Ocular adnexal lymphoid proliferations: clinical, histologic, flow cytometric, and molecular analysis of forty-three cases

Reactive lymphoid hyperplasia 1 month after LASIK surgery

PURPOSE

This study was conducted to investigate a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK).

METHODS

A 31-year-old man who underwent LASIK presented 1 month later with a fleshy conjunctival (plical) tumor in the left eye. An excision biopsy of the tumor was performed.

RESULTS

Histopathology of the excised tumor revealed reactive lymphoid hyperplasia.

DISCUSSION

Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumors. This report describes the unusual occurrence of a lymphoid conjunctival tumor after LASIK eye surgery.

MRI patterns in orbital malignant lymphoma and atypical lymphocytic infiltrates

OBJECTIVE

To evaluate the potential of MRI in differentiating between malignant lymphomas and atypical lymphocytic infiltrates in the orbit.

MATERIALS AND METHODS

MRI, clinical and histopathological findings in 30 patients presenting with orbital lymphoproliferative diseases (malignant lymphoma and atypical lymphocytic infiltrates) were evaluated.

RESULTS

MRI detected 28 out of 30 (93%) orbital lymphoid tumors. Seven out of eight (87.5%) atypical lymphocytic infiltrates and 21/22 (95.4%) of malignant lymphomas were detected. One conjunctival malignant lymphoma and one conjunctival atypical lymphocytic infiltrate were missed. Only malignant lymphoma lesions were hyperintense compared to the extraocular muscles on precontrast and postcontrast T1-weighted images. The lacrimal duct was involved only with malignant lymphoma. Bilateral disease was more likely to be malignant lymphoma. Intraconal lesions were more likely to be associated with lesions elsewhere. No malignant lymphoma involved the extraconal fat. Only intraconal atypical lymphocytic infiltrates had indistinct margins.

CONCLUSION

In the orbit, MRI features alone may not allow clear-cut differentiation of malignant lymphomas from atypical lymphocytic infiltrates. However, certain imaging features increase the likelihood of distinguishing them. MRI may miss conjunctival disease. Both orbits should be imaged when orbital lymphoid disease is a probability. The presence of intraconal disease should prompt a search for lesions elsewhere. The use of a head coil instead of a superficial coil may be advantageous by eliminating coil shine effect and allowing evaluation of both orbits. Comparison of lesion signal to extraocular muscle signal appears to be a better alternative than cerebral gray matter or periorbital fat in differentiating malignant lymphoma from atypical lymphocytic infiltrates. Since imaging findings overlap, histopathological diagnosis is necessary in all cases.

Lymphoproliferative lesions of the lacrimal gland: clinicopathological, immunohistochemical and molecular genetic analysis

BACKGROUND

Lacrimal gland lymphoproliferative disorders are usually classified as orbital adnexal tumours. Because the lacrimal gland is the only orbital structure with native lymphocytes, we examined cases with primary involvement of the gland.

METHODS

The 14 cases were selected from a review of all cases in the surgical pathology files of the Ottawa Hospital between 1992 and 2003. The lesions were categorized according to the latest World Health Organization classification of tumours of lymphoid tissues. We conducted a clinical, histopathological, immunohistochemical, immunophenotypic and molecular genetic analysis of the cases.

RESULTS

The 8 female and 6 male patients, aged 20 to 88 (mean 60) years, were followed for an average of 4 years (range 11 months to 13 years). All presented with supratemporal orbital swelling. The 5 primary lymphomas, of mucosa-associated lymphoid tissue (MALT), were confined to the lacrimal gland (stage IE); 1 tumour transformed to diffuse large B-cell lymphoma, necessitating chemotherapy, and the other 4 were treated with radiation. One of the 5 patients had previously had Sjögren's syndrome. The 6 secondary lymphomas (4 follicular) presented either concurrently with systemic lymphoma or up to 12 years afterwards and were treated in a variety of ways; all the patients had an orbital relapse. At the last follow-up assessment, 6 of the patients with lymphoma had no evidence of disease, 3 were alive with disease, 2 had died (1 of lymphoma, the other with no evidence of disease), and the status of 1 patient was not known. Of the 3 patients with reactive proliferations, 2 had reactive lymphoid hyperplasia (associated with Sjögren's syndrome in 1), and 1 had Rosai-Dorfman disease. All 9 lymphomas that underwent molecular genetic analysis were of B-cell lineage, and 8 had a monoclonal rearrangement in the immunoglobulin heavy-chain gene (IgH); the 9th lymphoma showed an oligoclonal rearrangement. One lymphoma showed the t(14;18) translocation, typical of follicular lymphoma; no lymphoma showed the t(11;18) translocation, commonly found in MALT lymphoma (but only 2 cases were studied). Molecular genetic analysis was performed in 2 of the cases of reactive lymphoid hyperplasia: monoclonal IgH rearrangement was detected in 1 case (the patient with Sjögren's syndrome), oligoclonal rearrangement in the other.

INTERPRETATION

Lacrimal gland lymphomas are B-cell tumours that develop in older adults. Primary tumours, a hIgH proportion of which have MALT characteristics, have a favourable prognosis. Molecular genetic studies may be useful when morphologic and immunophenotypic studies give equivocal results.

Helicobacter pylori (H. pylori) molecular signature in conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma

Conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal marginal zone B-cell lymphoma that is characterized by an exaggerated clonal expansion of B cells, which implicate a pathological proliferative response to antigen(s) including bacteria. Helicobacter pylori (H. pylori) infection is recognized as one of the causative agents of gastric MALT lymphoma; however, it has not been reported in extra gastric MALT lymphoma. We studied 5 patients (4 adults and 1 child) with salmon-colored conjunctival lesions. One patient also had a history of abnormal bone marrow biopsy a year earlier with lymphoid aggregates involving 5% of the overall bone marrow. The conjunctival lesions of the 5 patients were biopsied. Histopathological diagnoses were consistent with conjunctival MALT lymphoma. Lymphoma and normal conjunctival cells were microdissected using laser capture microscopy or manual techniques. DNA was extracted and subjected to PCR amplification using H. pylori gene-specific primers from the urease B and vac/m2 gene. Cells from chronic conjunctivitis (normal lymphocytes), conjunctival human T-cell lymphotropic virus type-1/adult T-cell leukemia/lymphoma (HTLV-1/ATL), and orbital B-cell lymphoma were also microdissected, processed and analyzed. PCR amplification and Southern blot hybridization demonstrated H. pylori DNA in the conjunctival MALT lymphoma cells of 4/5 cases. The negative case was the one with a history of abnormal bone marrow. In contrast, H. pylori gene was not detected in normal conjunctival cells from the cases of MALT lymphoma or the lymphocytes, ATL and orbital B-lymphoma cells from the controls. These data suggest that H. pylori may play a role in conjunctival MALT lymphoma.

Bilateral reactive lymphoid hyperplasia of the orbit in a child with Russell-Silver syndrome

Russell-Silver syndrome (RSS) primarily includes intrauterine growth retardation, postnatal growth failure, body asymmetry, and craniofacial disproportion. Four types of malignancies have been reported in patients with RSS: craniopharyngioma, testicular seminoma, hepatocellular carcinoma, and Wilms tumor.

Primary intraocular lymphoma: clinical, cytologic, and flow cytometric analysis

PURPOSE

To compare cytologic with flow cytometric results of vitreous biopsy specimens obtained to rule out primary intraocular lymphoma (PIOL).

STUDY DESIGN

Prospective noncomparative case series.

PARTICIPANTS

Patients suspected of having PIOL who underwent vitreous biopsy were evaluated.

METHODS

Patients underwent a standard 3-port vitrectomy and vitreous biopsy to rule out PIOL. Each undiluted specimen was split, and half was prepared for cytologic evaluation with the collodion bag method; the other half was submitted for flow cytometric immunophenotyping (FCI). The diluted specimen was processed as a cell block for cytology.

MAIN OUTCOME MEASURES

Final diagnosis based on cytology and FCI.

RESULTS

Ten of 14 patients had sufficient specimens for both cytologic and FCI evaluation. Three patients had chronic inflammation confirmed by both methods. Six patients had large cell lymphoma identified by both cytology and FCI. Two of those 6 patients initially had insufficient specimen for FCI. One patient had large cell lymphoma diagnosed cytologically that was initially negative for a clonal population by FCI. All lymphomas were B-cell type.

CONCLUSIONS

Cytologic evaluation is an accurate diagnostic technique to evaluate for PIOL. FCI is useful for immunophenotyping PIOL. Multiple biopsies may be required to achieve a diagnosis.