Vitreoretinal Lymphoma: from Symptoms to Diagnosis to Treatment lymph nodes, or a malignancy such as primary vitreoretinal lymphoma.” Earlier chest imaging had revealed a suspicious lymph node on the lung, which could have been consistent with either diagnosis. After consulting thoracic and rheumatology specialists at the Ann Arbor VA, it was determined his pulmonary node was highly calcified and therefore unlikely to produce a diagnostic sample if it were to be biopsied. “This meant that in order to make a diagnosis, we would instead need to proceed with a biopsy of vitreous fluid from Mr. Johnson’s eye,” she continues. “Given the small size and volume of the posterior segment of the eye, it can be challenging
Rajesh Rao, M.D., and Therese Sassalos, M.D., with Kenneth Johnson before his surgery
“
to get a large enough sample of cells to analyze.” Dr. Sassalos turned to a colleague at Kellogg with extensive clinical and research experience in complex vitreo-
COMPLEX CASES LIKE
retinal cases. Retinal and vitreous surgeon Rajesh Rao, M.D., per-
MR. JOHNSON’S REINFORCE THE VALUE
formed a diagnostic vitrectomy,
OF MULTIDISCIPLINARY COLLABORATION,
wasn’t right when, in May 2020, the Ann Arbor resident began
IS WILLING TO BE PART OF THAT TEAM,
experiencing a cluster of uncomfortable symptoms, including jaw pain, earache, and large black and white
THROUGH IT ALL, HIS ATTITUDE HAS BEEN TRULY INSPIRING.
spots in his vision. “I’ve had floaters before, but none like these,” he says.
— Therese Sassalos, M.D.
“There was a whole solar system of spots in my left eye.” Johnson phoned a nurse at the Veterans Administration Ann Arbor Healthcare System, who recommended
positive for lymphoma. “Vitreoretinal lymphoma is rare, and its consequences are serious,” Dr. Rao explains. “To be absolutely sure, we needed to go the extra mile.” Much of that extra mile happened behind the scenes in the pathology lab at
Kellogg and the U-M Department of Pathol-
ogy. In addition to traditional analysis, which
was overseen by Victor Elner, M.D., Ph.D., an ophthalmic
he visit the emergency room. The VA team performed a battery
pathologist specializing in rare ocular conditions, genetic testing
of tests, ruling out cardiovascular disease and other issues.
was performed by a team led by Noah Brown, M.D., Medical
To address the symptoms impacting his vision, they called upon Therese Sassalos, M.D. As a specialist in inflammatory
Director of the U-M Molecular Diagnostics Laboratory. “Genetic testing analyzes the DNA in the sample for muta-
and infectious eye conditions, Dr. Sassalos practices at the
tions and biomarkers linked to this particular type of cancer,”
Kellogg Eye Center and leads a dedicated uveitis clinic at the
explains Dr. Rao. “It is a more sensitive and specific analysis,
Ann Arbor VA.
and can be an important adjunct approach to enhance our
“Examining Mr. Johnson suggested a diagnosis of uveitis,” Dr. Sassalos recalls. “A complete systemic laboratory and
2
from the left eye. The cells tested
AND THE IMPORTANCE OF A PATIENT WHO
“
Kenneth Johnson knew something
removing nearly all of the vitreous
ability to detect this hard-to-diagnose cancer.” In order to analyze the DNA, Dr. Rao and Dr. Brown
radiologic evaluation ruled out an infectious cause. That left
needed to harness a fundamental tool of molecular diagnos-
two other possible diagnostic categories: an autoimmune condi-
tics — polymerase chain reaction (PCR) testing. PCR is used to
tion like sarcoidosis, which can impact the eyes, lungs and
make thousands of exact copies of DNA molecules from one
