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Amir A, Amir B, Sheikh S. Primary ocular adnexal mantle cell lymphoma with distant spread and involvement of the contralateral eye one year later; a case report and literature review. J Surg Case Rep 2024; 2024:rjae414. [PMID: 38863960 PMCID: PMC11165365 DOI: 10.1093/jscr/rjae414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
We herein report a middle-aged gentleman who initially presented with ocular adnexal mantle cell lymphoma (MCL) on the right eyelid. The lesion was excised and the patient was treated with radiation therapy. During the initial presentation, a PET CT was performed and did not reveal disease involvement beyond the eyelid. The patient presented 3 months later with ocular adnexal MCL of the contralateral eye. Re-evaluation using PET CT revealed a slight increase in the uptake in several lymph nodes and the spleen, which, after biopsy, confirmed systemic MCL. The patient was started on six cycles of chemotherapy. The patient also underwent autologous hematopoietic stem cell transplant. Approximately 80% of primary ocular adnexal lymphomas are B-cell in origin, with MCL being the rarest subtype constituting only 5% of B-cell ocular adnexal lymphomas. Despite its rarity, it is crucial for clinicians to detect the entity early and ensure rapid initiation of appropriate therapy.
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Affiliation(s)
- Amaar Amir
- Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam 31441, Saudi Arabia
| | - Baraa Amir
- Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam 31441, Saudi Arabia
| | - Salwa Sheikh
- Pathology Services, Pathology Services, John Hopkins Aramco Healthcare, Dhahran 34455, Saudi Arabia
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2
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Pereira VDC, Henker LC, Menegatt JCO, Vielmo A, Bertolini M, Legramanti WM, Panziera W, Bandinelli MB, Pavarini SP. Primary third eyelid lymphoma with aggressive local behavior in a dog. Top Companion Anim Med 2024:100864. [PMID: 38513794 DOI: 10.1016/j.tcam.2024.100864] [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: 08/16/2023] [Revised: 02/20/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Lymphoma is the most common hematopoietic neoplasm in dogs. However, cases primarily involving the third eyelid are rarely reported in the species. The subtype most frequently described in this location is marginal zone lymphoma of the mucosa-associated lymphoid tissue, which has an indolent behavior. A 10-year-old intact female Poodle was presented with a 2-month history of a nodule in the left third eyelid for evaluation. This nodule was surgically excised; however, local recurrence was detected nineteen days postoperatively, with the formation of a mass that expanded and replaced the extraocular orbital tissues and infiltrated the eye. Euthanasia was elected due to the deteriorating clinical condition, and a necropsy was performed. Macroscopically, the mass infiltrated and expanded the eyelids with narrowing of the palpebral fissure, expanded into the orbital space, and infiltrated the cornea and bulbar conjunctiva. Histologically, the mass was composed of sheets of intermediate to large neoplastic lymphocytes, with frequent epitheliotropism and tingible bodies. Neoplastic lymphocytes were immunoreactive for PAX5, CD20, and CD79a and were not immunoreactive for CD3. The neoplasm was restricted to the left eyelid and orbit. A diagnosis of primary third eyelid lymphoma (extranodal) with immunophenotype B and locally aggressive behavior was made based on the macroscopic, histological, and immunohistochemical findings.
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Affiliation(s)
- Vanessa de C Pereira
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil.
| | - Luan C Henker
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
| | - Jean C O Menegatt
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
| | - Andréia Vielmo
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
| | - Marianna Bertolini
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
| | | | - Welden Panziera
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
| | - Marcele B Bandinelli
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil
| | - Saulo P Pavarini
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Pr. 42505, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Veterinária (FAVET), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9090, Porto Alegre, Brazil
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Saksena A, Jain A, Pack SD, Kim J, Lee I, Tyagi M, Xi L, Pittaluga S, Raffeld M, Jaffe ES. Follicle Center Lymphoma (FCL) of the Lower Female Genital Tract (LFGT): A Novel Variant of Primary Cutaneous Follicle Center Lymphoma (PCFCL). Am J Surg Pathol 2023; 47:409-419. [PMID: 36461146 PMCID: PMC9974907 DOI: 10.1097/pas.0000000000002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Primary cutaneous follicle center lymphoma has been distinguished from nodal follicular lymphoma (FL) based on genomic and clinical features. The nature of other extranodal FLs is not well defined. We report 15 cases of follicle center lymphoma involving the lower female genital tract. Cases were evaluated using an immunohistochemical panel for B-cell lymphoma, B-cell clonality, fluorescence in situ hybridization for BCL2 gene rearrangement, and next-generation sequencing. All patients had localized disease with no evidence of bone marrow involvement. Most cases (12/15, 80%) had a follicular pattern, at least focally. Large centrocytes were a prominent feature leading to concern for diffuse large B-cell lymphoma by referring pathologists. Neoplastic cells were positive for CD20 and BCL-6, while BCL-2 was positive in 2/15 (13%) cases. Fluorescence in situ hybridization for BCL2 gene rearrangement was negative in 10/11 (91%) cases. Next-generation sequencing performed in 10 cases revealed TNFRSF14 as the most frequently mutated gene in 6/10 (60%) cases. No case had CREBBP or KMT2D mutations as seen in nodal FL. None of the patients had progressive disease with durable complete remission achieved in 10/12 (83%) cases. The median follow-up period was 7.8 years (range: 0.2 to 20.5 y) with a 5-year overall survival of 100%. We conclude that follicle center lymphoma of the lower female genital tract is a novel variant of primary cutaneous follicle center lymphoma. Despite a frequent component of large cells, it is characterized by localized disease and low risk for dissemination. Awareness and recognition are important to distinguish these lesions from aggressive B-cell lymphomas.
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Affiliation(s)
- Annapurna Saksena
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ashish Jain
- CCR Collaborative Bioinformatics Resource (CCBR), CCR, NCI, Bethesda, MD
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Svetlana D. Pack
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Jung Kim
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ina Lee
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Manoj Tyagi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Elaine S. Jaffe
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
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4
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Juniat V, Cameron CA, Roelofs K, Bajic N, Patel S, Slattery J, Davis G, Rootman D, Selva D. Radiological analysis of orbital lymphoma histological subtypes. Orbit 2023; 42:59-67. [PMID: 35192428 DOI: 10.1080/01676830.2022.2035772] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To characterise the radiological features of orbital lymphoma subtypes. METHODS This was a multicentre, retrospective study to analyse radiological and clinical characteristics of orbital lymphoma by histological subtype across two sites within Australia and the United States. RESULTS A total of eighty-eight patients were included. The most common subtypes were extranodal marginal zone lymphoma [EMZL] (48, 54.5%), follicular lymphoma [FL] (16, 18.2%), and diffuse large B-cell lymphoma [DLBCL] (15, 17.0%). Clinically, significant associations were found between DLBCL and vision change (p < .01), pain (p < .01), extraocular movement limitation (p = .01), and optic neuropathy (p = .01). Radiologically, there was no significant difference between the individual histopathological sub-groups with respect to bone destruction (p = .30), optic nerve involvement (p = .30) and diffuse appearance (p = .84). However, if categorised as either aggressive or indolent, aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically than indolent subtypes (Odds Ratio = 5.5, 95% CI: 1.3, 23.3; p = .02). CONCLUSIONS DLBCL was significantly associated with vision change, pain, extraocular movement limitation and optic neuropathy clinically. Aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically. Otherwise, there were no significant differences between lymphoma subtypes and radiological findings on MRI and CT.
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Affiliation(s)
- Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia
| | - Cassie A Cameron
- South Australian Institute of Ophthalmology, The University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia
| | - Kelsey Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute of UCLA, Los Angeles, California, USA
| | - Nicholas Bajic
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Slattery
- South Australian Institute of Ophthalmology, The University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia
| | - Garry Davis
- South Australian Institute of Ophthalmology, The University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia
| | - Daniel Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute of UCLA, Los Angeles, California, USA
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia
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5
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ULAŞ B, ÖZCAN A, İBAYEV A. Orbital and Ocular Adnexal Lymphomas: A Retrospective Single Center Study. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1126423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: To evaluate and present the clinical and histopathological features of patients with orbital and adnexal lymphoma.
Methods: Eight patients that had histologically proven orbital and adnexal lymphoma between 2011 and 2021 were evaluated retrospectively. Clinical appearance, age, gender, imaging, tumor localization, treatment methods, pathological diagnosis and systemic features of patients were obtained from the files.
Results: The mean age of the patients was 59.1 (range 42-79). While 6 of the patients were male, 2 were female. Painless mass and orbital swelling were the most common first signs and symptoms in patients. The MRI findings demonstrated unilateral involvement in 6 patients and bilateral involvement in 2 patients. Intraorbital location in 3 patients (behind the orbital septum), lid location in 2 patients (eyelids in front of orbital septum), conjunctival involvement in 1 patient and lacrimal gland involvement in 2 patients were detected. All cases were reported as Non-Hodgkin B-cell lymphoma [Primary extranodal marginal lymphoma of the mucosa-associated lymphoid tissue (5 patients), diffuse large B-cell lymphoma (2 patients), follicular lymphoma (1 patient)].
Conclusion: Lymphomas are common among orbital tumors and clinical findings change depending on the localization in orbita. Ophthalmologists should be attentive to orbital swellings and consider orbital and ocular adnexal lymphomas among differential diagnoses.
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6
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Kirkegaard MK. Ocular adnexal lymphoma: Subtype‐specific clinical and genetic features. Acta Ophthalmol 2022; 100 Suppl 270:3-37. [DOI: 10.1111/aos.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Knudsen Kirkegaard
- Department of Pathology, Eye Section, Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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7
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Simon M, Wawer Matos PA, Meinel J, Rokohl AC, Heindl LM. Klinisches Vorgehen bei periokulären Lymphomen. Ophthalmologe 2022; 119:686-691. [DOI: 10.1007/s00347-021-01568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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8
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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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9
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Paul N, Farah E, Zmuda M, Galatoire O. [Secondary eyelid pockets: Pitfalls in blepharoplasty surgery]. J Fr Ophtalmol 2021; 44:331-339. [PMID: 33516573 DOI: 10.1016/j.jfo.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Requests for cosmetic eyelid surgery are frequent. The surgeon must carry out a complete clinical examination in order to rule out any orbital pathologies responsible for eyelid pockets. METHODS Study of ten patients who have consulted in the oculopalpebral surgery department of La Fondation Ophtalmologique de Rothschild for cosmetic surgery of the eyelid pockets and in whom an underlying pathology was diagnosed. RESULTS The clinical examination allows to look for signs of alarms, such as medical history, unilateral involvement, pain and the presence of exophthalmos. These should lead to perform orbital imaging and surgical biopsy if an orbital mass has been identified for histological analysis which will make the diagnosis. We identified four cases of orbital lymphoma, one foreign body granuloma, chronic bilateral dacryoadenitis, sarcoidosis involvement, AAPOX syndrom, cavernous hemangioma, and simple fatty hernia. CONCLUSION These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.
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Affiliation(s)
- N Paul
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France.
| | - E Farah
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
| | - M Zmuda
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
| | - O Galatoire
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
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Westekemper H, Manthey A, Bechrakis N. [Diagnosis and Therapy of Benign and Malignant Tumors of the Conjunctiva]. Klin Monbl Augenheilkd 2020; 237:1143-1159. [PMID: 32777832 DOI: 10.1055/a-1211-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this paper is to give an overview of different benign and malignant epibulbar tumors. Categories can be made of the age of manifestation (paediatric tumors versus tumors of adults), the originating cell types (squamous cell tumors, melanocytic tumors, lymphomas or germ cell tumors) or genesis (proliferative, infectious or degenerating tumors). Most epibulbar tumors show lesions on the conjunctiva or the cornea. These can be flesh coloured or pigmented efflorescences with leucoplakias or hyperkeratosis. Especially malignant tumors show atypical growth of blood vessels, are often prominent and can have ulcerations or bleeding. In case of tumor growth, change in pigmentations or atypical bleedings a malign tumor can be suspected. The diagnosis should be confirmed using histopathological evaluation after an incisional or excisional biopsy. Molecular pathologic techniques extend the diagnostic tools and have an implication on the therapy of metastatic tumors. Therapeutic options of the malignant tumors (apart from lymphomas) are chirurgical excision preferably with a no touch technique and afterwards an adjuvant therapy consisting of radiation or cryotherapy. A topical chemotherapy with Mitomycin C, 5-Fluorouracil or Interferon α2b can be effective to reduce persisting precancerosis and reduce recurrences. In case of a suspected malignant tumor it is advisable to refer the patient to an ophthalmo-oncologic center to plan and ensure interdisciplinary therapy.
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Westekemper H, Manthey A, Bechrakis N. Benigne und maligne Bindehauttumoren in Diagnostik und Therapie. AUGENHEILKUNDE UP2DATE 2020. [DOI: 10.1055/a-1061-9973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungBindehauttumoren betreffen in Diagnostik und Therapie alle Bereiche der augenärztlichen Praxis. Das beginnt mit der klinischen Kontrolle von Bindehautnävi und anderen benignen Tumoren, der Einschätzung von entzündlichen Pseudotumoren und ihrer Abgrenzung zu Präkanzerosen oder vernarbenden Erkrankungen und mündet in der hochspezialisierten und interdisziplinären Führung onkologischer Patienten mit Lymphomen, hochmalignen Melanomen oder invasiven Plattenepithelkarzinomen.
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12
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Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Indian J Ophthalmol 2019; 67:1930-1948. [PMID: 31755426 PMCID: PMC6896532 DOI: 10.4103/ijo.ijo_2040_19] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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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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14
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Ocular adnexal marginal zone lymphoma of mucosa-associated lymphoid tissue. Clin Exp Med 2017; 18:151-163. [PMID: 28939925 DOI: 10.1007/s10238-017-0474-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
Ocular adnexal lymphomas are a group of heterogeneous neoplasms representing approximately 1-2% of non-Hodgkin lymphomas and 8% of extranodal lymphomas. The incidence of primary ocular adnexal lymphoid tumors has raised over the last decades, and this could be probably attributed to the more sophisticated diagnostic techniques. Due to the wide spectrum of clinical manifestations, ocular tissue biopsy is important in order to set a precise diagnosis based on histological, immunophenotypical and, in some cases, molecular findings. The most common subtype, which may account for up to 80% of primary ocular adnexal lymphomas, is extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue. This lymphoma is usually asymptomatic in the early phase of the disease causing a delay in the final diagnosis and prompt therapy. The pathogenesis of a proportion of these tumors has been linked to chronic inflammatory stimulation from specific infectious factors (e.g., Chlamydia psittaci) or to autoimmunity. The further improvement in diagnostic methods and the further understanding of the pathogenesis of ocular adnexal EMZL may contribute to the establishment of a more successful multidisciplinary therapeutic planning.
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Abstract
Ophthalmic pathology has a long history and rich heritage in the field of ophthalmology. This review article highlights updates in ophthalmic pathology that have developed significantly through the years because of the efforts of committed individuals and the confluence of technology such as molecular biology and digital pathology. This is an exciting period in the history of ocular pathology, with cutting-edge techniques paving the way for new developments in diagnostics, therapeutics, and research. Collaborations between ocular oncologists and pathologists allow for improved and comprehensive patient care. Ophthalmic pathology continues to be a relevant specialty that is important in the understanding and clinical management of ocular disease, education of eye care providers, and overall advancement of the field.
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Affiliation(s)
- Pia R Mendoza
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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16
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Ong SJ, Jung SM, Lin HC. Conjunctival lymphoma during pregnancy: a case report. BMC Ophthalmol 2017; 17:131. [PMID: 28750630 PMCID: PMC5530954 DOI: 10.1186/s12886-017-0518-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 07/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background To present a case of conjunctival lymphoma in a young woman complicated by pregnancy. Case presentation A 38-year-old previously healthy woman presented with a 2-year history of progressive right blepharoptosis. Giant papillomatous sessile masses were identified in the upper and lower fornix bilaterally and involved the tarsus of the right upper lid. The remaining ophthalmic examination was unremarkable. Histopathology and immunohistochemistry showed mucosa-associated lymphoid tissue (MALT) lymphoma with immunoglobulin kappa monotype. Further workup showed no evidence of systemic lymphoma or orbital involvement. Conclusions Partial regrowth of conjunctival lymphoma occurred 6 months after excision and the MALT lymphoma remained indolent during the course of her pregnancy without radiotherapy.
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Affiliation(s)
- Sherine Jue Ong
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chiung Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital and University, #5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taiwan.
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Qi D, Lin H, Gao Y, Lin J, Hu LT, Zhao GQ. The expressions of metadherin and LEF-1 in mucosa-associated lymphoid tissue lymphoma of ocular adnexal. Int J Ophthalmol 2017; 10:705-710. [PMID: 28546924 DOI: 10.18240/ijo.2017.05.07] [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: 09/08/2016] [Accepted: 02/23/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the expressions of metadherin (astrocyte elevated gene-1, AEG-1) and lymphoid enhancer-binding factor-1 (LEF-1) in ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction (PCR) analysis. RESULTS AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis (P<0.05). Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result (P<0.05). A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma (r=0.435, P=0.016). CONCLUSION The over expressions of AEG-1 and LEF-1 at the level of protein and mRNA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.
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Affiliation(s)
- Dan Qi
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hong Lin
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Yan Gao
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jing Lin
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Li-Ting Hu
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Gui-Qiu Zhao
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
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Briscoe D, Safieh C, Ton Y, Shapiro H, Assia EI, Kidron D. Characteristics of orbital lymphoma: a clinicopathological study of 26 cases. Int Ophthalmol 2017; 38:271-277. [PMID: 28364339 DOI: 10.1007/s10792-017-0457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluation of the medical data of patients with orbital and adnexal lymphoma. DESIGN Cohort study of all cases diagnosed with orbital or adnexal lymphoma at Meir Medical Center between 1993 and 2007. PARTICIPANTS Twenty-six patients, with intraorbital or subconjunctival masses with orbital involvement, were examined and followed up between 1 and 8 years. MATERIALS AND METHODS Examined data included: clinical presentation, age, gender, imaging, tumor location, surgical management, and pathological diagnosis. RESULTS Presenting signs and symptoms included proptosis, eyelid lesions, tearing, chemosis, decreased visual acuity, ptosis, pain, squint, and optic nerve compression. In five cases, lymphoma was misdiagnosed on neuroimaging. Bone changes were seen in four patients. All cases were B cell lymphomas; with the majority (22 cases) of small B cell type; consisting of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and two cases of small cell lymphoma. One small cell lymphomas was of follicular type on a background of CLL, and the other was CLL/SLL type. Fourteen cases were primary orbital disease, and 12 cases were systemic disease. Macroscopic appearance of lymphoma at open biopsy was characteristic in most cases. Flow cytometry phenotyping gave rapid reliable diagnosis of the disease. CONCLUSIONS Epiphora or chemosis in the presence of an orbital mass should alert the ophthalmologist to suspect lymphoma. Lymphoma may be easily misinterpreted on neuroimaging for other diseases. Bone changes seen on CT are more common than is generally perceived. Macroscopic appearance at open biopsy was characteristic.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel. .,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
| | - Christine Safieh
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Hava Shapiro
- Department of Haematocytology, Meir Medical Center, Kfar Saba, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Dvora Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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Prasad GL, Hegde A, Menon G, Mathew M. Primary Orbital Follicular Lymphoma: A Case Report and Review. J Clin Diagn Res 2017; 11:XD01-XD03. [PMID: 28511490 PMCID: PMC5427416 DOI: 10.7860/jcdr/2017/24674.9400] [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: 10/11/2016] [Accepted: 12/20/2016] [Indexed: 01/22/2023]
Abstract
Orbital Lymphomas (OL) constitute a heterogeneous group of lymphoproliferative disorders of the orbit. They are predominantly of the Mucosa-Associated Lymphoid Tissue (MALT) subtype. Radiotherapy is the mainstay of treatment in localized orbital tumours, while chemotherapy is reserved for systemic disease. Authors report a case of a primary orbital lymphoma of follicular subtype (stage 1E) in a 54-year-old female managed by surgery and adjuvant radiotherapy.
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Affiliation(s)
- G Lakshmi Prasad
- Assistant Professor, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Ajay Hegde
- Registrar, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Girish Menon
- Professor and Head, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Mary Mathew
- Professor, Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
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20
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Verma S, Gupta N, Mohindra S, Sachdeva MS, Rajwanshi A. Primary orbital mantle cell lymphoma: Flow cytometric immunophenotyping as an adjunct to fine-needle aspiration cytology for diagnosis. Cytojournal 2017; 14:2. [PMID: 28217141 PMCID: PMC5288933 DOI: 10.4103/1742-6413.198816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sangeeta Verma
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyawati Mohindra
- Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manupdesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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AlAkeely AG, Alkatan HM, Alsuhaibani AH, AlKhalidi H, Safieh LA, Coupland SE, Edward DP. Benign reactive lymphoid hyperplasia of the conjunctiva in childhood. Br J Ophthalmol 2016; 101:933-939. [PMID: 27899370 DOI: 10.1136/bjophthalmol-2016-309030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM Our aim is to the report the clinical and histopathological features of benign reactive lymphoid hyperplasia (BRLH) of the conjunctiva in children and the outcomes of treatment. METHODS A retrospective chart review was performed for children aged 0-18 years, diagnosed with conjunctival BRLH from January 2000 to December 2013 at two large ophthalmology hospitals in the Middle East. Data were collected on patient demographics, features of the lesions, the site of the lesion, location, adnexal involvement, lymph nodes involvement, local spread, histopathology and molecular genetic studies of the cases (if available), outcomes of treatment and recurrence. RESULTS There were 24 patients with lymphoid lesions classified as conjunctival BRLH during the 12-year period evaluated in this study. The mean age at diagnosis was 11.6 years. Twenty-three patients were males (96%). Systemic medical history included three patients with bronchial asthma, one patient with Down's syndrome, one patient with generalised skeletal malformation and one patient with gastritis. The initial uncorrected visual acuity was 20/30 or better in 93.5% of the eyes. At presentation, the tumour was unilateral in 12 cases (50%). The conjunctival mass was located on the bulbar conjunctiva in all cases. The mass was present nasally in 96% of lesions. No cases (that were tested) had an infectious aetiology. PCR demonstrated monoclonality suggestive of lymphoma in two cases; however, this did not alter the final diagnosis as BRLH per histopathological criteria and clinical course, CONCLUSIONS: All investigated cases of paediatric conjunctival BRLH had a benign clinical course with no local or systemic dissemination and a male predominance. Recurrence was rare, and in our cohort, it was not associated with malignant transformation.
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Affiliation(s)
| | - Hind M Alkatan
- Department of Ophthalmology, King Saud University Medical City, Riyadh, Saudi Arabia.,Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hisham AlKhalidi
- Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Sarah E Coupland
- Department of Cellular Pathology, Royal Liverpool University Hospital, UK
| | - Deepak P Edward
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
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22
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Nodular Lymphocyte Predominant Hodgkin Lymphoma Presenting With Unilateral Orbital Involvement. Ophthalmic Plast Reconstr Surg 2016; 33:e29-e31. [PMID: 27015240 DOI: 10.1097/iop.0000000000000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 40-year-old white woman presented to her general ophthalmologist for swelling of the left upper eyelid that began approximately 6 months before. CT scan of the orbits with and without contrast demonstrated homogenous enhancement of the left lacrimal gland. Examination was notable for left hypoglobus and proptosis. The patient underwent left lateral orbitotomy with biopsy of the mass and frozen section analysis showed lymphoid infiltrates. Subsequent histopathologic diagnosis was consistent with nodular lymphocyte predominant Hodgkin lymphoma, a rare subtype of Hodgkin lymphoma that has only once been previously reported in the orbit. The authors review the case and the relevant literature.
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23
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Isolated blepharoptosis may point to HIV-associated Burkitt's lymphoma. Acta Neurol Belg 2015; 115:833-5. [PMID: 25828838 DOI: 10.1007/s13760-015-0463-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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24
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18F-FDG PET/CT in a bilateral lacrimal gland infiltration of mantle cell lymphoma. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Choung H, Kim YA, Kim N, Lee MJ, Khwarg SI. Clinicopathologic Study of Chromosomal Aberrations in Ocular Adnexal Lymphomas of Korean Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:285-93. [PMID: 26457033 PMCID: PMC4595253 DOI: 10.3341/kjo.2015.29.5.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/13/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose The incidence and clinical correlation of MALT1 translocation and chromosomal numerical aberrations in Korean patients with ocular adnexal mucosa associated lymphoid tissue (MALT) lymphoma have not yet been reported. We investigated the incidence and clinicopathologic relationship of these chromosomal aberrations in ocular adnexal MALT lymphomas in a Korean population. Methods Thirty ocular adnexal MALT lymphomas were investigated for the t(11;18) API2-MALT1, t(14;18) IgH-MALT1 translocations and chromosomes 3 and 18 aneuploidies using fluorescence in situ hybridization. Patient medical records were reviewed retrospectively for information on demographics and clinical characteristics, including treatment response. Results The MALT1 gene rearrangement was found in one out of 30 cases. The t(14;18) IgH-MALT1 translocation was demonstrated in only one case (3.3%), and the t(11;18) API2-MALT1 translocation was not found in any of the cases. Trisomy 3 was observed in three ocular adnexal MALT lymphomas (10.0%), and five cases showed trisomy 18 (16.7%). Translocation positive cases also showed trisomy 18. One case of tumor relapse showed trisomy 18 only in the recurrent biopsies. There were no statistically significant correlations between chromosomal aberrations and clinical characteristics and treatment responses. Conclusions Translocations involving the MALT1 gene are not common in Korean ocular adnexal MALT lymphomas. The t(14;18) translocation was detected in only one out of 30 cases, and the t(11;18) translocation was not found at all. Furthermore, the chromosomal aberrations found in this study had no prognostic implications.
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young A Kim
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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26
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Özkan MC, Palamar M, Tombuloğlu M, Hekimgil M, Özsan N, Saydam G, Şahin F. Ocular Adnexal Lymphomas: Single-Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S158-60. [DOI: 10.1016/j.clml.2015.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
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27
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Martínez-Esteve A, García-Gómez FJ, Borrero-Martin JJ, Fajardo-Pico E, Borrego-Dorado I. 18F-FDG PET/CT in a case of bilateral lacrimal gland infiltration by mantle cell lymphoma. Rev Esp Med Nucl Imagen Mol 2015; 34:396-7. [PMID: 25956958 DOI: 10.1016/j.remn.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- A Martínez-Esteve
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F J García-Gómez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Borrero-Martin
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Fajardo-Pico
- Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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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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Abstract
Lymphomas predominantly affect the lymph nodes but can present at unusual sites, which are termed as extranodal lymphomas. Involvement of the ocular adnexa is an extremely uncommon occurrence, which is usually seen in patients with non-Hodgkin lymphoma. We report herewith an unusual case of a 5-year-old child with Hodgkin lymphoma and involvement of extraocular muscle leading to ptosis. The child was managed by alternating cycles of cyclophosphamide, vincristine, procarbazine and prednisolone and adriamycin, bleomycin, vinblastine, and dacarbazine. He had complete response to chemotherapy with resolution of ptosis.
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Moslehi R, Coles FB, Schymura MJ. Descriptive epidemiology of ophthalmic and ocular adnexal non-Hodgkin's lymphoma. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 6:175-180. [PMID: 24353742 DOI: 10.1586/eop.11.16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this article, we provide an update on incidence rates of ophthalmic non-Hodgkin's lymphoma (NHL), in the context of other NHL, in the USA. We also provide population-based estimates of incidence and survival for ocular adnexal NHL, the most common form of ophthalmic NHL, for which descriptive patterns have not been previously reported. Ophthalmic and ocular adnexal NHL have unique incidence patterns, including equal rates among both genders, predominance among Asians/Pacific Islanders, and steady and rapid increases in the past few decades. Studies of international variations in the incidence of ocular adnexal NHL may provide clues as to the underlying mechanisms influencing its unique epidemiology.
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Affiliation(s)
- Roxana Moslehi
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, NY, USA ; Cancer Research Center, State University of New York at Albany, NY, USA
| | - F Bruce Coles
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, NY, USA ; Epidemiology Research Institute, Wadsworth Center, New York State Department of Health, NY, USA
| | - Maria J Schymura
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, NY, USA ; New York State Cancer Registry, New York State Department of Health, NY, USA
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Moslehi R, Schymura MJ, Nayak S, Coles FB. Ocular adnexal non-Hodgkin's lymphoma: a review of epidemiology and risk factors. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 6:181-193. [PMID: 23976898 DOI: 10.1586/eop.11.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ocular adnexal non-Hodgkin's lymphoma (NHL), the most common form of ophthalmic NHL, has a unique incidence pattern showing a steady and rapid increase in the past few decades, nearly equal rates among both genders, and predominance among Asians/Pacific Islanders. No major cause for ocular adnexal NHL has been identified, although infectious agents, immune disorders and genetic/epigenetic factors have all been implicated in its etiology. Identifying putative risk factors and biologic mechanisms leading to carcinogenesis in ocular adnexal NHL may enable implementation of effective preventive and/or therapeutic approaches for this malignancy. This article summarizes current knowledge on epidemiology of ocular adnexal NHL and the role of various potential risk factors in its etiology.
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Affiliation(s)
- Roxana Moslehi
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, NY, USA ; Cancer Research Center, State University of New York at Albany, NY, USA
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Yang JM, Lee JJ, Yoon KC. Clinical Analysis of Primary Conjunctival Malignant Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.9.1298] [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)
- Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Je Jung Lee
- Department of Hemato-Oncology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Walia SS, Stelton CR, Shantha JG, Connors DB, Walia HS. Bilateral proptosis as initial manifestation of mantle cell lymphoma. Am J Med 2013; 126:862-3. [PMID: 23932161 DOI: 10.1016/j.amjmed.2013.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
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Savino G, Battendieri R, Gari M, Caputo CG, Laurenti L, Blasi MA. Long-term outcomes of primary ocular adnexal lymphoma treatment with intraorbital rituximab injections. J Cancer Res Clin Oncol 2013; 139:1251-5. [PMID: 23625184 DOI: 10.1007/s00432-013-1438-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/15/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE We recently reported on the efficacy of intralesional rituximab for treating primary ocular adnexal lymphoma in a pilot study. After treatment, a complete response was observed in two of five patients, a partial response in one patient, and lesion recurrence in two patients. In this study, we evaluate the long-term follow-up of the five previously treated patients as well as the response of two new patients to an augmented dose of rituximab. METHODS We followed up the five patients who were treated with rituximab during the initial pilot study. Two additional patients were also enrolled and treated with four intraorbital injections of 10 mg rituximab once a week for 1 month (total dose of 40 mg). Median follow-up period was 4 years for the first five patients and 1 year for the last two patients. RESULTS Lymphoma did not relapse in the two patients who originally responded immediately to treatment. Of the initial partial responders, one became disease-free after additional rituximab treatment, and one experienced a standardized uptake value reduction, as measured with positron emission tomography-CT. One patient who experienced abdominal and pulmonary localization 7 months later showed no local recurrence. The two newly enrolled patients had complete remission after the first cycle of treatment and no disease recurrence eight and 11 months later, respectively. CONCLUSIONS This study suggests that intralesional administration of rituximab for treating localized ocular adnexal CD20+ lymphomas could be an effective front-line therapeutic option with negligible side effects and a good response rate and duration.
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Affiliation(s)
- Gustavo Savino
- Institute of Ophthalmology, Catholic University of Sacred Heart, Largo F Vito 1, 00168 Rome, Italy.
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Hata M, Miyamoto K, Ogino K, Sumiyoshi S, Yoshimura N. Conjunctival extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in the fornix: do not overlook conjunctival lymphomas. Clin Ophthalmol 2013; 7:663-6. [PMID: 23576865 PMCID: PMC3617790 DOI: 10.2147/opth.s40551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Here we report three cases of conjunctival lymphoma that were initially unnotified or misdiagnosed as other ocular diseases because of the small tumor size, peripheral tumor location (the tumor was hidden in the fornix), and nonspecific symptoms. Methods Three patients diagnosed with conjunctivitis or nasolacrimal duct obstruction were referred to our clinic because they were unresponsive to standard medical treatments. Routine anterior segment examination did not reveal any lesions, but further careful examination with a strong eyelid draw revealed minimally elevated tumors in the peripheral fornix under the lid. Excisional biopsies were performed. Results Histopathologic and immunohistologic examinations indicated the presence of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). All patients underwent additional radiation therapy. There was no evidence of recurrence in any patient during the follow-up period. Conclusion Detection of conjunctival lymphoma can be challenging. If no apparent lesion is present and the patient has nonspecific symptoms, the inner surface of the eyelid should be carefully examined. Elaborate eyelid eversion, with eyeball movement, should be performed to avoid misdiagnosing or overlooking peripheral conjunctival lymphomas.
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Affiliation(s)
- Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan
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Ocular adnexal lymphoma staging and treatment: American Joint Committee on Cancer versus Ann Arbor. Eur J Ophthalmol 2013; 23:344-55. [PMID: 23397158 DOI: 10.5301/ejo.5000224] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL).
METHODS A multicenter, consecutive case series of patients with biopsy-proven conjunctival, orbit, eyelid, or lacrimal gland/sac lymphoma was performed. The electronic pathology and clinical records were reviewed for new or recurrent cases of ocular adnexal lymphoma. The main outcome measures included pathology and clinical staging (AJCC and Ann Arbor systems), treatment, and recurrence (local and systemic). Statistical analysis included demographic evaluations and the Kaplan-Meier survival probability method.
RESULTS Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue were the most common (n=60/83, 72%). The most common Ann Arbor clinical stages were IE (76%) followed by IIE (17%) and IIIE (7%). Pathology identified 13 cases (15%) that were upstaged to group IV (p=0.017). Similarly, AJCC clinical stages were cT1NOMO (21.7%), cT2NOMO (44.6%), cT3N0M0 (5%), and cT4NOMO (2.4%). Local control was achieved in 75% of treated patients. There were 19 local recurrences from which 14 (74%) belonged to the non-radiation treatment groups. Lower-risk groups (T1 and T2 without lymph node involvement or metastatic disease of AJCC and IE of Ann Arbor) had longer disease-free survival than the higher-risk groups (AJCC T1, T2 with nodal involvement or metastatic disease, T3, and T4 as well as Ann Arbor II, III, and IV). The overall mean follow-up was 43.3 months (range 6-274).
CONCLUSIONS Regardless of stage, recurrence and disease-free survival were more closely related to treatment and histopathology rather than tumor size or site-specific location.
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Abstract
Burkitt's lymphoma (BL) is a rare monoclonal proliferation of Blymphocytes and is classified as a poorly differentiated lymphocytic lymphoma. Typically, Burkitt's lymphoma involves the jaw bones, but the orbit can also be involved. Burkitt"s lymphoma is seen, sporadically in India, and 3 cases of orbital Burkitt's lymphoma were diagnosed during the past 4 years. Three cases of acute proptosis in children are presented to us. The provisional clinical diagnosis was rhabdomyosarcoma and the histopathology revealed Burkitt's lymphoma. The fast growth rate, hematologic manifestations and the urgency of diagnosis are emphasized. We present 3 cases here and review prevailing concepts about Burkitt's lymphoma.
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Affiliation(s)
- Rijuneeta Gupta
- Department of Otolaryngology and Head & Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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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Electron Irradiation of Conjunctival Lymphoma—Monte Carlo Simulation of the Minute Dose Distribution and Technique Optimization. Int J Radiat Oncol Biol Phys 2012; 83:1330-7. [DOI: 10.1016/j.ijrobp.2011.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 08/09/2011] [Accepted: 09/11/2011] [Indexed: 11/17/2022]
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Corrêa ZM, Augsburger JJ, Dalal MD, Spaulding A. Secondary intraocular uveal involvement by primary paranasal sinus lymphoma. Int Ophthalmol 2012; 32:397-400. [PMID: 22581320 DOI: 10.1007/s10792-012-9570-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 04/15/2012] [Indexed: 10/28/2022]
Abstract
To report an unusual case of primary paranasal sinus lymphoma associated with intraocular secondary uveal involvement. Retrospective case report emphasizing the histopathologic diagnosis as well as imaging studies, and review of the pertinent literature. The diagnosis of ophthalmologic lymphoma can be difficult due to the infrequency of the disease, the diverse presentation, and the need for biopsy for definitive diagnosis. Prior clinical history and systemic testing may be important confirmations in diagnosing such cases.
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Affiliation(s)
- Zélia M Corrêa
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Abstract
The diagnosis and treatment of orbital and periorbital malignancies are challenging. These tumors can result in blindness, death, and significant cosmetic deformities. Herein, we present the most common ocular malignancies and a systematic approach to diagnosis. Further, we integrate the seventh edition American Joint Committee on Cancer staging system, biomarkers, and multidisciplinary approaches to treatment.
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Affiliation(s)
- Robert M Schwarcz
- The Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York City, NY, USA
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43
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Orbital lymphoma mimicking Graves’ ophthalmopathy: a case report. Open Med (Wars) 2011. [DOI: 10.2478/s11536-011-0081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractOrbital tumor is a rare presentation of lymphoma. Unspecific symptoms, local infiltration, chronic progression may mimic other more common orbital diseases and often make the diagnosis difficult. We report a case of orbital non-Hodgkin lymphoma initially diagnosed as Graves’ disease. A 65-year-old woman was admitted to the Department of Endocrinology with a diagnosis of a left eye tumor. On admission, apart from the tumor, exophthalmos and the upper eyelid proptosis were present. The lesion had been observed for two years before hospitalization. Due to the muscle infiltration, as detected on computed tomography scanning and magnetic resonance imaging, Graves’ disease was suggested. The thyroid function was normal. Further diagnosis performed during hospitalization revealed lymphoplasmacytic lymphoma. Lymphoma may manifest as a localized orbital tumor without extraorbital or constitutive symptoms. Rare orbital diseases, among others lymphoproliferations, should be taken into account in the differential diagnosis of exophthalmos.
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Savino G, Battendieri R, Balia L, Colucci D, Larocca LM, Laurenti L, De Padua L, Blasi MA, Balestrazzi E. Evaluation of intraorbital injection of rituximab for treatment of primary ocular adnexal lymphoma: a pilot study. Cancer Sci 2011; 102:1565-7. [PMID: 21564418 PMCID: PMC11159486 DOI: 10.1111/j.1349-7006.2011.01976.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An interventional pilot study to assess the tolerability and activity of the intralesional injection of rituximab, a chimeric mAb that targets the CD20 antigen, in patients with orbital B-cell lymphoma. Five patients received four intralesional injections (one injection a week) of rituximab together with ropivicaine 2%. Side-effects and tumor response were assessed after each injection and during the follow-up (20 months). Two patients obtained complete remission of the intraorbital lesion. Two patients showed incomplete response after induction therapy and received planned escalating rituximab doses, obtaining regression of subjective symptoms. One patient did not achieve tumor regression after the first injection and underwent systemic treatment. This small exploratory study suggests that intralesional rituximab is a well-tolerated treatment for patients with primary ocular adnexal lymphoma. These preliminary findings suggest that intralesional rituximab is a well-tolerated strategy in anterior intraorbital lesion localization of lymphoma.
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Affiliation(s)
- Gustavo Savino
- Institute of Ophthalmology, Catholic University of Sacred Heart, Rome, Italy.
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Carmody J, Misra RP, Langford MP, Byrd WA, Ditta L, Vekovius B, Texada DE. Orbital sporadic Burkitt lymphoma in an adult diabetic African American female and a review of adult orbital cases. Clin Ophthalmol 2011; 5:509-15. [PMID: 21573040 PMCID: PMC3090307 DOI: 10.2147/opth.s16751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Indexed: 11/23/2022] Open
Abstract
A case of sporadic Burkitt lymphoma (sBL) presenting with jaw and lid involvement in a diabetic adult African American female and a review of adult orbital Burkitt lymphoma cases are presented. Lid edema, visual loss, ophthalmoparesis, proptosis, and sinusitis progressed over 4 weeks despite antibiotic and steroid treatment. Upper lid biopsy histopathological evaluation and immunophenotyping revealed a homogenous mass of atypical CD10 and CD20-negative B-cells and tingible body macrophages yielding a "starry sky" appearance. Cytogenetic analysis detected a minor variant c-MYC translocation, but no Epstein-Barr virus RNA. Detection of multiple lesions prompted a diagnosis of stage IV disease that totally regressed following radiation and chemotherapy. Review results of the six adult orbital sBL cases support a poor prognosis and a heightened suspicion of variant CD10, CD20 and BCL6 positive sBL in adults presenting with jaw pain and rapidly progressive orbital symptoms, particularly in female, African American, and diabetic patients.
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Affiliation(s)
| | - Raghunath P Misra
- Department of Ophthalmology
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Schmatz AI, Streubel B, Kretschmer-Chott E, Püspök A, Jäger U, Mannhalter C, Tiemann M, Ott G, Fischbach W, Herzog P, Seitz G, Stolte M, Raderer M, Chott A. Primary follicular lymphoma of the duodenum is a distinct mucosal/submucosal variant of follicular lymphoma: a retrospective study of 63 cases. J Clin Oncol 2011; 29:1445-51. [PMID: 21383289 DOI: 10.1200/jco.2010.32.9193] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Small series with limited follow-up have suggested primary follicular lymphoma of the duodenum (FL-D) to be an indolent disease. We report our experience on a large series of patients followed for a median time period of longer than 6 years. PATIENTS AND METHODS The study comprised 63 patients with primary FL-D defined as stage I disease. Endoscopy and detailed pathologic work-up was performed at diagnosis and at restaging to monitor the behavior of the neoplastic process. RESULTS Histologically, all 63 patients had FL, low grade (1 to 2). Duodenal endosonography demonstrated lesions confined to mucosa/submucosa in 19 of 20 patients. At an overall median follow-up of 77 months (range, 12 to 177 months), only two untreated patients had developed nodal disease, the remaining 61 patients never experienced extrasmall intestinal disease and large cell transformation did not occur at all. Among 24 patients followed by watch and wait strategy, seven showed spontaneous complete regression and 17 had stable disease; radiotherapy resulted in complete regression in all 19 patients; anti-CD20 antibody monotherapy achieved complete regression in four patients and stable disease in one patient. Various chemotherapy protocols in eight patients caused complete regression in all of them, but local relapses occurred in three. No patients required surgery or died of disease. CONCLUSION These findings characterize primary FL-D as a remarkably indolent FL variant, which, even left untreated, does not develop tumorous growth, very rarely disseminates (two of 63 patients) and does not transform to high grade disease. A watch and wait approach appears to be the most sensible strategy.
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Affiliation(s)
- Ana-Iris Schmatz
- Medical University Vienna, Vienna General Hospital, Vienna, Austria
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Hong IH, Bae SH, Lee SG, Park JK, Ji AR, Ki MR, Han SY, Lee EM, Kim AY, You SY, Kim TH, Jeong KS. Mucosa-associated lymphoid tissue lymphoma of the third eyelid conjunctiva in a dog. Vet Ophthalmol 2011; 14:61-5. [DOI: 10.1111/j.1463-5224.2010.00843.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cowan CL. Review for Disease of the Year: Differential Diagnosis of Ocular Sarcoidosis. Ocul Immunol Inflamm 2010; 18:442-51. [DOI: 10.3109/09273948.2010.522434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Hicks D, Mick A. Recurrent subconjunctival hemorrhages leading to the discovery of ocular adnexal lymphoma. ACTA ACUST UNITED AC 2010; 81:528-32. [PMID: 20705524 DOI: 10.1016/j.optm.2009.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 10/29/2009] [Accepted: 11/22/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subconjunctival hemorrhages commonly occur idiopathically or from causes including ocular surgery, trauma, anticoagulation medications, or a Valsalva maneuver. When a hemorrhage persists or recurs, a more extensive list of differential diagnoses must be considered. This report details a case in which persistent subconjunctival hemorrhages led to the discovery of ocular adnexal lymphoma. CASE REPORT A 68-year-old white man presented with a 7- to 8-month history of a recurrent red left eye. There was no associated pain, discharge, or change in vision over that time. The right eye was never involved. An ocular examination of the left eye found a mild nasal subconjunctival hemorrhage and a salmon-pink-colored lesion involving the superior conjunctiva. Clinical findings, photos, magnetic resonance images, and histopathology results are presented and reviewed. The signs, symptoms, incidence, pathophysiology, treatment, and prognosis of ocular adnexal lymphoma are also discussed. CONCLUSION Lymphomas can occur in a variety of sites in the body. It is well documented that primary tumors can originate in the ocular adnexa. Although not typical, the first sign in this case was a recurrent subconjunctival hemorrhage. The importance of a thorough ocular examination is paramount for a patient's ocular health and possibly the patient's life.
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Affiliation(s)
- Dave Hicks
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA.
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