A 68-year-old man with elevated LDH and β2-microglobulin is found to have bilateral vitritis, subretinal infiltrates, and creamy yellow lesions at the RPE-choroid interface. Vitreous biopsy reveals large atypical B-lymphocytes. This is primary vitreoretinal lymphoma (PVRL). The MOST appropriate systemic investigation is:
- A PET-CT scan to exclude systemic lymphoma
- B Bone marrow biopsy alone
- C MRI brain and lumbar puncture to exclude CNS lymphoma ✓
- D CT thorax to look for mediastinal involvement
Explanation
Primary vitreoretinal lymphoma (PVRL) is a variant of primary CNS lymphoma (PCNSL) — it is almost invariably diffuse large B-cell lymphoma (DLBCL). PVRL is strongly associated with concurrent or subsequent CNS involvement (brain, meninges) in up to 65–90% of cases. Therefore, MRI brain with gadolinium and CSF analysis (lumbar puncture for cytology and flow cytometry) are mandatory to assess CNS involvement, which determines staging and guides treatment (intrathecal vs systemic methotrexate, radiation). PET-CT assesses systemic lymphoma but misses CNS involvement. Bone marrow biopsy is for systemic lymphoma staging, not CNS.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.