1
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Mautone L, Dierlamm J, Heinrich MC, Viehweger F, Schäfer H, Schüttauf F, Green S, Dulz S. [Immunohistochemical and molecular genetic profile of mantle cell lymphoma of the lacrimal gland: a case series of an uncommon tumour of the lacrimal gland]. Laryngorhinootologie 2024; 103:445-449. [PMID: 37726019 DOI: 10.1055/a-2109-6646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Luca Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dierlamm
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marie-Christine Heinrich
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Viehweger
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hansjörg Schäfer
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Schüttauf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia Green
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Dulz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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2
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Gündüz AK, Mirzayev I, Kuzu I, Gahramanli Z, Mirzayeva L. A rare case of orbital mantle cell lymphoma presenting as a well-demarcated mass on magnetic resonance imaging. Orbit 2024; 43:253-257. [PMID: 36036259 DOI: 10.1080/01676830.2022.2114501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
A 71-year-old male presented with painless and slowly progressive proptosis of the right eye. The patient had no history of cancer and was in good health. Orbital magnetic resonance imaging showed a well-demarcated, slightly lobulated intraconal orbital mass hypo-isointense on T1- weighted and isointense on T2-weighted images, demonstrating contrast enhancement in the right orbit. The lesion had a central cavitary region. An anterior orbitotomy with lower lid crease incision was performed and the lesion was excised in toto. Histopathologic examination revealed diffuse infiltration of monomorphic population of small lymphoid cells. Immunohistochemical staining demonstrated diffuse and strong positivity for CD20, CD5, and cyclin D1. Histopathological and immunohistochemical findings were consistent with mantle cell lymphoma. Positron emission tomography-computed tomography did not show systemic involvement. The patient underwent orbital external beam radiotherapy (36 Gy). There was no recurrence and/or systemic involvement at 2.5 years follow-up.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Private Eye Clinic, Ankara, Turkey
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Işınsu Kuzu
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Leyla Mirzayeva
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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3
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Sen M, Demirci H, Honavar SG. Targeted therapy in ophthalmic oncology: The current status. Asia Pac J Ophthalmol (Phila) 2024; 13:100062. [PMID: 38642707 DOI: 10.1016/j.apjo.2024.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024] Open
Abstract
There have been rapid advancements in the field of ocular oncology for the diagnosis and management of intraocular, adnexal, and orbital tumors. Targeted therapy is in the forefront of medical research in all fields including ocular oncology. Targeted therapy include drugs that target specific genetic mutations, pathways or proteins involved in the development of cancer. In contrast to traditionally used chemotherapy, drugs used in targeted therapy are highly specific for tumor cells and preserve the function of normal cells. This review aims to familiarize ophthalmologists with the drugs that are currently approved or undergoing clinical trials for use in ocular oncology. Targeted therapy is particularly useful for locally advanced or metastatic tumors, including but not limited to eyelid and periocular basal cell carcinoma, periocular cutaneous and conjunctival squamous cell carcinoma, ocular adnexal lymphoma, conjunctival melanoma, and uveal melanoma. The results are promising with improved survival outcomes and better tolerability than chemotherapeutic drugs.
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Affiliation(s)
- Mrittika Sen
- Ocular Oncology Service, Raghunath Netralaya, Mumbai, India
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight Eye Hospital, Hyderabad, India.
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4
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Vest SD, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Hindso TG, Holm F, Honavar SG, Khong JJ, Kirkegaard MK, McKelvie PA, Mikkelsen LH, Mulay K, Rasmussen PK, Siersma V, Sjö LD, Sniegowski MC, Thuro BA, Vemuganti GK, Heegaard S. Specific location of ocular adnexal lymphoma and mortality: an international multicentre retrospective study. Br J Ophthalmol 2023; 107:1231-1238. [PMID: 35512851 DOI: 10.1136/bjophthalmol-2021-320466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine whether the specific location of ocular adnexal lymphoma (OAL) and the American Joint Committee on Cancer (AJCC) TNM tumour stage are prognostic factors for mortality in the main OAL subtypes. METHODS Clinical and survival data were retrospectively collected from seven international eye cancer centres. All patients from 1980 to 2017 with histologically verified primary or secondary OAL were included. Cox regression was used to compare the ocular adnexal tumour locations on all-cause mortality and disease-specific mortality. RESULTS OAL was identified in 1168 patients. The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=688, 59%); follicular lymphoma (FL) (n=150, 13%); diffuse large B-cell lymphoma (DLBCL) (n=131, 11%); and mantle cell lymphoma (MCL) (n=89, 8%). AJCC/TNM tumour-stage (T-stage) was significantly associated with disease-specific mortality in primary ocular adnexal EMZL and increased through T-categories from T1 to T3 disease. No associations between AJCC/TNM T-stage and mortality were found in primary ocular adnexal FL, DLBCL, or MCL. EMZL located in the eyelid had a significantly increased disease-specific mortality compared with orbital and conjunctival EMZL, in both primary EMZL and the full EMZL cohort. In DLBCL, eyelid location had a significantly higher disease-specific mortality compared with an orbital or lacrimal gland location. CONCLUSION Disease-specific mortality is associated with AJCC/TNM T-stage in primary ocular adnexal EMZL patients. Lymphoma of the eyelid has the highest disease-specific mortality in primary EMZL, and in the full cohort of EMZL and DLBCL patients.
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Affiliation(s)
- Stine Dahl Vest
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York City, New York, USA
| | - Gerardo F Graue
- The New York Eye Cancer Center, New York City, New York, USA
| | - Hans E Grossniklaus
- Section of Ocular Oncology, Emory University Eye Center, Atlanta, Georgia, USA
| | | | - Frederik Holm
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Santosh G Honavar
- Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Lene Dissing Sjö
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Matthew C Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Geeta K Vemuganti
- Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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5
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Mautone L, Dierlamm J, Heinrich MC, Viehweger F, Schäfer H, Schüttauf F, Green S, Dulz S. [Immunohistochemical and Molecular Genetic Profile of Mantle Cell Lymphoma of the Lacrimal Gland: A Case Series of an Uncommon Tumour of the Lacrimal Gland]. Klin Monbl Augenheilkd 2023; 240:33-38. [PMID: 36706768 DOI: 10.1055/a-1973-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mantle cell lymphomas (MCL) represent a rare subclass of Non-Hodgkin Lymphoma affecting the lacrimal gland (GL). AIM To extensively describe the immunohistochemical profile of GL-MCL. MATERIAL UND METHODS Single center, retrospective electronic records review of 3 patients with biopsy proven LG-MCL. RESULTS The herein presented case series of three patients comprises a focal case involving solely the lacrimal gland, a symptomatic LG-MCL manifesting as the first sign of a systemic disease as well as a case of LG-MCL presenting as a relapsed systemic lymphoma. The three patients presented positive CD19 and CD20, negative CD10 and CD23. One patient showed an uncommon negativity for CD5. The increased expression of cyclin D1 caused by the classical translocation t(11;14) (q13;q32) in the fluorescence-in-situ-hybridisation were observed in all cases. B-cell-lymphoma-2 protein (BCL-2) and transcription factor SOX-11 (SOX-11) were also overexpressed. DISCUSSION LG-MCL show an immunohistochemical profile corresponding to the classical profile of MCL. Overexpression of molecules for target therapies was found in all cases (CD20 for rituximab, BCL2 for Bruton-kinase-inhibitors and CD19 for CAR-T cell therapy). The removal of the GL can potentially drive to severe complications, even if aimed to confirm diagnosis. Therefore, the choice between GL-biopsy and exstirpation should be carefully evaluated, especially in cases of suspected lymphoma.
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Affiliation(s)
- Luca Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Judith Dierlamm
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Marie-Christine Heinrich
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Florian Viehweger
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hansjörg Schäfer
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Frank Schüttauf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sylvia Green
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Simon Dulz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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6
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Kim JS, Trobe JD, Joseph SS. Progressively Worsening Unilateral Ptosis in a Woman in Her 60s. JAMA Ophthalmol 2022; 140:644-645. [PMID: 35323852 DOI: 10.1001/jamaophthalmol.2021.5716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jane S Kim
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Jonathan D Trobe
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor.,Department of Neurology, University of Michigan, Ann Arbor.,Department of Neurosurgery, University of Michigan, Ann Arbor
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
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7
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Castillejo Becerra CM, Dalvin LA, Jevremovic D, Hodge DO, Tooley AA. Clinical characteristics and outcomes of ocular adnexal mantle cell lymphoma. Orbit 2022; 41:97-104. [PMID: 35100932 DOI: 10.1080/01676830.2021.2018715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare characteristics of initial ocular adnexal (OA) mantle cell lymphoma (MCL) and initial systemic MCL. METHODS Retrospective, comparative case series. Patients treated for MCL at Mayo Clinic from 1/1/1990 to 11/30/2020. MCL was classified as initial OA if first site was OA or initial systemic if first site was elsewhere with progression or recurrence to the OA region. OUTCOME MEASURES Features, treatment, and survival. RESULTS There were 50 patients with MCL, 23 initial OA and 27 initial systemic. Patients with initial OA MCL had more conjunctival (52% vs. 19%, p = .017) involvement and less frequently received chemotherapy plus autologous stem cell transplant (ASCT) (9% vs. 33%, p = .046) as initial treatment. Complete remission was achieved in 41 (91% vs. 74%, p = .152) patients. Five-year disease-specific survival was similar in initial OA and initial systemic MCL (92% vs. 83%, p = .187). Subanalysis of patients with initial OA MCL revealed 9 (39%) patients developed tumor recurrence, with mean time to recurrence of 28 months. Comparison (no recurrence vs. recurrence) of initial OA MCL patients revealed those with no recurrence had shorter mean final follow-up (3.3 vs. 9.8 years, p = .005) and more frequent initial treatment with rituximab-based chemotherapy plus ASCT (43% vs. 0%, p = .048). Recurrence had no effect on the 5-year age-adjusted risk of death from lymphoma (HR 2.17, 95% CI 0.55-9.09, p = .266). CONCLUSIONS Initial OA and initial systemic MCL patients differ in presentation and management but have similar survival.
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Affiliation(s)
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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8
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Hafeez S, Mancini A, Mega J, Greenberg PB, Siegel C, Hunter A. Case Report: Ocular Manifestation of Mantle Cell Lymphoma. Optom Vis Sci 2022; 99:186-189. [PMID: 34889856 DOI: 10.1097/opx.0000000000001841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Mantle cell lymphoma (MCL) is a rare lymphoma that can present even more rarely in the orbit. Diagnosis, differentiation, and systemic treatment with the help of an oncologist are necessary for improved prognosis. Eye care providers must be vigilant when addressing ocular findings to determine next steps. PURPOSE We present a case of presumed orbital fat prolapse confirmed as MCL found on routine eye examination. CASE REPORT A 72-year-old White man presented for an annual comprehensive eye examination and was found to have conjunctival elevation in the superior and inferior fornices bilaterally. The patient had stable lymphadenopathy on positron emission tomography/computed tomography imaging 1 week before presentation. Coupled with the patient's recent diagnosis of systemic MCL, there was high suspicion that the conjunctival lesions were malignant. Biopsy of the conjunctival lesion confirmed MCL. A reevaluation of the previous imaging with a neuroradiologist confirmed the presence of orbital lesions consistent with MCL. The patient responded to treatment with low-dose focal radiation therapy. CONCLUSIONS Primary eye care providers should be aware of limitations of orbital imaging during routine positron emission tomography and computed tomography scans in those with MCL, and consultation with neuroradiology for image review may be useful if the clinical findings are suspicious.
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9
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Chung HU, Son JH. Ocular adnexal lymphoma: an updated review of pathogenesis, diagnosis, and treatment. Yeungnam Univ J Med 2021; 39:3-11. [PMID: 34521183 PMCID: PMC8895963 DOI: 10.12701/yujm.2021.01263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 12/02/2022] Open
Abstract
Lymphoma is the most common primary tumor of the orbit, accounting for 55% of all orbital malignancies. When divided into histopathological subtypes, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) comprises the largest proportion. Clinical manifestations are unspecific, but in patients with slow-growing painless orbital mass, or red conjunctival lesion suggestive of ‘salmon patch’, ocular adnexa lymphoma (OAL) should be suspected. Although the pathogenetic mechanism of ocular adnexal MALT lymphoma (OAML) is not yet fully understood, the relationship between OAML and Chlamydia psittaci has been hypothesized recently, similar to that between gastric MALT lymphoma and Helicobacter pylori. This suggests a new treatment option for OAML; bacterial eradication therapy with systemic antibiotics. Several other treatment methods for OAML have been introduced, but no treatment guidelines have been established yet. In this article, we summarize the current knowledge on the clinical features, pathogenesis, diagnostic methods, therapeutic strategies, and prognosis of OAML.
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Affiliation(s)
- Hyun Uk Chung
- Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Korea
| | - Jun Hyuk Son
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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10
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11
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Small L, Ma C, Shah M, Ramanathan S, Rasool N. Bilateral vision loss as the initial presentation for central nervous system involvement of mantle cell lymphoma: A case series. Am J Ophthalmol Case Rep 2021; 23:101131. [PMID: 34151045 PMCID: PMC8192816 DOI: 10.1016/j.ajoc.2021.101131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Mantle cell lymphoma is a rare aggressive subtype of non-Hodgkins B cell lymphoma. It typically presents with asymptomatic monoclonal lymphocytosis, lymphadenopathy or bulky extranodal disease. Mantle cell lymphoma rarely affects the central nervous system. We present two cases in which vision loss was the initial symptom of central nervous system involvement by the malignancy. Observations Both patients initially received high dose intravenous steroids with notable improvement in their vision. Conclusions and importance Early detection and management of optic nerve infiltration by mantle cell lymphoma is essential as it improves visual outcomes and enables prompt management of the patient's systemic disease.
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Affiliation(s)
- L Small
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - C Ma
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - M Shah
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - S Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - N Rasool
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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12
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Shah DS, Homer NA, Epstein A, Durairaj VD. Simultaneous presentation of orbital mantle cell lymphoma and endocrine mucin-producing sweat gland carcinoma. Orbit 2021; 41:509-513. [PMID: 33657963 DOI: 10.1080/01676830.2021.1894583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mantle cell lymphoma is a rare malignancy to present in the orbit, comprising only 1-5% adnexal lymphomas. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an equally uncommon adnexal tumor of sweat gland origin that may present on the eyelid. Herein we present a case of a 77-year old man with no previous cancer history who presented with painless progressive left globe proptosis and an enlarging left upper lid margin lesion, ultimately determined upon biopsy to be simultaneous orbital mantle cell lymphoma with systemic involvement and isolated eyelid EMPSGC. The pathogenesis, clinical manifestation, and management for each rare disease entity are reviewed and concept of collision tumors is discussed.
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Affiliation(s)
- Darsh S Shah
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Natalie A Homer
- Department of Ophthalmology, UC Davis, Sacramento, California, USA
| | | | - Vikram D Durairaj
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,TOC Eye and Face, Austin, Texas, USA
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13
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Cruz AAV, Gomes DM, Chahud F. Bilateral Mantle Cell Lymphoma of the Lacrimal Sac and Nasolacrimal Duct. JAMA Ophthalmol 2020; 138:e202394. [PMID: 33300970 DOI: 10.1001/jamaophthalmol.2020.2394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Antonio A V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Diego M Gomes
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Fernando Chahud
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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14
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Lymphoma of the Lacrimal Gland - An International Multicenter Retrospective Study. Am J Ophthalmol 2020; 219:107-120. [PMID: 32574779 DOI: 10.1016/j.ajo.2020.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE To characterize the clinical features of subtype-specific lacrimal gland lymphoma and their effect on patient survival. DESIGN Multicenter retrospective interventional case series. METHODS Patient data were collected from 6 international eye cancer centers from January 1, 1980, through December 31, 2017. All patients with histologically verified primary or secondary lymphoma of the lacrimal gland were included. Primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS A total of 260 patients with lacrimal gland lymphoma were identified. The median age was 58 years and 52% of patients were men. Non-Hodgkin B-cell lymphomas constituted 99% (n = 258) and T-cell lymphomas constituted 1% (n = 2). The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n = 177, 68%), follicular lymphoma (FL) (n = 26, 10%), diffuse large B-cell lymphoma (DLBCL) (n = 25, 10%), and mantle cell lymphoma (MCL) (n = 17, 7%). Low-grade lymphomas (EMZL and FL) were most commonly treated with external beam radiotherapy (EBRT), whereas high-grade lymphomas (DLBCL and MCL) were treated with chemotherapy in combination with rituximab and/or EBRT. The prognosis was relatively good with a 5-year OS and DSS of 73.8% and 87.5%, respectively. Lymphoma subtype was a statistically significant predictor for DSS, with EMZL (5-year DSS: 93.4%) having the best prognosis and DLBCL (5-year DSS: 52.6%) having the poorest. CONCLUSIONS This is the largest reported collection of data of subtype-specific lacrimal gland lymphoma. The subtype distribution of lacrimal gland lymphoma resembles that of the ocular adnexa. Prognosis is good and the histologic subtype is a significant predictor for disease-specific survival.
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15
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Toumi E, Peyrade F, Nahon S, Marin L, Baillif S, Martel A. [Orbital mantle cell lymphoma succesfully treated by Bcl-2 inhibitor: Report of a case]. J Fr Ophtalmol 2020; 44:239-243. [PMID: 32981740 DOI: 10.1016/j.jfo.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 10/23/2022]
Abstract
Lymphoma is the most common orbital malignancy in adults. Among the types of lymphoma, mantle cell lymphoma is a particularly aggressive form, often discovered through systemic involvement, with a dismal prognosis due to frequent recurrences. It is secondary to a t (11 ; 14) (q13; q32) chromosomal translocation resulting in an anti-apoptotic signal via overexpression of Bcl-2. Treatment is based on R-CHOP poly-chemotherapy. We describe the case of a patient with an orbital recurrence of mantle cell lymphoma successfully treated with oral Bcl-2 inhibitor monotherapy. A 58-year-old man who was treated with R-CHOP 8 years ago for mantle cell lymphoma, in remission for 5 years, presented with progressive decreased visual acuity in the left eye, along with binocular diplopia. Clinical examination revealed a decrease in visual acuity in the left eye to 1/20 Parinaud 20 and a relative afferent pupillary defect on the left. External examination revealed a left cranial nerve VI palsy, 2mm of painless proptosis, and hypesthesia of the left V1 territory, leading to a diagnosis of left orbital apex syndrome. The disc and macular OCT were normal. The visual field showed enlargement of the left blind spot. An emergency CT scan and MRI revealed an apical extraconal tissue mass infiltrating the medial rectus muscle, extending to the superior orbital fissure, optic canal and left cavernous sinus, hyperintense on T2 weighted images and isointense on T1. The morphological appearance was strongly suggestive of an infiltrative lymphomatous process. An 18 FDG PET-scan identified the orbital lesion as well as enhancing lesions in the axilla and colon; given the clinical features and test results, the diagnosis of recurrent mantle cell lymphoma was made without biopsy. Treatment with Venetoclax (Bcl-2 inhibitor) was initiated. At one month of treatment, the orbital apex syndrome had entirely resolved, with visual acuity increased to 8/10 Parinaud 4 and a metabolic return to normal on PET scan. The PET scanner and clinical examination at 3 months were entirely normal. At the one-year follow-up visit, the patient was still on Venetoclax, the clinical examination was unchanged, and the PET-scan still showed a complete metabolic response.
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Affiliation(s)
- E Toumi
- CHU Pasteur II, service d'ophtalmologie, 30, voie Romaine, 06000 Nice, France.
| | - F Peyrade
- Service d'oncologie, centre Antoine Lacassagne, 33 avenue de Valombrose, 06189 Nice Cedex 2, France
| | - S Nahon
- CHU Pasteur II, service d'ophtalmologie, 30, voie Romaine, 06000 Nice, France
| | - L Marin
- CHU Pasteur II, service d'ophtalmologie, 30, voie Romaine, 06000 Nice, France
| | - S Baillif
- CHU Pasteur II, service d'ophtalmologie, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- CHU Pasteur II, service d'ophtalmologie, 30, voie Romaine, 06000 Nice, France
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Orbital and Eyelid B-Cell Lymphoma: A Multicenter Retrospective Study. Cancers (Basel) 2020; 12:cancers12092538. [PMID: 32906630 PMCID: PMC7563111 DOI: 10.3390/cancers12092538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The treatment of orbital and eyelid B-cell lymphoma remains a field of progress. The aim of our study was to analyze patients diagnosed, staged and treated for orbital and eyelid B-cell lymphoma to assess clinical characteristics, treatment outcomes and recurrence patterns. We included in this study 141 cases of orbital and eyelid B-cell lymphoma. We found five lymphoma subtypes and we confirmed that the histopathologic subtype and the type of treatment were found to be the main factors influencing treatment outcome. Abstract Background: The aim of this study was to analyze patients diagnosed, staged and treated for orbital and eyelid B-cell lymphoma (OEL). Methods: One hundred and forty-one cases of OEL were included in this study. Primary endpoints were to analyze the histopathologic findings, the main risk factors and the type of treatment and to correlate them with recurrence of OEL. The secondary endpoint was to determine the progression-free survival (PFS) time. Results: Extranodal marginal zone B-cell lymphoma was the most frequent subtype (66%), followed by small lymphocytic lymphoma (12.7%), diffuse large B-cell lymphoma (DLBCL) (9.2%), follicular lymphoma (6.6%), mantle cell lymphoma (4.3%) and Burkitt lymphoma (1.2%). The probability of relapse was influenced by the histopathologic subtype DLBCL (OR = 7.7, 95% CI 1.8–32.3) and treatment with chemotherapy (OR = 14.9, 95% CI 2.6–83.7). Multivariate analysis showed that the histopathologic subtype DLBCL and chemotherapy treatment retained statistical significance for a poorer PFS, with hazard ratios of 8.581 (p = 0.0112) and 9.239 (p = 0.0094), respectively. Conclusions: Five lymphoma subtypes were found in patients with OEL. The histopathologic subtype and the type of treatment were found to be the main factors influencing treatment outcome.
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17
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Jain P, Finger PT, Fili M, Damato B, Coupland SE, Heimann H, Kenawy N, J Brouwer N, Marinkovic M, Van Duinen SG, Caujolle JP, Maschi C, Seregard S, Pelayes D, Folgar M, Yousef YA, Krema H, Gallie B, Calle-Vasquez A. Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study. Br J Ophthalmol 2020; 105:1358-1364. [PMID: 32892167 PMCID: PMC8479743 DOI: 10.1136/bjophthalmol-2020-316293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/26/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Background To relate conjunctival melanoma characteristics to local control. Methods Retrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system. Results 288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence. Conclusion This multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.
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Affiliation(s)
- Puneet Jain
- The New York Eye Cancer Center, New York, New York, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York, New York, USA
| | - Maria Fili
- St. Er's Eye Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Nihal Kenawy
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | | | | | | | | | - Celia Maschi
- St. Roch Hospital, Nice University Hospital, Nice, France
| | - Stefan Seregard
- St. Er's Eye Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Hatem Krema
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Brenda Gallie
- Princess Margaret Hospital, Toronto, Ontario, Canada
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18
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Holm F, Mikkelsen LH, Kamper P, Rasmussen PK, Larsen TS, Sjö LD, Heegaard S. Ocular adnexal lymphoma in Denmark: a nationwide study of 387 cases from 1980 to 2017. Br J Ophthalmol 2020; 105:914-920. [PMID: 32732342 DOI: 10.1136/bjophthalmol-2019-315637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nationwide studies of ocular adnexal lymphoma (OAL) are very rare in the literature, and knowledge on incidence, subtype distribution and long-term survival data is limited. This is the largest national study of OAL to date. This study sought to find information on incidence, changes in incidence, clinical findings, distribution of subtypes, survival and prognostic factors. METHODS Patients diagnosed with OAL from January 1, 1980 to December 31, 2017 were identified in Danish registers, and clinical as well as survival data were collected. The data were analysed with Kaplan-Meier plots and log-rank test. RESULTS 387 patients were included in the study. The major lymphoma subtypes were extranodal marginal-zone B cell lymphoma (EMZL) (55%), diffuse large B cell lymphoma (DLBCL) (13%), mantle cell lymphoma (MCL) (11%) and follicular lymphoma (FL) (10%). OAL is a disease of the elderly (median age 69 years). The incidence of lymphoma of the ocular adnexal region has increased significantly throughout the time period of the study (Pearson correlation coefficient, r=0.65; P<0.001). In the period 1980-1984, the incidence was 0.086 per 100 000, which increased to 0.307 per 100 000 in the period 2013-2017. Low-grade, low-stage primary lymphomas were treated with radiotherapy, whereas patients with high-stage, high-grade and/or relapsed disease were treated with chemotherapy. Low-grade subtypes EMZL (89%) and FL (56%) had better 10-year disease-specific survival than the high-grade lymphomas DLBCL (38%) and MCL (31%)(p<0.001). CONCLUSION OAL is increasing in incidence in the Danish population for unknown reasons. However, the prognosis for most OAL is favourable, as highlighted in this national long-term study.
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Affiliation(s)
- Frederik Holm
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Peter Kamper
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Kristian Rasmussen
- Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene Dissing Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark .,Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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19
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Hirji SH, Maeng MM, Tooley AA, Soderquist C, Annunziata J, Kazim M. Orbital marginal cell lymphoma and mantle cell lymphoma subclone in patient with monoclonal gammopathy of unknown significance. Orbit 2020; 40:247-251. [PMID: 32363993 DOI: 10.1080/01676830.2020.1760312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Indolent lymphomas have the potential to transform into more aggressive phenotypes. This phenomenon is best exemplified by the transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma into diffuse large B-cell lymphoma. However, it is less common to find multiple small cell lymphomas in the orbit, particularly mantle cell lymphoma. We present a case of an extranodal marginal zone lymphoma arising in the orbit that acquired a subclonal t(11;14) (q13;32) CCND1-IGH translocation, giving rise to a subclone of mantle cell lymphoma. The management of this tumor was targeted towards the more aggressive mantle cell subclone. The tumor exhibited an incomplete response to rituximab alone. To the best of the authors' knowledge, this represents the first such case to be described irrespective of site of origin.
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Affiliation(s)
- Sitara H Hirji
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michelle M Maeng
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Andrea A Tooley
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Craig Soderquist
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Joseph Annunziata
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Michael Kazim
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
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20
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Williams KJ, Allen RC, Weng CY. An Orbital Lesion Diagnosed on Routine Fundus Examination. JAMA Ophthalmol 2019; 137:1456-1457. [PMID: 31647505 DOI: 10.1001/jamaophthalmol.2019.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katherine J Williams
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Richard C Allen
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Christina Y Weng
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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21
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White VA. Understanding and Classification of Ocular Lymphomas. Ocul Oncol Pathol 2019; 5:379-386. [PMID: 31768360 PMCID: PMC6872993 DOI: 10.1159/000499845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lymphomas that involve the tissues of the ocular adnexae and the eye itself can be confusing for both the new and seasoned learner alike. In this review, I present a simple way of classifying these disorders that will help to facilitate understanding of these myriad entities. SUMMARY Classifications of lymphomas have changed significantly over the last 40 years, but in recent decades, the basic structure of the WHO classification has remained the same, facilitating understanding. KEY MESSAGES The ocular lymphomas can be divided into those that are external to the eye (ocular adnexae) and those that are internal (vitreoretinal and uveal). At each of these sites specific subtypes of lymphoma are common. Focusing on these common subtypes can aid the learner to create a scaffold that enables current understanding and upon which they can build for the future.
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Affiliation(s)
- Valerie A. White
- WHO/IARC Classification of Tumours Group, International Agency for Research on Cancer, Lyon, France
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22
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Nishiyama‐Fujita Y, Nakazato T, Ito C, Ogura S, Mizuno K, Kamiya T, Aisa Y, Mori T. Rare case of ocular adnexal relapse with mantle cell lymphoma treated with ibrutinib monotherapy. Intern Med J 2019; 49:1187-1189. [DOI: 10.1111/imj.14432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tomonori Nakazato
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Chisako Ito
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Shinji Ogura
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Kota Mizuno
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Takahiro Kamiya
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Yoshinobu Aisa
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Takehiko Mori
- Division of HematologyKeio University School of Medicine Tokyo Japan
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Hindsø TG, Esmaeli B, Holm F, Mikkelsen LH, Rasmussen PK, Coupland SE, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Sjö LD, Vemuganti GK, Thuro BA, Heegaard S. International multicentre retrospective cohort study of ocular adnexal marginal zone B-cell lymphoma. Br J Ophthalmol 2019; 104:357-362. [DOI: 10.1136/bjophthalmol-2019-314008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/27/2019] [Accepted: 05/11/2019] [Indexed: 01/12/2023]
Abstract
Backgrounds/aimsTo date, this is the largest cohort study on extranodal marginal zone B-cell lymphoma (EMZL) of the ocular adnexa (OA). The aim of the study was to characterise the clinical features of OA-EMZL.MethodsA retrospective multicentre study involving seven international eye cancer centres. Data were collected from 1 January 1980 through 31 December 2017. A total of 689 patients with OA-EMZL were included.ResultsThe median follow-up time was 42 months. The median age was 62 years (range, 8–100 years), and 55 % (378/689 patients) of patients were women. The majority of patients (82%, 558/680 patients) were diagnosed with primary OA-EMZL with Ann Arbor stage IE (90%, 485/541 patients) and American Joint Committee on Cancer stage T2 (61%, 340/557 patients) at the time of diagnosis. The orbit (66%, 452/689 patients) and the conjunctiva (37%, 255/689 patients) were the most frequently involved anatomical structures. The 5-year, 10-year and 20-year disease-specific survival (DSS) were 96%, 91% and 90%, respectively. Stage IE patients treated with external beam radiation therapy (EBRT) as monotherapy (10-year DSS, 95%) were found to have a better DSS than stage IE patients treated with chemotherapy (10-year DSS, 86%). Stage IIIE/IVE patients treated with chemotherapy and rituximab had a better DSS (10-year DSS, 96%) than stage IIIE/IVE patients treated with chemotherapy without rituximab (10-year DSS, 63%).Conclusions and relevanceEMZL is a slow-growing tumour with an excellent long-term survival. Low-dose EBRT as monotherapy should be considered in localised OA-EMZL. Rituximab-based chemotherapy should be chosen in those patients with disseminated disease.
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24
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Iqbal M, Castano YG, Sher T, Kharfan-Dabaja MA. Intraocular involvement of Mantle cell lymphoma: A case report and literature review. Hematol Oncol Stem Cell Ther 2019; 14:147-152. [PMID: 30978309 DOI: 10.1016/j.hemonc.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
Lymphomatous involvement of the ocular adnexal region (OAR) is generally rare; however, it constitutes the most common ocular malignancy. Most cases of ocular adnexal lymphomas are extra nodal marginal zone B cell lymphomas. Mantle cell lymphoma involvement (MCL) of the OAR is a less common presentation compared with other lymphomas and it has been reported anecdotally. Studies have suggested an association of OAR involvement with poor prognosis. Here, we report the case of a 61 year old man who started experiencing conjunctival erythema which was followed by development of bilateral proptosis. The diagnosis of Stage IV Mantle cell lymphoma with OAR involvement was confirmed 5 months after patient onset of symptomatology. He underwent treatment with systemic chemotherapy, which was followed by high-dose chemotherapy and autologous hematopoietic cell transplant. He is currently day +100 from his transplant and is in complete remission. A review of the literature regarding ocular involvement of MCL is also summarized.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.
| | - Yennifer Gil Castano
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Taimur Sher
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
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25
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Olsen TG, Holm F, Mikkelsen LH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Sjö LD, Vemuganti GK, Thuro BA, Heegaard S. Orbital Lymphoma-An International Multicenter Retrospective Study. Am J Ophthalmol 2019; 199:44-57. [PMID: 30419193 DOI: 10.1016/j.ajo.2018.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate and characterize the clinical features of subtype-specific orbital lymphoma. DESIGN Retrospective, interventional case series. METHODS The study included 7 international eye cancer centers. Patient data were collected from January 1, 1980 through December 31, 2017. A total of 797 patients with a histologically verified orbital lymphoma were included. The primary endpoints were overall survival, disease-specific survival, and progression-free survival. RESULTS The median age was 64 years, and 51% of patients (n = 407) were male. The majority of lymphomas were of B-cell origin (98%, n = 779). Extranodal marginal zone B-cell lymphoma (EMZL) was the most frequent subtype (57%, n = 452), followed by diffuse large B-cell lymphoma (DLBCL) (15%, n = 118), follicular lymphoma (FL) (11%, n = 91), and mantle cell lymphoma (MCL) (8%, n = 66). Localized Ann Arbor stage IE EMZL and FL were frequently treated with external beam radiation therapy. DLBCL, MCL, and disseminated EMZL and FL were primarily treated with chemotherapy. EMZL and FL patients had a markedly better prognosis (10-year disease-specific survival of 92% and 71%, respectively) than DLBCL and MCL patients (10-year disease-specific survival of 41% and 32%, respectively). CONCLUSIONS Four lymphoma subtypes were primarily found in patients with orbital lymphoma: EMZL, DLBCL, FL, and MCL. The histologic subtype was found to be the main predictor for outcome, with EMZL and FL patients having a markedly better prognosis than DLBCL and MCL.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Brachytherapy
- Disease-Free Survival
- Female
- Humans
- Internationality
- Lymphoma/classification
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Mantle-Cell/diagnostic imaging
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Orbital Neoplasms/classification
- Orbital Neoplasms/pathology
- Positron Emission Tomography Computed Tomography
- Retrospective Studies
- Survival Rate
- Tomography, X-Ray Computed
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Holm
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah E Coupland
- Department of Clinical and Cancer Medicine, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York, New York, USA
| | | | | | - Santosh G Honavar
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India; Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penelope A McKelvie
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | - Lene Dissing Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India; Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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26
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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De Niear MA, Greer JP, Seegmiller A, Mawn LA. Blastic Transformation of a Mantle Cell Lymphoma Presenting as an Enlarging Unilateral Orbital Mass. Ocul Oncol Pathol 2018; 5:245-251. [PMID: 31367585 DOI: 10.1159/000492832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/12/2018] [Indexed: 12/22/2022] Open
Abstract
Mantle cell lymphoma (MCL) is an uncommon form of non-Hodgkin lymphoma predominantly affecting male individuals of advanced age. Approximately 1-9% of cases of lymphoma affecting the orbital and ocular adnexal regions are attributed to MCL. We describe the case of a 65-year-old man with a 24-year history of MCL with initial remission followed by multiple relapses who presented with acute-onset binocular diplopia and proptosis of the left eye. Subsequent imaging demonstrated a new left superior orbital mass. Biopsy of the mass revealed two clonally related, yet distinct cellular components demonstrating the classical mantle cell morphology and large cells that appeared to have transformed to the blastoid variant of MCL. Transformation of classical MCL to the blastoid variant of MCL is rare, with few reports in the literature. The blastoid variant of MCL tends to be aggressive and associated with a poor prognosis. The case we describe represents perhaps the first report of MCL transformation observed in the orbit.
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Affiliation(s)
- Matthew A De Niear
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John P Greer
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Seegmiller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Affiliation(s)
- Lauge Hjorth Mikkelsen
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen
| | - Natacha Storm Würtz
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen
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