Suspected Secondary Intraocular Lymphoma With Choroidal Involvement Following Testicular Diffuse Large B-cell Lymphoma: A Case Report

Secondary intraocular lymphoma is an uncommon manifestation of systemic lymphoma and may relapse in immune-privileged sites years after apparent remission. We report the case of a 67-year-old man with a history of right testicular diffuse large B-cell lymphoma (DLBCL) treated with orchiectomy and systemic chemotherapy who presented five years later with painless progressive vision loss in the left eye. Examination revealed visual acuity of 20/80, fibrinoid material with hemorrhage in the anterior chamber, and yellow-white choroidal infiltrates extending from the optic disc toward the periphery with associated subretinal fluid. Multimodal imaging demonstrated subretinal infiltrates and diffuse choroidal thickening. Diagnostic pars plana vitrectomy was performed during repair of an associated retinal detachment. Routine cytology was nondiagnostic, MYD88 L265P testing was negative, and flow cytometry using a limited panel identified an abnormal lambda-restricted B-cell population comprising 45.2% of CD45+ events, without definitive morphologic confirmation. In the context of the patient’s prior lymphoma history, supportive multimodal ocular findings, and exclusion of major infectious and inflammatory etiologies, the overall clinicopathologic impression favored secondary intraocular lymphoma with choroidal involvement. Systemic restaging showed no active extraocular or central nervous system disease. Treatment with oral ibrutinib 560 mg daily was associated with clinical stability over 24 months, improvement of visual acuity to 20/40, resolution of subretinal fluid, stable residual choroidal changes, and no evidence of systemic recurrence. This case highlights the importance of long-term ophthalmic surveillance in patients with testicular DLBCL and the integration of multimodal imaging, ocular fluid analysis, and systemic restaging in the evaluation of suspected ocular relapse.