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Abstract
Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies range from reactive lymphoid hyperplasia to specific IgG4-related inflammation to malignant lymphomas. This review summarizes current concepts regarding pathology, clinical presentation, diagnosis, staging, and treatment strategies of major orbital lymphoproliferative diseases based on updated and relevant bibliography.
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Affiliation(s)
- Emmy Y Li
- From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; †Hong Kong Eye Hospital; and ‡Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
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Ahn CJ, Kim NJ. A Case of Orbital MALT Lymphoma in a Patient with Rheumatoid Arthritis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.5.780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chan Joo Ahn
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Ju Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Lee JJ, Kim MS, Choi HY, Park KS, Lee SB. Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Min Su Kim
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
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Haradome K, Haradome H, Usui Y, Ueda S, Kwee TC, Saito K, Tokuuye K, Matsubayashi J, Nagao T, Goto H. Orbital lymphoproliferative disorders (OLPDs): value of MR imaging for differentiating orbital lymphoma from benign OPLDs. AJNR Am J Neuroradiol 2014; 35:1976-82. [PMID: 24874530 PMCID: PMC7966261 DOI: 10.3174/ajnr.a3986] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Accurate discrimination of orbital lymphoma from benign orbital lymphoproliferative disorders is crucial for treatment planning. We evaluated MR imaging including DWI and contrast-enhanced MR imaging for differentiating orbital lymphoma from benign orbital lymphoproliferative disorders. MATERIALS AND METHODS Forty-seven histopathologically proved orbital lymphoproliferative disorders (29 orbital lymphomas and 18 benign orbital lymphoproliferative disorders) were evaluated. Two board-certified radiologists reviewed visual features on T1-weighted, fat-suppressed T2-weighted, diffusion-weighted, and contrast-enhanced MR images. For quantitative evaluation, ADC and contrast-enhancement ratio of all lesions were measured and optimal cutoff thresholds and areas under curves for differentiating orbital lymphoma from benign orbital lymphoproliferative disorders were determined using receiver operative characteristic analysis; corresponding sensitivities and specificities were calculated. RESULTS Multivariate logistic regression analysis showed that ill-defined tumor margin (P = .003) had a significant association with orbital lymphoma whereas the "flow void sign" (P = .005) and radiologic evidence of sinusitis (P = .0002) were associated with benign orbital lymphoproliferative disorders. The mean ADC and contrast-enhancement ratio of orbital lymphomas were significantly lower than those of benign orbital lymphoproliferative disorders (P < .01). An ADC of less than 0.612 × 10(-3) mm(2)/s and a contrast-enhancement ratio of less than 1.88 yielded areas under curves of 0.980 and 0.770, sensitivity of 94.1% and 95.5%, and specificities of 93.3% and 80.0% for predicting orbital lymphoma, respectively. CONCLUSIONS Some characteristic MR imaging features and quantitative DWI and contrast-enhanced MR imaging are useful in further improving the accuracy of MR imaging for differentiation of orbital lymphoma from benign orbital lymphoproliferative disorders.
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Affiliation(s)
- K Haradome
- From the Departments of Ophthalmology (K.H., Y.U., S.U., H.G.)
| | - H Haradome
- Department of Radiology (H.H.), Nihon University School of Medicine, Tokyo, Japan
| | - Y Usui
- From the Departments of Ophthalmology (K.H., Y.U., S.U., H.G.)
| | - S Ueda
- From the Departments of Ophthalmology (K.H., Y.U., S.U., H.G.)
| | - T C Kwee
- Department of Radiology (T.C.K.), University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - J Matsubayashi
- Anatomic Pathology (J.M., T.N.), Tokyo Medical University, Tokyo, Japan
| | - T Nagao
- Anatomic Pathology (J.M., T.N.), Tokyo Medical University, Tokyo, Japan
| | - H Goto
- From the Departments of Ophthalmology (K.H., Y.U., S.U., H.G.)
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Kiesewetter B, Lukas J, Kuchar A, Mayerhoefer ME, Streubel B, Lagler H, Müllauer L, Wöhrer S, Fischbach J, Raderer M. Clinical features, treatment and outcome of mucosa-associated lymphoid tissue (MALT) lymphoma of the ocular adnexa: single center experience of 60 patients. PLoS One 2014; 9:e104004. [PMID: 25077481 PMCID: PMC4117536 DOI: 10.1371/journal.pone.0104004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/04/2014] [Indexed: 11/25/2022] Open
Abstract
Background Orbital marginal zone B-cell lymphoma (OAML) constitutes for the most frequent diagnosis in orbital lymphoma. Relatively little data, however, have been reported in larger cohorts of patients staged in a uniform way and no therapy standard exists to date. Material and Methods We have retrospectively analyzed 60 patients diagnosed and treated at our institution 1999–2012. Median age at diagnosis was 64 years (IQR 51–75) and follow-up time 43 months (IQR 16–92). All patients had undergone uniform extensive staging and histological diagnosis was made by a reference pathologist according to the WHO classification. Results The majority of patients presented with stage IE (n = 40/60, 67%), three had IIE/IIIE and the remaining 17 stage IVE. Seven patients with IVE had bilateral orbital disease whereas the others showed involvement of further organs. Treatment data were available in 58 patients. Local treatment with radiotherapy (14/58, 24%) or surgery (3/58, 5%) resulted in response in 82% of patients. A total of 26 patients (45%) received systemic treatment with a response rate of 85%. Nine patients received antibiotics as initial therapy; response rate was 38%. Watchful-waiting was the initial approach in 6/58 patients. In total 28/58 patients (48%) progressed and were given further therapy. Median time-to-progression in this cohort was 20 months (IQR 9–39). There was no difference in time-to-progression after first-line therapy between the different therapy arms (p = 0.14). Elevated beta-2-microglobulin, plasmacytic differentiation, autoimmune disorder and site of lymphoma were not associated with a higher risk for progress. Conclusion Our data underscore the excellent prognosis of OAML irrespective of initial therapy, as there was no significant difference in time-to-progression and response between local or systemic therapy. In the absence of randomized trials, the least toxic individual approach should be chosen for OAML.
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Affiliation(s)
- Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Julius Lukas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Andreas Kuchar
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | - Berthold Streubel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Wöhrer
- Department of Medicine I, Division of Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Julia Fischbach
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Hassan WM, Alfaar AS, Bakry MS, Ezzat S. Orbital tumors in USA: difference in survival patterns. Cancer Epidemiol 2014; 38:515-22. [PMID: 25052531 DOI: 10.1016/j.canep.2014.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is a wide range of tumors affecting the orbital adnexa. Key such tumors include lymphomas, carcinomas, melanomas and rhabdomyosarcomas. Several studies have proposed that these histological subtypes differ in their survival outcomes. In this study we aim to describe the difference in survival outcomes between such subtypes. METHODS The SEER database was used to gather patient information. All 18 SEER registries were used. Patients diagnosed from 1996 to 2005 were included in the analysis. Observed five-year survival rate was calculated using the SEER*Stat software version 8.1.2. Data were extracted into IBM SPSS version 20 to generate Kaplan Meier curve for each group. RESULTS There were 2180 patients in the SEER databases who met the selection criteria. Lymphomas were the most common histology in adults. The overall five-year observed survival for all lymphoma patients was 75.9% (95% CI: 73.7-78.1). There was statistically significant difference between observed survival rates of lymphoma subtypes. Carcinomas were the second most common tumors. Their five-year observed survival rate in our study was 60.4%. There was no statistically significant difference between carcinoma subtypes' observed survival rates in the 20-49 age group, while, in the older age group, the difference was found to be statistically significant. Rhabdomyosarcomas were the most common tumors in children. The overall five-year observed survival rate for rhabdomyosarcomas patients was 89.8%. There was no statistically significant difference between observed survival rates of rhabdomyosarcomas subtypes. There was no statistically significant difference between relative survival rates according to gender and treatment received except within melanomas. CONCLUSION In adults, lymphomas have better survival rates than carcinomas. Whereas the lymphoma subtype can be used as a determinant prognostic factor in any age, the carcinoma subtype can be used as such a determinant in older age groups only. In children, rhabdomyosarcomas are the predominant tumors affecting the orbital adnexa. Further studies are needed to determine if the difference between embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma observed survival rates are statistically significant.
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Affiliation(s)
- Waleed M Hassan
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Ahmad S Alfaar
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; Cairo University School of Medicine, Cairo, Egypt; Ulm University, 89069 Ulm, Baden-Württemberg, Germany.
| | - Mohamed S Bakry
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Sameera Ezzat
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; National Liver Institute, Menoufiya University, Shebin Elkom, Egypt.
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Sahu KK, Uthamalingam P, Sampath S, Jinagal J, Das A, Prakash G, Malhotra P, Varma SC. Ocular adnexal lymphomas: report of 2 cases of mantle cell lymphomas and short review of literature. Indian J Hematol Blood Transfus 2014; 30:163-8. [PMID: 25114401 DOI: 10.1007/s12288-014-0389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/03/2014] [Indexed: 11/26/2022] Open
Abstract
Mantle cell lymphoma in ocular region is a rare phenomenon which can be either primary or secondary. Most of these cases are usually diagnosed after excisional biopsy of the involved area with first visit being in the Ophthalmology OPD. We share our experience of two such cases being referred from Ophthalmology OPD. 1st case is about a 52-year-old man who came for complaints of redness of left eye with excessive lacrimation. Examination revealed congestion of left temporal bulbar conjunctiva and a small pinkish outgrowth 2 × 2 cm adherent to temporal bulbar conjunctiva. 2nd case is a 55-year-old gentlemen who presented with complaints for 8 months duration of swelling left eyelid. Excisional biopsy and histopathological examination in both the cases were done to confirm the diagnosis. CECT head and neck were done at baseline and during follow up. These cases are being presented due to the rarity and dramatic response to chemotherapy.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Preithy Uthamalingam
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Santhosh Sampath
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Jitender Jinagal
- Department of Opthalmology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Ashim Das
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Subhash Chander Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Ruiz-Medrano J, Peralta-Díaz LM, Santos-Bueso E. Orbitary MALT lymphoma in a patient diagnosed with non-Hodgkin lymphoma. ACTA ACUST UNITED AC 2014; 90:292-3. [PMID: 24553351 DOI: 10.1016/j.oftal.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Affiliation(s)
- J Ruiz-Medrano
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - L M Peralta-Díaz
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
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Asynchronous presentation of follicle center lymphoma and reactive lymphoid hyperplasia of the ocular adnexa. Am J Dermatopathol 2014; 36:e87-92. [PMID: 24394299 DOI: 10.1097/dad.0b013e3182a36541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although ocular lymphoproliferative diseases may be rarely encountered by dermatopathologists, the frequency may increase particularly as more and more subspecialties rely on dermatopathology services. Emerging data suggest that there are some similarities between ocular and cutaneous lymphoproliferative diseases with respect to their clinical behavior, prognosis, and cytogenetics. In this case report, a patient with ocular follicle center lymphoma who subsequently developed ocular reactive lymphoid hyperplasia is presented with an accompanying review of the literature on the subjects. The encounter of both follicular center lymphoma and reactive lymphoid hyperplasia in the same patient provides a rare opportunity to compare and contrast the clinical, histological, and immunohistochemical findings of the respective lymphoproliferative diseases situated at opposite ends of the spectrum.
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60
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Clinical characteristics of 95 patients with ocular adnexal and uveal lymphoma: treatment outcomes in extranodal marginal zone subtype. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:203-10. [PMID: 24417911 DOI: 10.1016/j.clml.2013.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphoma rarely presents in the ocular adnexa but is usually extranodal marginal zone (ENMZ) lymphoma when it does. Involved-field radiotherapy (IFRT) is the standard of care for unilateral disease, but the optimal management of more extensive disease is unclear. PATIENTS AND METHODS We retrospectively evaluated the clinical characteristics and outcomes of 95 patients with ocular adnexal lymphoma (OAL) or uveal lymphoma treated or diagnosed at our institution. All patients identified were included in the risk factor analysis for progression-free survival (PFS). The initial treatment-related outcomes were assessed for ENMZ OAL only (n = 62). RESULTS With a median follow-up of 32 months, significant risk factors for PFS after initial treatment were age (hazard ratio, 1.33; 95% confidence interval, 1.02-1.74), female gender (hazard ratio, 2.04; 95% confidence interval, 1.04-4.00), and a history of lymphoma (hazard ratio, 2.31; 95% confidence interval, 1.12-4.78). In ENMZ, IFRT was associated with improved PFS (median, 5.4 years; P < .001). Progression occurred in 7 of 39 (23%), with 6 of the 7 (86%) at systemic sites. Single-agent rituximab was typically used for bilateral ocular or systemic presentations of ENMZ OAL. Progression occurred in 7 of 11 (64%), with no progression at systemic sites. All progression events in those initially treated with rituximab occurred in the ocular adnexa. CONCLUSION The results of the present study have confirmed IFRT as the standard for unilateral ENMZ OAL. Single-agent rituximab was an effective agent for bilateral ocular or systemic ENMZ OAL, particularly for systemic control, but ocular progression should be closely monitored. Combined modality therapy should be studied further in bilateral and systemic ENMZ OAL.
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Nasser QJ, Pfeiffer ML, Romaguera J, Fowler N, Debnam JM, Samaniego F, El-Sawy T, McLaughlin P, Bakhoum MF, Esmaeli B. Clinical value of magnetic resonance imaging and other baseline testing for conjunctival mucosa-associated lymphoid tissue lymphoma. Leuk Lymphoma 2013; 55:1013-7. [DOI: 10.3109/10428194.2013.826353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Teo L, Seah LL, Choo CT, Chee SP, Chee E, Looi A. A survey of the histopathology of lacrimal gland lesions in a tertiary referral centre. Orbit 2013; 32:1-7. [PMID: 23387446 DOI: 10.3109/01676830.2012.736595] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the histopathological distribution of biopsied lacrimal gland lesions in a tertiary referral centre in Singapore. METHODS This was a retrospective chart review. Clinical records of patients who underwent lacrimal gland biopsy at a tertiary referral centre in Singapore between 2000 to 2010, were reviewed. Data collated included patient demographics, clinical presentation, association with systemic disease and histopathological diagnosis. RESULTS Sixty-nine patients were studied. Median age of presentation was 50 years. Forty patients (58%) were female and the majority (84%, n = 29) were Chinese. The mean follow-up duration was 35.0 ± 34.5 months. 30.4% (n = 21) of the patients had bilateral disease. Chronic dacryoadenitis (46%, n = 32) was the most common histopathological diagnosis, followed by lymphoproliferative disorders (38%, n = 26) and pleomorphic adenoma (10%, n = 7). The diagnoses in four other patients included adenoid cystic carcinoma, lacrimal gland hypertrophy, lacrimal duct cyst and orbital vascular malformation. CONCLUSION Chronic dacryoadenitis and lymphoproliferative disorders are the two commonest causes of lacrimal gland lesions in our series. Although many cases remain non-specific, about 60% have a specific inflammation that may be associated with a systemic disease. As one third of our patients with lymphoproliferative disease of the lacrimal gland had an associated systemic lymphoma, patients with such lesions should be referred for investigation of possible systemic lymphoma. The results of our study can aid in providing a more targeted approach to patient management.
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Affiliation(s)
- Livia Teo
- Singapore National Eye Centre, Singapore.
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Rasmussen PK. Diffuse large B-cell lymphoma and mantle cell lymphoma of the ocular adnexal region, and lymphoma of the lacrimal gland: an investigation of clinical and histopathological features. Acta Ophthalmol 2013; 91 Thesis 5:1-27. [PMID: 24041159 DOI: 10.1111/aos.12189] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) constitute two distinct subtypes of non-Hodgkin lymphoma (NHL) associated with considerable morbidity and mortality. Marked diversities with regard to molecular biology and clinical features are recognized in different subsets of the two lymphomas. Because these differences could be related to the location of the lymphoma, it is of interest to investigate the clinical and histopathological features of DLBCL and MCL involving the ocular adnexal region (i.e. the orbit, eyelids, conjunctiva, lacrimal gland and lacrimal sac). Similarly, the lacrimal gland is the only glandular structure within the orbit. Because the lacrimal gland represents an important part of the immunological system, it is of interest to investigate lymphomas involving this location with regard to clinical and histological characteristics. PURPOSE To characterize the clinical and histopathological features of Danish patients with DLBCL of the ocular adnexal region between 1980 and 2009 and of Danish ocular adnexal MCL patients from 1980 to 2005. Furthermore, the aim of this PhD was to review all specimens from patients with lymphoma of the lacrimal gland in Denmark between 1975 and 2009 to determine the distribution of lymphoma subtypes of the lacrimal gland and to describe the clinicopathological features of these patients. RESULTS A total of 34 patients with DLBCL and 21 with MCL of the ocular adnexal region were identified. Twenty-seven patients had lacrimal gland lymphoma, including four DLBCLs and three MCLs from studies I and II. Elderly patients predominated in all three groups, with median ages of 78, 75 and 69 years in the DLBCL, the MCL and the lacrimal gland lymphoma groups, respectively. MCL patients had a preponderance of males, whereas females prevailed among lacrimal gland lymphoma patients. The orbit was the most common site of involvement in DLBCL and MCL. Most DLBCL patients had unilateral involvement, while MCL patients had a high frequency of bilateral involvement. Similarly, localized lymphoma was relatively frequently seen in DLBCL patients in contrast to the predominance of disseminated lymphoma in the MCL group. The majority of lacrimal gland lymphomas were low grade, and the distribution of subtypes was as follows: extranodal marginal zone lymphoma, 10 (37%); follicular lymphoma, 5 (19%); DLBCL, 4 (15%); MCL, 3 (11%); chronic lymphocytic leukaemia/small lymphatic lymphoma, 2 (7%); and unclassified B-cell lymphoma, 3 (11%). The overall survival rates at 3 and 5 years for the entire study group of DLBCL were 42% and 20%, whereas 58% and 22% of MCL patients were alive 3 and 5 years after the time of diagnosis. The 5-year overall survival rate of lacrimal gland lymphoma patients was 70%. Concordant bone marrow involvement and the International Prognostic Index score were predictive factors for the overall survival in the DLBCL group in Cox regression analysis. Rituximab-containing chemotherapy was associated with an improved survival rate in MCL patients. CONCLUSIONS Diffuse large B-cell lymphoma and MCL involving the ocular adnexal region and lymphoma of the lacrimal gland are prevalent among elderly patients. The overall prognosis in DLBCL and MCL was poor, whereas the prognosis for lacrimal gland lymphoma patients was relatively good. Concordant bone marrow involvement and the International Prognostic Index score were independent predictive factors for mortality in the DLBCL group. Chemotherapy containing rituximab significantly improved survival in the MCL group.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Female
- Humans
- Lacrimal Apparatus/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/mortality
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Morbidity
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/mortality
- Orbital Neoplasms/pathology
- Prevalence
- Prognosis
- Registries
- Rituximab
- Survival Rate
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Affiliation(s)
- Peter Kristian Rasmussen
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Ocular adnexal lymphoma: assessment of a tumor-node-metastasis staging system. Ophthalmology 2013; 120:1915-9. [PMID: 23664470 DOI: 10.1016/j.ophtha.2013.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/25/2013] [Accepted: 02/05/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess distribution, correlations, and prognostic effect of tumor (T), node (N), and metastasis (M) staging on relapse and survival. DESIGN Retrospective clinical review. PARTICIPANTS Sixty-three patients diagnosed with primary ocular adnexal lymphoma (OAL) between January 1986 and November 2011. METHODS Complete ocular examination and systemic evaluation were performed. Patients were staged according to the American Joint Committee on Cancer (AJCC) seventh edition tumor-node-metastasis (TNM) clinical staging system for OAL and followed every 6 to 12 months (median follow-up, 27.9 months). MAIN OUTCOME MEASURES Relapse defined as lymphoma recurrence in the initial site of presentation, the contralateral ocular adnexal structures, or other systemic site and overall survival. RESULTS There were 40 men (63.5%). The median age was 65 years (range, 24-85 years). The affected site was the conjunctiva in 27 patients (42.9%), orbit in 38 patients (60.3%), and eyelid in 3 patients (4.8%). The histologic subtype was extranodal marginal zone lymphoma (EMZL) in 51 patients (81.0%). A total of 14 patients (23.3%) had T1, 42 patients (70.0%) had T2, 1 patient (1.7%) had T3, and 3 patients (5.0%) had T4 disease. A total of 48 patients (82.8%) had N0 disease, and 10 patients (17.2%) had N1-4 disease. M stage was M0 in 47 patients (81.0%) and M1 in 11 patients (19.0%). With advanced T stage, there was an increase in both N1-4 (P = 0.045) and M1 disease (P = 0.041). M1 disease was greater among patients with N1-4 disease compared with N0 stage (50.0% vs. 12.5%, P = 0.003). Overall, 18 patients (28.6%) relapsed and 6 patients (9.5%) died. In Cox analysis, relapse was not associated with T stage (hazard ratio [HR], 1.14 per 1 level increase, P = 0.71), N stage (HR, 1.47; P = 0.51 N1-4 vs. N0), or M stage (HR, 1.22; P = 0.76 M1 vs. M0). T stage was not associated with survival (HR, 0.86; P = 0.81), whereas N1-4 had marginally worse survival than N0 (HR, 5.35; P = 0.07), and M1 had worse survival than M0 (HR, 9.27; P = 0.008). CONCLUSIONS The TNM staging system for primary OAL is useful for precise characterization of extent of local disease. Although T stage does not predict relapse or survival, N1-4 and M1 stages indicated less favorable survival. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Taghipour Zahir S, Miratashi SA, Nazemian M, Zand S. Primary follicular lymphoma of the conjunctiva in a 12 year-old male. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2013; 3:83-5. [PMID: 24575276 PMCID: PMC3915453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 03/06/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Follicular lymphoma (FL) is the second most common adnexal lymphoma of the eye that almost all of them are reported in elderly patients. Primary FL of the eye has been reported in only two children. Pediatric FL appears to be biologically distinct from typical adult FL. In cases without other organ involvement excision alone with close monitoring is a treatment of choiceand the prognosis is excellent. CASE PRESENTATION A 12 year -old male with a nodular lesion involving the inner can thus of the right eye was admitted to ophthalmology clinic. The lesion was painless and the nodule size gradually increased over a period of 6 months.Excisional biopsy demonstrated follicular lymphoma composed of neoplastic lymphoid cells which arranged in follicular pattern without germinal centers. Neoplastic cells were positive for Bcl2 and CD20. CONCLUSION Although follicular lymphoma of the conjunctiva is rare in childhood but it could be considered as one of the differential diagnosis in this age group.
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Affiliation(s)
- Sh Taghipour Zahir
- Associate Professor of clinical and surgical pathology, Shahid Sadoughi university of Medical Sciences, Yazd, Iran
| | - S A Miratashi
- Assisstant Professor of ophthalmology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - M Nazemian
- Medical Student, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - S Zand
- Medical Student, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Eckardt AM, Lemound J, Rana M, Gellrich NC. Orbital lymphoma: diagnostic approach and treatment outcome. World J Surg Oncol 2013; 11:73. [PMID: 23506357 PMCID: PMC3616859 DOI: 10.1186/1477-7819-11-73] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 02/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphomas of the orbit and orbital adnexae are rare tumors, comprising only 1% of all non-Hodgkin's lymphoma. The majority of non-Hodgkin's lymphomas of the orbit are extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue type. Because of nonspecific clinical signs and symptoms, some diagnostic delay may occur. The purpose of the study was to evaluate the diagnostic approach in orbital lymphomas and to analyze their treatment outcome. METHODS In the period from 2005 to 2012, from a group of 135 patients with tumors of the orbit, we identified 11 patients diagnosed with orbital lymphoma. This patient cohort was reviewed retrospectively. RESULTS The patient group consisted of 11 patients (seven females, male males) with a median age of 57.7 years (range 42 to 88 years). Orbital swelling, pain and motility impairment were the leading clinical symptoms. Diagnosis was confirmed by surgical biopsy. Depending on the anatomic location of the tumor, a surgical biopsy was taken using a blepharoplasty incision, a lateral orbitotomy or a navigation-guided biopsy. The predominant histology was extranodal non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue type (82%). All patients underwent complete clinical staging. These were clinical stage IEA in seven patients, and stages IIEA (n = 2) and IIIEA (n = 2) in four patients . Patients in stage IEA were treated with radiation therapy alone, with radiation doses between 25 and 40 Gy, and patients with stage IIEA received systemic chemotherapy with bendamustin/rituximab. Those two patients diagnosed with diffuse large B-cell lymphoma and mantle cell lymphoma received systemic chemotherapy according to the R-CHOP protocol. CONCLUSIONS Owing to unspecific clinical symptoms, some diagnostic delay may occur in orbital lymphoma. If unspecific orbital symptoms are present, adequate imaging studies followed by early surgical biopsy will contribute to early diagnosis. Once diagnosis is established and staging is complete, radiation therapy is the recommended treatment for stage IEA patients. Systemic chemotherapy is indicated in selected stage IIEA patients and in patients with stage IIIEA disease.
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Affiliation(s)
- André M Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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Abstract
PURPOSE Lymphoma is the most common malignancy of the ocular adnexa. Most of the ocular adnexa lymphomas are non-Hodgkin B-cell lymphomas. The most common type of ocular adnexa lymphoma is primary extranodal marginal zone B-cell lymphoma of the MALT (mucosa-associated lymphoid tissue). Most of these neoplasms are primary extranodal lymphomas, although 10% to 32% are secondary tumors from disseminated disease. CASE REPORT A 58-year-old woman presented for a comprehensive examination, with the chief complaint of ocular discomfort in both eyes. Anterior segment examination revealed bilateral salmon-colored lesions of the inferior and superior conjunctivae. The patient was referred for systemic evaluation and histopathology of the conjunctival lesions. She was diagnosed as having marginal zone lymphoma of the MALT and underwent radiation therapy (RT). CONCLUSIONS Ocular lymphoma may present on routine examination or with mild symptoms. Although most commonly a primary extranodal neoplasm, the condition may be associated with disseminated lymphoma and requires thorough evaluation and staging of the disease for determination of appropriate treatment. The primary eye care provider plays an important role in the identification and staging of the disease, as well as managing complications from RT. It is also important to recognize that concurrent conditions requiring treatment with topical medications, such as glaucoma, may be complicated after treatment because of the inflammation and ocular surface irritation after RT. The necessity and benefit of the addition of intraocular pressure medications during that time should be measured on a case-by-case basis. Patients should be followed closely after treatment for relapse of disease and identification of complications from ocular RT.
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Lee SJ, Jung JH, Choi HY. Analysis of Clinical Features and Prognostic Factor Analysis of Orbital and Adnexal Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Jun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Contini C, Seraceni S, Maritati M, Cavazzini F, Perri P. Role of Chlamydia in the Development of Ocular Adnexal Lymphoma. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.42082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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71
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Khanlari M, Bagheri B, Vojdani R, Mohammadianpanah M, Paydar S, Daneshbod Y. Conjunctival mass as an initial presentation of mantle cell lymphoma: a case report. BMC Res Notes 2012; 5:671. [PMID: 23210924 PMCID: PMC3549763 DOI: 10.1186/1756-0500-5-671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/15/2012] [Indexed: 01/16/2023] Open
Abstract
Background To describe a rare manifestation of mantle cell lymphoma (MCL) in conjunctiva, with clinical, hisologic, immunohistologic and genetic findings together with review of the Literature. Case presentation Most ocular adnexal lymphomas are extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). A few cases of ocular adnexal mantle cell lymphomas have been reported in the literature. We present a case of mantle cell lymphoma presenting as right conjunctival mass of at least three months duration in a 64-year-old man. Histopathologic examination showed a proliferation of monomorphous small-to-medium-sized lymphoid cells with cleaved nuclei in the subconjunctiva. By immunohistochemistry, the infiltrate was positive for CD20, CD5, BCL-2, cyclin D1, and the transcription factor SOX11. Fluorescent in situ hybridization demonstrated the presence of IGH-CCND1 fusion indicating t(11;14). Conclusion A rigorous approach to initial diagnosis and staging of small cell lymphomas of the ocular adnexa is needed. The recognition of ocular MCL requires appropriate immunohistochemical staining and/or genetic confirmation to differentiate this rare form of presentation of MCL from other more frequent small cell lymphomas.
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Affiliation(s)
- Mahsa Khanlari
- Institute of Hematopathology, Dr Daneshbod Pathology Laboratory, Shiraz, Iran
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72
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Diffuse large B-cell lymphoma of the orbit: clinicopathologic, immunohistochemical, and prognostic features of 20 cases. Am J Ophthalmol 2012; 154:87-98.e1. [PMID: 22503694 DOI: 10.1016/j.ajo.2012.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/20/2012] [Accepted: 01/23/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate a series of orbital diffuse large B-cell lymphomas (DLBCL) for prognostic features and therapeutic outcomes. DESIGN Retrospective multicenter case study of clinical and immunohistochemical features of 20 patients. METHODS Clinical, histopathologic, and immunohistochemical features were correlated with outcomes. Immunohistochemistry for biomarkers including Bcl-6, CD5, CD10, CD20, FOXP1, GCET1, and MUM1 was performed to differentiate between 2 major genetic subtypes of DLBCL: activated B-cell-like (ABC) and germinal center B-cell-like (GCB). RESULTS Sixteen patients presented with unilateral and 4 with bilateral tumors. Three had bony erosion of the orbit on imaging studies. Of 14 patients with detailed follow-ups, 3 had a prior or concurrent lymphomatous disease; 8 had stage I disease (limited to the orbit) at presentation; and 3 were newly diagnosed with systemic (stage IV) DLBCL. Localized disease was treated with combined systemic chemotherapy, including rituximab and radiation with no deaths to date; there was 1 death related to systemic DLBCL. Clinical staging was the best predictive method and no immunohistochemical feature or subcategory (ABC vs GCB) correlated with outcome. CONCLUSIONS Primary orbital DLBCL has a more favorable prognosis than systemic DLBCL and may arise from a preexistent hematolymphomatous neoplasm (4 out of 20 cases). In our series, orbital DLBCL had a 57% likelihood of being restricted to the ocular adnexa. Clinical staging was more helpful in predicting outcome than any single immunohistopathologic feature or combination of biomarkers. Orbital radiation of 30 gray in conjunction with systemic chemotherapy with rituximab can achieve disease-specific survival approaching 100% in purely localized cases.
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73
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Karamchandani JR, Younes SF, Warnke RA, Natkunam Y. IgG4-related systemic sclerosing disease of the ocular adnexa: a potential mimic of ocular lymphoma. Am J Clin Pathol 2012; 137:699-711. [PMID: 22523207 DOI: 10.1309/ajcpe1g8drhxrpih] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IgG4-related sclerosing disease has been described in the orbit and ocular adnexa. Of 164 biopsies of the ocular region for suspected lymphoma, we identified 6 cases of IgG4 disease, 4 of which were previously unrecognized. All 6 cases demonstrated increased plasma cells in a background of sclerosis and increased absolute numbers of IgG4-expressing cells. Our results confirm the difficulty in diagnosing IgG4-related sclerosing disease in the ocular region. Based on the findings, we suggest that specimens from biopsies of the eye and ocular adnexa for which a definitive diagnosis of lymphoma is not established undergo further workup for IgG and IgG4, particularly if increased plasma cells and sclerosis are present. When IgG4-expressing plasma cells account for greater than 50% of IgG-expressing plasma cells, a diagnosis of IgG4 disease should be considered. Timely recognition would benefit patients by allowing appropriate management with corticosteroid therapy and avoiding more aggressive or unnecessary therapeutic options.
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74
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Primary lymphoma of the ocular adnexa (orbital lymphoma) and primary intraocular lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:339-44. [PMID: 22521959 DOI: 10.1016/j.clon.2012.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/02/2012] [Indexed: 11/23/2022]
Abstract
Lymphomas of the orbit and eye are rare conditions that should be treated as separate entities due to the differences in presumed aetiology, investigations, management and outcomes. Orbital lymphoma is most often of low-grade histology; thyroid eye disease may predispose and chlamydial infection has been suggested as a trigger. Commonly, stage IE, in most cases, can be managed with radiotherapy alone using either a kilovoltage portal for conjunctival disease or a wedged pair of megavoltage beams for more infiltrative disease to a dose of 30 Gy in 15 fractions over 3 weeks. However, medical therapy is being investigated, including a rituximab-only approach for conjunctival-only presentations. The cure rate for stage IE disease is very high. In contrast, primary ocular lymphoma is often of high-grade histology, in particular diffuse large B-cell lymphoma, and can be regarded as one end of primary central nervous system lymphoma - both eyes and brain being at risk. Immunosuppression predisposes to the disease. Management consists of an initial high-dose chemotherapy regimen with methotrexate. In most cases, this should be followed by radiotherapy to the whole brain and globes to a dose of 30-36 Gy with a boost to bulk/presenting disease. Cure rates are rarely above 50%.
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75
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Abstract
The eye allows living functioning blood vessels to be observed and is thus ideal for the study of haematological disease. Disorders of the blood have significant ocular manifestations and pose a real threat to vision, making knowledge of the subject essential to ophthalmologists, haematologists, oncologists and general physicians.
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76
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Abstract
Blepharoplasty is a frequent request in consultations of plastic surgery. Patients are often presenting with a progressive swelling of the eyelids. For functional or aesthetic reasons, we commonly perform a superior and/or inferior blepharoplasty to correct this problem. We present the case of a 72-year-old woman who consulted us with a prominent unattractive swelling of both lower eyelids. Because of the atypical and suspicious presentation, supplementary examinations were conducted, and the fat was also sent for analysis. A diagnosis of unilateral orbital lymphoma was obtained. The patient was treated as a primarily localized lymphoma with a positive outcome. When correctly diagnosed and treated, orbital lymphomas can have a very good prognosis.
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77
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Blasi MA, Tiberti AC, Valente P, Laguardia M, Sammarco MG, Balestrazzi A, Larocca LM, Balestrazzi E. Intralesional interferon-α for conjunctival mucosa-associated lymphoid tissue lymphoma: long-term results. Ophthalmology 2012; 119:494-500. [PMID: 22226154 DOI: 10.1016/j.ophtha.2011.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To report the long-term therapeutic results for patients with conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma who were treated with intralesional injections of interferon-α (IFN-α). DESIGN Prospective, nonrandomized, interventional case series. PARTICIPANTS Twenty eyes of 16 patients with histologically proven conjunctival MALT lymphoma in the absence of systemic disease. METHODS Patients were given 1,500,000 international units (IU) of IFN-α (Roferon-A; Roche s.p.a., Milano, Italy) subconjunctivally inside the lesion 3 times weekly for 4 weeks. If there was even a minimal response, a further cycle of 1,000,000 IU 3 times weekly for 4 weeks was administered. MAIN OUTCOME MEASURES Patients were followed up clinically using slit-lamp examination to determine evidence of tumor disappearance or recurrence. In 10 eyes, an incisional biopsy was performed 6 months after therapy to verify the histologic absence of the lesion. RESULTS A complete response was obtained in 15 eyes (75%) at the end of first cycle treatment, and in 5 eyes (25%) after further cycles. Seventeen eyes (85%) showed no local recurrence after a median follow-up of 65 months (range, 15-136 months). Three eyes (15%) demonstrated recurrence at variable points after treatment. One patient with stage IIA lymphoma exhibited systemic lymphoma progression. CONCLUSIONS Local immunotherapy with IFN-α seems to be an effective and lasting treatment method and provides an alternative to radiotherapy for conjunctival MALT lymphomas. Very few transient side effects were detected.
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78
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Localized Orbital Mucosa-Associated Lymphoma Tissue Lymphoma Managed With Primary Radiation Therapy: Efficacy and Toxicity. Int J Radiat Oncol Biol Phys 2011; 81:e659-66. [DOI: 10.1016/j.ijrobp.2011.03.050] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/28/2011] [Accepted: 03/05/2011] [Indexed: 12/31/2022]
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79
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Primary, Unilateral Ocular Adnexal Lymphoma: Disease Progression and Long-Term Survival. Ophthalmic Plast Reconstr Surg 2011; 27:405-9. [DOI: 10.1097/iop.0b013e31821cc4bb] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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80
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Lim SH, Kang M, Son J. Extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type of the ocular adnexa: retrospective single institution review of 95 patients. Indian J Ophthalmol 2011; 59:273-7. [PMID: 21666310 PMCID: PMC3129750 DOI: 10.4103/0301-4738.81993] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: There are few reports on the management of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT), which are based on the experience of a single institution, as opposed to large multicenter randomized trials. Aim: The aim of this study was to report on the clinical experience of a single institution. Materials and Methods: A retrospective review was undertaken of records of 95 patients with MALT lymphoma of the ocular adnexa. Histologic diagnosis of MALT lymphoma was made according to established criteria, and clinical staging was carried out to determine treatment modalities. All patients were treated by external beam irradiation (30.6–45.0 Gy) after biopsy. Additional chemotherapy was performed in accordance with the clinical stage of the disease. All the patients were treated by the same hemato-oncologist and radio-oncologist. Results: Almost all patients showed complete response, except for four patients who showed partial response. In two of 95 patients, contralateral eye showed recurrence, and they were salvaged by additional radiotherapy. The 3-year overall survival and event-free survival rates were 100 and 97%, respectively, by Kaplan–Meier survival analysis. Moreover, there were no serious radiation-associated complications. Conclusions: Radiotherapy alone can be an important treatment modality for the local control and survival in patients with localized MALT lymphoma of ocular adnexa. Systemic chemotherapy should be considered in patients with advanced stage disease.
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Affiliation(s)
- Su-Ho Lim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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81
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Long-term outcome and patterns of failure in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 2011; 82:1509-14. [PMID: 21664061 DOI: 10.1016/j.ijrobp.2011.04.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy. METHODS AND MATERIALS Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22-85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. RESULTS The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma. CONCLUSIONS Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.
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82
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Bayraktar S, Bayraktar UD, Stefanovic A, Lossos IS. Primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (MALT): single institution experience in a large cohort of patients. Br J Haematol 2010; 152:72-80. [PMID: 21083656 DOI: 10.1111/j.1365-2141.2010.08429.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extranodal marginal zone B-cell lymphoma is the most common orbital tumour. We conducted a retrospective analysis to examine: (i) the impact of initial presentation and staging on outcome and (ii) response to various treatment modalities and the effect of the latter on recurrence. Ninety patients with primary ocular adnexal marginal zone lymphoma (POAML) diagnosed at our institution between 1984 and 2009 were studied. POAML was associated with monoclonal gammopathy (13%) at presentation. Most POAML patients (86%) presented with Ann-Arbor stage I disease. Radiotherapy led to excellent local control, but relapses occurred in 18% of Ann-Arbor stage I patients during a median follow-up of 5 years. Local relapses, including secondary central nervous system (CNS) involvement, were observed in patients receiving radiation doses <30·6 Gy. No differences in relapse rate and survival were observed between patients who did or did not undergo staging bone marrow biopsy. Ann-Arbor stage II-IV disease and high lactate dehydrogenase levels were associated with shorter freedom from progression. In conclusion, POAML is an indolent lymphoma with continuous risk for relapse. Radiation doses of at least 30·6 Gy should be given in Ann-Arbor stage I disease, since lower doses may be more frequently associated with relapses, including CNS relapses.
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Affiliation(s)
- Soley Bayraktar
- Department of Medicine, Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Avenue, Miami, FL 33136, USA
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83
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Stacy RC, Jakobiec FA, Schoenfield L, Singh AD. Unifocal and multifocal reactive lymphoid hyperplasia vs follicular lymphoma of the ocular adnexa. Am J Ophthalmol 2010; 150:412-426.e1. [PMID: 20599186 DOI: 10.1016/j.ajo.2010.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/06/2010] [Accepted: 04/12/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To characterize the differentiating histopathologic and immunophenotypic features of reactive lymphoid hyperplasia (RLH) and follicular lymphoma of the ocular adnexa. DESIGN Retrospective case study with clinical follow-up and review of the literature. METHODS Clinical records of 9 cases of RLH and 6 cases of follicular lymphoma from 2 institutions were reviewed. Light microscopic evaluation and immunohistochemical stains including CD20, CD3, CD5, CD21, CD23, BCL-2, BCL-6, CD10, kappa, lambda, and Ki67 were used to distinguish the 2 categories. RESULTS RLH preferentially involved the conjunctiva, whereas follicular lymphoma had a propensity to involve the lacrimal gland. Microscopic analysis with immunohistochemical staining distinguished RLH from follicular lymphoma. BCL-2 was positive in follicular centers of follicular lymphoma but not in RLH. CD10 identified follicular center cells and Ki67 quantified cells in S-phase. CD21 and CD23 detected dendritic cell scaffoldings of indistinct germinal centers. None of the patients with RLH developed lymphoma during their clinical courses (up to 18 years). However, 3 patients with orbital, but not conjunctival, RLH developed immunohistochemically proven multifocal nonophthalmic supradiaphragmatic adnexal RLH (sites included lung, parotid, axillary nodes, and uvea). All 6 patients with follicular lymphoma had disseminated disease. CONCLUSIONS A correct diagnosis of RLH vs follicular lymphoma can be reliably established employing immunohistochemical methods. A heretofore undescribed "multifocal RLH" syndrome must be distinguished from follicular lymphoma. Conjunctival RLH can usually be managed surgically without radiotherapy, but "multifocal RLH" required systemic treatment in 2 of 3 patients. Follicular lymphoma requires systemic chemotherapy if discovered beyond stage 1E.
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Affiliation(s)
- Rebecca C Stacy
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Zhang D, Dong L, Li H, Jin H, Ye H, Zhou X, Gao Z, Dong G, Zhu J, Liu H, Gong L. Ocular adnexal mucosa-associated lymphoid tissue lymphoma in Northern China: high frequency of numerical chromosomal changes and no evidence of an association with Chlamydia psittaci. Leuk Lymphoma 2010; 51:2031-8. [PMID: 20807089 DOI: 10.3109/10428194.2010.513751] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Studies from different countries showed variations of genetic changes and association with Chlamydia psittaci in ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. A total of 38 ocular adnexal MALT lymphoma cases from Northern China were studied. Genetic abnormalities were investigated in 28 cases by interphase FISH. C. psittaci and other infectious agents that are commonly-associated with chronic eye disease were screened in 38 cases by PCR. Genetic abnormalities were detected in 60.7% of cases. Among them, only one showed a break-apart of the IgH gene and all others showed numerical abnormalities, including trisomy 18 in 7 cases (25%), 3 copies of BCL6 gene in 12 cases (43%), and 3 copies of C-MYC gene in 2 cases (7%). C. pneumoniae was positive in two cases (5.3%), and C. psittaci, C. trachomatis, HSV1, HSV2, ADV8, and ADV19 were not detected in any cases. In conclusion, numerical abnormalities are frequent and the chromosomal translocations commonly associated with MALT lymphomas are rare in ocular adnexal MALT lymphoma of Northern China. C. psittaci and other infectious agents are not associated with ocular adnexal MALT lymphoma in these patients.
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Affiliation(s)
- Dandan Zhang
- Department of Pathology, Capital Medical University, Beijing, China
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85
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Abstract
Ocular adnexal lymphomas comprise 1% to 2% of all non-Hodgkin lymphomas and about 8% of extranodal lymphomas. They are a heterogeneous group of malignancies, the majority of which are primary extranodal lymphoma with most (up to 80%) of the marginal zone of mucosa associated lymphoid tissue type (MALT lymphoma). This review will encompass the incidence, histology, immunophenotyping, recent advances in molecular and cytogenetics, clinical features including outcome, and prognostic factors. The association with Chlamydia psittaci and the very recently recognized occurrence in the context of IgG4-related sclerosing disease will be discussed. Finally, traditional (surgery, radiotherapy, chemotherapy) and newer forms of therapy (immunotherapy and radioimmunotherapy) will be reviewed.
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86
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Hafezi F, Moesen I, Carels G, Mooy C, Paridaens D. [Waldenstrom's macroglobulinaemia of the lacrimal gland in a patient with sarcoidosis]. Ophthalmologe 2010; 107:60-3. [PMID: 19669149 DOI: 10.1007/s00347-009-2010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a case of bilateral lacrimal gland involvement as the first sign of Waldenstrom's macroglobulinaemia in a patient with sarcoidosis. Histological analysis of an incisional biopsy revealed a lymphoplasmocytic lymphoma consistent with Waldenstrom's macroglobulinaemia. No noncaseating granulomas were encountered. Systemic treatment was initiated and resulted in complete resolution of the lesions. In a patient with a systemic disease, such as sarcoidosis, and lacrimal gland involvement, a biopsy of the lacrimal gland mass should be taken to make a correct diagnosis and start appropriate treatment.
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Affiliation(s)
- F Hafezi
- IROC, Institut für Refraktive und Ophthalmo-Chirurgie, Zürich, Schweiz
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87
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Carugi A, Onnis A, Antonicelli G, Rossi B, Mannucci S, Luzzi A, Lazzi S, Bellan C, Tosi GM, Sayed S, De Falco G, Leoncini L. Geographic variation and environmental conditions as cofactors in Chlamydia psittaci association with ocular adnexal lymphomas: a comparison between Italian and African samples. Hematol Oncol 2010; 28:20-6. [PMID: 19728399 DOI: 10.1002/hon.921] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A particular extra-nodal lymphoma type arises from B cells of the marginal zone (MZ) of mucosa-associated lymphoid tissue (MALT). The aetiology of MZ lymphomas suggests that they are associated with chronic antigenic stimulation by microbial pathogens, among which Helicobacter pylori-associated gastric MALT lymphoma is the best studied. Recently, MALT lymphomas have been described in the context of chronic conjunctivitis, which can be associated with Chlamydia spp. infection. Studies from Italy showed the presence of Chlamydia psittaci in 87% of ocular adnexal lymphomas (OAL), and C. psittaci has been described in a large part of samples from Austria and Korea as well. However, this finding was not always confirmed by other studies, suggesting that the association with C. psittaci may depend on geographic heterogeneity. Interestingly, none of the studies up to now has been carried out in the African population, where a strong association between infectious agents and the occurrence of human neoplasms has been reported. This study was designed to investigate the possible association of Chlamydia psittaci in cases retrieved from Kenya, compared to cases from Italy. Our results showed that there was a marked variation between the two geographical areas in terms of association with C. psittaci, as 17% (5/30) of the samples from Italy were positive for C. psittaci, whereas no association with this pathogen was observed in any of the African samples (0/9), suggesting that other cofactors may determine the OAL occurrence in those areas. OAL cases are often characterized by down-regulation of p16/INK4a expression and promoter hypermethylation of the p16/INK4a gene. Our results showed a partial methylation of p16/INK4a promoter in C. psittaci-negative cases, whereas no hypermethylation of this gene was found in C. psittaci-positive cases, suggesting that mechanisms other than promoter hypermethylation lead to p16/INK4a silencing in C. psittaci-positive cases. We may conclude that the role of epidemiologic, environmental and genetic factors, must be considered in the aetiology of this disease.
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Affiliation(s)
- Alessandro Carugi
- Department Human Pathology and Oncology, University of Siena, 53100 Siena, Italy
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88
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Decaudin D. Clinicopathologic features and treatment options of ocular adnexal lymphoma. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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89
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Bradley KT, Arber DA, Brown MS, Chang CC, Coupland SE, de Baca ME, Ellis DW, Foucar K, Hsi ED, Jaffe ES, Lill MC, McClure SP, Medeiros LJ, Perkins SL, Hussong JW. Protocol for the examination of specimens from patients with hematopoietic neoplasms of the ocular adnexa. Arch Pathol Lab Med 2010; 134:336-40. [PMID: 20196660 DOI: 10.5858/134.3.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle T Bradley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
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90
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Abstract
Most lymphomas that involve the ocular adnexal structure are low grade, B cell, non-Hodgkin’s lymphomas. The treatment depends upon the grade and stage of the disease. High grade lymhoma requires treatment with systemic chemotherapy whereas the localized low grade (extranodal marginal zone lymphoma) can be successfully managed with local radiotherapy. Chlamydia psittaci infection is associated with low grade ocular lymphoma; however there is wide geographic variation in the strength of this association. Blanket antibiotic therapy is not advised unless there is proof of an infective agent. The monoclonal antibody, rituximab, may be successful for CD20 positive lymphoma, although it is likely that rituximab will have better long-term results when used in combination with systemic chemotherapy.
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91
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Madge SN, McCormick A, Patel I, Hatef E, Menon V, Prabhakaran VC, Irion L, Bonshek R, Honovar S, Leatherbarrow B, Esmaeli B, Selva D. Ocular adnexal diffuse large B-cell lymphoma: local disease correlates with better outcomes. Eye (Lond) 2009; 24:954-61. [PMID: 19942938 DOI: 10.1038/eye.2009.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the clinical, immunohistochemical and prognostic features, as well as outcomes of a large series of patients with orbital and periorbital diffuse large B-cell lymphoma (DLBCL). DESIGN This study is a multicentre, retrospective non-comparative consecutive case series. METHODS The setting for this study was institutional. A total of 37 consecutive patients identified from the institutions' databases with periorbital and orbital DLBCL were enrolled in the study. A retrospective chart review was used for observation. The main outcome measures were patient demographics, clinical features, imaging, immunohistochemical and histopathological data, treatments administered, and survival. RESULTS A total of 20 out of 37 cases (54.1%) represented localised periorbital disease (group L), 11 of 37 (29.7%) had systemic disease at presentation with periorbital disease (group S1), and 6 of 37 (16.2%) had previous history of systemic lymphoma (group S2). In all, 28 out of 30 (93.3%) patients were CD20+, 5 of 25 (20%) were CD3+, and 11 of 11 (100%) were CD79a+ (varying denominators reflect the different numbers of patients tested). A total of 25 out of 32 patients (78.1%) received chemotherapy, 14 (43.8%) received rituxmab plus chemotherapy, and 19 (59.3%) received radiotherapy. Nine deaths occurred, one in group L (not lymphoma related), six in group S1, and two in group S2. Five-year Kaplan-Meier survival estimates were 55.9% for all cases, 90.9% for group L, 36.0% for group S1, and 0% for group S2. One-year progression-free survival estimates in groups S1 and S2 combined were 58.3% for patients treated with rituximab and 28.6% for those who were not. CONCLUSIONS To our knowledge, this report represents the largest series of patients with periorbital and orbital DLBCL in the literature. The difference in survival between groups L, S1 and S2 was striking, reflecting the grave prognosis of systemic DLBCL, but conversely the relatively optimistic outlook for patients with localised disease. Rituximab plus chemotherapy may be associated with increased survival.
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Affiliation(s)
- S N Madge
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, and Discipline of Ophthalmology and Visual Sciences, Level 8, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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92
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Morley AMS, Verity DH, Meligonis G, Rose GE. Orbital Plasmablastic Lymphoma—Comparison of a Newly Reported Entity with Diffuse Large B-cell Lymphoma of the Orbit. Orbit 2009; 28:425-9. [PMID: 19929677 DOI: 10.3109/01676830903177427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Adult
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Biomarkers, Tumor/analysis
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Fatal Outcome
- HIV Infections/complications
- HIV Infections/drug therapy
- Humans
- Immunophenotyping
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/pathology
- Plasma Cells/pathology
- Prednisone/therapeutic use
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
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93
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Coupland SE, White VA, Rootman J, Damato B, Finger PT. A TNM-Based Clinical Staging System of Ocular Adnexal Lymphomas. Arch Pathol Lab Med 2009; 133:1262-7. [DOI: 10.5858/133.8.1262] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2009] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The ocular adnexal lymphomas (OAL) arise in the conjunctiva, orbit, lacrimal gland, and eyelids. To date, they have been clinically staged using the Ann Arbor staging system, first designed for Hodgkin and later for nodal, non–Hodgkin lymphoma. The Ann Arbor system has several shortcomings, particularly when staging extranodal non– Hodgkin lymphomas, such as OAL, which show different dissemination patterns from nodal lymphomas.
Objective.—To describe the first TNM-based clinical staging system for OAL.
Design.—Retrospective literature review.
Results.—We have developed, to our knowledge, the first American Joint Committee on Cancer–International Union Against Cancer TNM-based staging system for OAL to overcome the limitations of the Ann Arbor system. Our staging system defines disease extent more precisely within the various anatomic compartments of the ocular adnexa and allows for analysis of site-specific factors not addressed previously. It aims to facilitate future studies by identifying clinical and histomorphologic features of prognostic significance. This system is for primary OAL only and is not intended for intraocular lymphomas.
Conclusions.—Our TNM-based staging system for OAL is a user-friendly, anatomic documentation of disease extent, which creates a common language for multicenter and international collaboration. Data points will be collected with the aim of identifying biomarkers to be incorporated into the staging system.
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Affiliation(s)
- Sarah E. Coupland
- From the Department of Pathology, University of Liverpool, Liverpool, England (Dr Coupland); the Departments of Pathology and Laboratory Medicine (Dr White) and Ophthalmology (Dr Rootman), Vancouver General Hospital, Vancouver, Canada; the St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato); and The New York Eye Cancer Center, New York City (Dr Finger)
| | - Valerie A. White
- From the Department of Pathology, University of Liverpool, Liverpool, England (Dr Coupland); the Departments of Pathology and Laboratory Medicine (Dr White) and Ophthalmology (Dr Rootman), Vancouver General Hospital, Vancouver, Canada; the St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato); and The New York Eye Cancer Center, New York City (Dr Finger)
| | - Jack Rootman
- From the Department of Pathology, University of Liverpool, Liverpool, England (Dr Coupland); the Departments of Pathology and Laboratory Medicine (Dr White) and Ophthalmology (Dr Rootman), Vancouver General Hospital, Vancouver, Canada; the St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato); and The New York Eye Cancer Center, New York City (Dr Finger)
| | - Bertil Damato
- From the Department of Pathology, University of Liverpool, Liverpool, England (Dr Coupland); the Departments of Pathology and Laboratory Medicine (Dr White) and Ophthalmology (Dr Rootman), Vancouver General Hospital, Vancouver, Canada; the St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato); and The New York Eye Cancer Center, New York City (Dr Finger)
| | - Paul T. Finger
- From the Department of Pathology, University of Liverpool, Liverpool, England (Dr Coupland); the Departments of Pathology and Laboratory Medicine (Dr White) and Ophthalmology (Dr Rootman), Vancouver General Hospital, Vancouver, Canada; the St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato); and The New York Eye Cancer Center, New York City (Dr Finger)
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94
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Abstract
Due to their indolent nature, conjunctival lymphomas have different treatment options compared to other adnexal lymphomas. Therapeutic options directed towards conjunctival lymphomas include radiotherapy (external beam radiation), brachytherapy, cryotherapy, intralesional interferon injections, systemic rituximab, and observation. Radiotherapy that has been demonstrated to be highly effective for both low and high-grade tumors, however, can be associated with a high percentage of short-term side effects and long-term complications. Brachytherapy can provide local tumor control, but can also cause many complications. Cryotherapy may be used for certain tumor locations, but has a high recurrence rate. Both interferon and rituximab show promising results for treating low-grade tumors while avoiding the complications associated with radiotherapy. Finally, reports of spontaneous regression of low-grade conjunctival lymphomas have led some investigators to advocate a course of careful observation following biopsy.
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Affiliation(s)
- Patricia S Tsai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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95
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Hon C, Chan RTT, Ma ESK, Shek TW, Yau K, Au WY. Lymphomatous proptosis as a novel feature of mantle cell lymphoma. Leuk Lymphoma 2009; 47:71-5. [PMID: 16321830 DOI: 10.1080/10428190500301058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe eight cases of acute proptosis due to mantle cell lymphoma (MCL), among 26 consecutive MCL cases. The median time of onset was 29 months (range 0-102) from diagnosis. Two cases presented initially with orbital masses while five as sudden disease progression after multiple courses of chemotherapy. In each case, there was dramatic loss of vision and severe proptosis, which uniformly responded to radiotherapy and/or further chemotherapy. Unilateral blindness only occurred in two cases, with recurrent orbital relapse and repeated retinal irradiation and retro-orbital optic nerve involvement, respectively. The high incidence, as well as bilateral and recurrent nature, of orbital involvement suggested a homing mechanism of MCL to this site. Despite the absence of central nervous system involvement, most cases died of refractory disease. Apart from lymphomatous polyposis of the gut, MCL cells also show predilection to ocular presentation, and must be considered as a differential diagnosis to maltoma in the two anatomical sites.
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Affiliation(s)
- Charmaine Hon
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong.
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96
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Meunier J, Lumbroso-Le Rouïc L, Dendale R, Vincent-Salomon A, Asselain B, Arnaud P, Némati F, Fourquet A, Desjardins L, Plancher C, Levy C, Chaoui D, Validire P, Decaudin D. Conjunctival low-grade non-Hodgkin's lymphoma: a large single-center study of initial characteristics, natural history and prognostic factors. Leuk Lymphoma 2009; 47:1295-305. [PMID: 16923560 DOI: 10.1080/10428190500518966] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To define the initial characteristics and prognostic factors of patients with conjunctival low-grade malignant lymphoma, all patients treated for low-grade lymphoma with initial conjunctival involvement were reviewed. Forty-nine cases were selected, including 45 cases with exclusive ophthalmologic conjunctival involvement. Pathologic review showed 55% of mucosa-associated lymphoid tissue type lymphoma, and 23% of lymphoplasmocytic lymphoma. Initial characteristics were median age of 62 years, nodal involvement in 17% of cases, and stage IV in 22% of patients with 10% of bone marrow involvement. With a median follow-up of 75 months, the 5-year disease-free survival (DFS) and overall survival were 65% and 83%, respectively. On multivariate analysis, nodal involvement was the only factor with a pejorative impact on DFS. Our patient cohort represents one of the largest published series defining the characteristics and prognostic factors of primary conjunctival low-grade malignant lymphoma.
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Affiliation(s)
- Jérôme Meunier
- Department of Clinical Hematology, Institut Curie, Paris, France
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97
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Abstract
Lymphomas of the ocular adnexa are a heterogeneous group of malignancies, composing approximately 1% to 2% of non-Hodgkin lymphomas (NHLs) and 8% of extranodal lymphomas. The most common subtype, accounting for up to 80% of cases of primary ocular adnexal lymphoma, is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. In the recent past, there have been significant advances in our understanding of the clinical characteristics, morphology and phenotype, etiology, pathogenesis, diagnosis, natural history, treatment approaches, outcome, and prognostic factors of this disease entity. Novel immunologic and molecular techniques have aided in the distinction between MALT lymphoma and other lymphoproliferative disorders and led to the identification of tissue markers of prognostic significance. Modern imaging modalities provide invaluable tools for accurate staging and treatment planning. Besides radiotherapy and chemotherapy, a variety of new treatment options have emerged in the management of patients with ocular adnexal MALT lymphoma, especially monoclonal antibody therapy and antibiotic therapy against Chlamydia psittaci, which has been associated with the pathogenesis of ocular adnexal lymphomas in some parts of the world. In this review, we present a state-of-the-art summary of ocular adnexal MALT lymphomas.
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98
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Nam H, Ahn YC, Kim YD, Ko Y, Kim WS. Prognostic significance of anatomic subsites: Results of radiation therapy for 66 patients with localized orbital marginal zone B cell lymphoma. Radiother Oncol 2009; 90:236-41. [DOI: 10.1016/j.radonc.2008.09.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 09/09/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
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99
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Abstract
The multimodality management of visual pathway tumors frequently involves radiation. Most commonly, photons are delivered via multiple focused beams aimed at the tumor while sparing adjacent tissues. The dose can be delivered in multiple treatments (radiation therapy) or in a single treatment (radiosurgery). Children with visual pathway gliomas should be treated with chemotherapy alone, delaying the use of radiation therapy until progression. Definitive radiation therapy of optic nerve sheath meningiomas results in stable vision in most patients. Radiation therapy or radiosurgery for pituitary tumors can result in control of both tumor growth and hormone hypersecretion. Postoperative radiation therapy or radiosurgery of craniopharyngiomas significantly improves local control rates compared with surgery alone. Radiation therapy is highly effective for eradicating orbital pseudolymphoma and lymphoma. The risk of complications from radiation treatment is dependent on the organ at risk, the cumulative dose it receives, and the dose delivered per fraction.
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100
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Lagoo AS, Haggerty C, Kim Y, Hammons M, Neufeld K, Redher C, Woodward J, Klintworth GK. Morphologic Features of 115 Lymphomas of the Orbit and Ocular Adnexa Categorized According to the World Health Organization Classification: Are Marginal Zone Lymphomas in the Orbit Mucosa-Associated Lymphoid Tissue–Type Lymphomas? Arch Pathol Lab Med 2008; 132:1405-16. [DOI: 10.5858/2008-132-1405-mfolot] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Marginal zone lymphomas (MZLs) are the most common lymphomas encountered in the orbit and ocular adnexa. The accurate categorization of these lymphomas is critical to avoid undertreatment or overtreatment.
Objective.—To identify features of orbital MZLs that distinguish them from other lymphomas and reactive lymphoid infiltrates and support the categorization of orbital MZL as mucosa-associated lymphoid tissue (MALT)–type MZLs.
Design.—Biopsies from 149 patients with lymphoid lesions of ocular adnexa were examined. Additional immunohistochemical stains and fluorescence in situ hybridization study for the MALT1 locus were performed in selected cases, and patient charts were reviewed.
Results.—A total of 115 lymphomas and 34 reactive infiltrates were identified, of which B-cell lymphomas constituted 92% and MZLs constituted 54% of all lymphomas. Certain clinical features (young age, race, bilaterality) favored a reactive infiltrate, but none were diagnostic. Histologic features, such as infiltrative lesions, reactive B-cell follicles, and lymphoepithelial lesions, overlapped between reactive infiltrates and conjunctival MZL. In contrast to conjuctival MZL, orbital MZL infrequently showed reactive follicles, rarely showed epithelial tissue, and did not show lymphoepithelial lesions. Cytogenetic abnormality involving the MALT1 locus was demonstrated in only 15% of ocular adnexal MZLs.
Conclusion.—Many MZLs of orbital soft tissue lack key features associated with MALT-type MZL, and the designation MALT lymphoma should be avoided in their diagnosis.
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Affiliation(s)
- Anand S. Lagoo
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Christopher Haggerty
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Young Kim
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Matthew Hammons
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Kenneth Neufeld
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Catherine Redher
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Julie Woodward
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Gordon K. Klintworth
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
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