: 275–92. PMC 1358994. PMID 14971583.
- ↑ Coupland, Sarah E; Damato, Bertil (2008). "Understanding intraocular lymphomas". Clinical & Experimental Ophthalmology. 36 (6): 564–578. doi:10.1111/j.1442-9071.2008.01843.x. ISSN 1442-6404.