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Goh HY, Che Daud CMB, Santhirathelagan C, Retnasabapathy S. Primary Low Grade Follicular Lymphoma of the Conjunctivae Mimicking Nodular Anterior Scleritis: A Case Report. Clin Med Res 2022; 20:111-113. [PMID: 35478097 PMCID: PMC9242737 DOI: 10.3121/cmr.2022.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022]
Abstract
Conjunctival lymphomas are rare entities and may present with non-specific ocular signs that resemble inflammation. They may mimic common ocular pathologies, leading to a delay in diagnosis and treatment. The treatment options of conjunctival lymphomas should be tailored to individuals due to their indolent nature compared to other adnexal lymphomas. Herein, the authors report a case of a primary follicular conjunctival lymphoma in a patient who presented with signs and symptoms of nodular anterior scleritis. The final histology of the conjunctiva lesion revealed primary follicular lymphoma. The patient was managed conservatively with active surveillance.
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Affiliation(s)
- Hui Yin Goh
- Department of Ophthalmology, Hospital Sungai Buloh, Jalan Hospital, Buloh, Selangor, Malaysia
| | | | | | - Shamala Retnasabapathy
- Department of Ophthalmology, Hospital Sungai Buloh, Jalan Hospital, Buloh, Selangor, Malaysia
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Theotoka D, Wall S, Galor A, Sripawadkul W, Khzam RA, Tang V, Sander DL, Karp CL. The use of high resolution optical coherence tomography (HR-OCT) in the diagnosis of ocular surface masqueraders. Ocul Surf 2022; 24:74-82. [PMID: 35231640 PMCID: PMC9058205 DOI: 10.1016/j.jtos.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ocular surface masqueraders encompass any ocular surface lesion masquerading as another ocular surface lesion. High resolution optical coherence tomography (HR-OCT) has emerged as an adjunctive tool to clinical acumen. This study's purpose is to evaluate the utility of HR-OCT images in guiding the diagnosis and management of those lesions. MATERIAL AND METHODS 22 individuals with a clinically ambiguous ocular surface lesion with slit lamp photographs (SLP), HR-OCT images, and histopathological examination were included in the study. The presumptive clinical diagnosis based on SLP was compared to the diagnosis suggested by HR-OCT findings and to definitive diagnosis by histopathology. The main outcome of this study was the frequency in which HR-OCT findings guided the clinician to the correct diagnosis. RESULTS 7 lesions were epithelial, 3 had an epithelial and a subepithelial component, and 12 were subepithelial. HR-OCT was most effective in discerning lesion location, successfully identifying the location in 100% of cases. Classic HR-OCT findings were detected in 68.2% of cases while suggestive features were detected in 31.8% of cases. The epithelial lesions' mean epithelial thickness was 265.4 ± 140.6 μm, the subepithelial lesions' mean was 58.0 ± 25.0 μm, and the combined lesions' mean was 140.0 ± 70.0 μm. The epithelium was significantly thicker in epithelial lesions compared to subepithelial and combined lesions. By ROC analysis we identified that using a cut off of 156 μm, the sensitivity was 86% and the specificity was 93%. DISCUSSION HR-OCT can be a valuable diagnostic tool, assisting in the differentiation of ambiguous ocular surface pathologies by providing a cross-sectional, morphological image of the lesion.
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Affiliation(s)
- Despoina Theotoka
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vincent Tang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dubovy L Sander
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
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Chung HU, Son JH. Ocular adnexal mucosa-associated lymphoid tissue lymphoma: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:3-11. [PMID: 34521183 PMCID: PMC8895963 DOI: 10.12701/yujm.2021.01263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 12/02/2022]
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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Chan EH, Kapadia M, Cheung NC. Asymptomatic Follicular Conjunctivitis in an Elderly Man. JAMA Ophthalmol 2019; 137:451-452. [DOI: 10.1001/jamaophthalmol.2018.5464] [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)
- Eric H. Chan
- University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Manasvee Kapadia
- University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Natalie C. Cheung
- Cornea and External Disease, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio
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Jung SK, Paik JS, Park GS, Cho SG, Yang SW. Refractory follicular conjunctival lesions: overlook as just inflammation or not? Br J Ophthalmol 2019; 103:1660-1665. [PMID: 30709807 DOI: 10.1136/bjophthalmol-2018-312836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/11/2018] [Accepted: 12/31/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the clinical manifestations of 199 patients with suspected conjunctival lymphoma, the associations between these features and the pathological diagnoses, and the prognosis of conjunctival lesions during long-term follow-up. METHODS We conducted a retrospective chart review of 199 patients who underwent conjunctival biopsy on suspicion of conjunctival lymphoproliferative disease between January 2008 and June 2015. We focused on slit-lamp findings in the conjunctiva and the pathological diagnoses. RESULTS In total, 261 specimens of 199 patients were included in this study. The median age of patients was 42 years (range, 16-87 years), and those over 60 years of age constituted 17.1% of all patients. The proportion finally diagnosed with mucosa-associated lymphoid tissue (MALT) lymphomas was 58.2%. In these patients, the most common slit-lamp findings were the 'salmon patch' appearance (73.7%), followed by a follicular appearance (14.5%) and a nodular or subconjunctival mass (6.6%). Bilateral ocular manifestations were more common in patients with disease with the follicular appearance, as compared with patients with the salmon-patch appearance. CONCLUSION Conjunctival MALT lymphoma presents in various ways, not only with the salmon-patch appearance. Therefore, biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the typical appearance of MALT lymphoma. In cases of follicular lesions responding poorly to topical steroids, a conjunctival MALT lymphoma may be suspected, given that chronic inflammation may precede neoplasia in patients with extranodal marginal zone lymphoma.
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Affiliation(s)
- Su-Kyung Jung
- Eye Clinic Hospital, National Cancer Center, Gyeonggi-do, Korea
| | - Ji-Sun Paik
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gyeong-Sin Park
- Department of Pathology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk-Woo Yang
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Cham KM, Riad H. Salmon-coloured lesions mimicking conjunctival papillae: an unusual presentation of unilateral conjunctival lymphoma in a young man. Clin Exp Optom 2016; 99:289-92. [PMID: 27121644 DOI: 10.1111/cxo.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/17/2016] [Accepted: 02/23/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia.
| | - Helen Riad
- Harris, Blake and Parsons, Croydon, Victoria, Australia
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Abstract
PURPOSE Conjunctival lymphoma rarely can have atypical clinical presentations. The authors report a case of conjunctival follicular lymphoma that presented solely as bilateral chronic follicular conjunctivitis. This case underscores that the pathological characteristics of conjunctival follicles can only be determined by histopathologic examination. METHODS The patient underwent conjunctival scraping and biopsy after clinical history and examination failed to reveal the etiology of his chronic, symptomatic, follicular conjunctivitis. RESULTS Histopathologic and immunohistochemical testing disclosed a bilateral low-grade conjunctival follicular lymphoma. The patient was treated with radiation therapy and remained in remission clinically 6 months after the treatment. CONCLUSIONS Although rare, conjunctival lymphoma should be included in the differential diagnosis of chronic follicular conjunctivitis. This case is unique and further supports the notion that tissue biopsy may be needed for chronic, symptomatic conjunctivitis of unknown etiology.
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Conjunctival Lymphoid Hyperplasia Associated With Multiple Recurrent Chalazia. Ophthalmic Plast Reconstr Surg 2015; 31:335-6. [PMID: 26164039 DOI: 10.1097/iop.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wiggans KT, Skorupski KA, Reilly CM, Frazier SA, Dubielzig RR, Maggs DJ. Presumed solitary intraocular or conjunctival lymphoma in dogs and cats: 9 cases (1985–2013). J Am Vet Med Assoc 2014; 244:460-70. [DOI: 10.2460/javma.244.4.460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Comparative study of descemet stripping automated endothelial keratoplasty donor preparation by Moria CBm microkeratome, horizon microkeratome, and Intralase FS60. Cornea 2011; 30:320-4. [PMID: 21304290 DOI: 10.1097/ico.0b013e3181f22cc3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the quality of stromal bed and the safety on endothelium in preparation of donor tissue for Descemet stripping automated endothelial keratoplasty in a masked fashion using 2 mechanical microkeratomes and a femtosecond laser. METHODS Deep anterior lamellar dissection was performed on 15 donor corneas. Central endothelial cell density was calculated using specular microscopy before and after the dissection. One cornea from each of 5 donor pairs was cut with the Moria ALTK system with the CBm microkeratome using the 300-μm head and the mate cut with the Horizon disposable 300-μm microkeratome. Five additional donor corneas were cut with the Intralase 60-kHz FS laser. The donor corneas were then bisected with half of the cornea used for Live/Dead assay to study central endothelial viability. The other halves were sent for scanning electron microscopy of the stromal bed. Qualitative surface roughness of the scanning electron microscopy images was graded by 2 masked observers, and quantitative surface roughness was assessed using roughness evaluation software. RESULTS The Horizon group showed a smoother stromal bed compared with the Moria or Intralase groups by 2 masked observers. However, the Moria group had the smoothest quantitative score of all the groups when assessed by roughness evaluation software. There was no statistically significant difference among the 3 groups in the percentage change in the central endothelial cell density or percentage of viable central endothelium by Live/Dead assay after the dissection. CONCLUSIONS Both mechanical microkeratomes created smoother stromal bed dissections than the femtosecond laser. All systems provided good endothelial cell viability.
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Shetty RK, Adams BH, Tun HW, Runyan BR, Menke DM, Broderick DF. Use of rituximab for periocular and intraocular mucosa-associated lymphoid tissue lymphoma. Ocul Immunol Inflamm 2010; 18:110-2. [PMID: 20370339 DOI: 10.3109/09273940903450313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The clinical efficacy of rituximab therapy in systemic mucosa-associated lymphoid tissue (MALT) lymphoma with both periocular and intraocular involvement is described. Ophthalmic examination and radiologic imaging demonstrated tumor with bilateral periorbital, lacrimal, and subconjunctival infiltration, a pseudohypopyon in one eye, and extensive systemic lymph node involvement. Lymph node biopsy confirmed the pathologic findings of a low-grade MALT lymphoma. The patient had a complete remission within 3 months of starting rituximab therapy. A recurrence 6 months later remitted with a second round of rituximab therapy and the patient remained tumor-free at 1 year.
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Ozdemir G, Bakaris S. Ocular adnexal lymphoma mimicking glaucoma: a case presentation. Can J Ophthalmol 2010; 45:296-7. [PMID: 20436540 DOI: 10.3129/i10-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
Due to their indolent nature, conjunctival lymphomas have different treatment options compared to other adnexal lymphomas. Therapeutic options directed towards conjunctival lymphomas include radiotherapy (external beam radiation), brachytherapy, cryotherapy, intralesional interferon injections, systemic rituximab, and observation. Radiotherapy that has been demonstrated to be highly effective for both low and high-grade tumors, however, can be associated with a high percentage of short-term side effects and long-term complications. Brachytherapy can provide local tumor control, but can also cause many complications. Cryotherapy may be used for certain tumor locations, but has a high recurrence rate. Both interferon and rituximab show promising results for treating low-grade tumors while avoiding the complications associated with radiotherapy. Finally, reports of spontaneous regression of low-grade conjunctival lymphomas have led some investigators to advocate a course of careful observation following biopsy.
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Affiliation(s)
- Patricia S Tsai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Verma V, Shen D, Sieving PC, Chan CC. The role of infectious agents in the etiology of ocular adnexal neoplasia. Surv Ophthalmol 2008; 53:312-31. [PMID: 18572051 DOI: 10.1016/j.survophthal.2008.04.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors.
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MESH Headings
- Alphapapillomavirus/isolation & purification
- Alphapapillomavirus/physiology
- Carcinoma, Squamous Cell/virology
- Chlamydophila psittaci/isolation & purification
- Chlamydophila psittaci/physiology
- Conjunctival Neoplasms/microbiology
- Conjunctival Neoplasms/virology
- Eye Infections, Bacterial/microbiology
- Eye Infections, Bacterial/pathology
- Eye Infections, Viral/pathology
- Eye Infections, Viral/virology
- Eye Neoplasms/microbiology
- Eye Neoplasms/virology
- Eyelid Neoplasms/microbiology
- Eyelid Neoplasms/virology
- HIV-1/isolation & purification
- HIV-1/physiology
- Helicobacter pylori/isolation & purification
- Helicobacter pylori/physiology
- Hepacivirus/isolation & purification
- Hepacivirus/physiology
- Herpesvirus 8, Human/isolation & purification
- Herpesvirus 8, Human/physiology
- Humans
- Lacrimal Apparatus Diseases/microbiology
- Lacrimal Apparatus Diseases/virology
- Lymphoma, B-Cell, Marginal Zone/virology
- Orbital Neoplasms/microbiology
- Orbital Neoplasms/virology
- Sarcoma, Kaposi/virology
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Affiliation(s)
- Varun Verma
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, Bethesda, Maryland 20892-1857, USA
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Abstract
PURPOSE To report a case of chronic recurrent multifocal osteomyelitis (CRMO) with conjunctival involvement. METHODS Retrospective chart review. RESULTS A 10-year-old girl who complained of fatigue and debilitating pain in both hips and legs for >1 year had recurrent episodes of redness and discharge in both eyes with little response to different topical medications. The diagnosis of CRMO was confirmed with the help of magnetic resonance imaging, bone scan, and bone biopsy results. She had moderate hyperemia and multiple discrete salmon-colored lesions in both palpebral and fornical conjunctivae. Biopsy revealed chronic inflammatory infiltration composed predominantly of lymphocytes forming a follicular pattern. Conjunctival lesions worsened during relapses of skeletal symptoms, improved during remission, and resolved shortly after the initiation of oral prednisolone therapy. No recurrence was observed during 16 months of follow-up. CONCLUSIONS Salmon-colored conjunctival lesions may accompany CRMO and respond favorably to systemic steroid therapy.
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Monzen Y, Hasebe H. Radiotherapy for localized orbital mucosa-associated lymphoid tissue lymphoma. Ophthalmologica 2007; 221:233-7. [PMID: 17579288 DOI: 10.1159/000101924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 09/22/2006] [Indexed: 11/19/2022]
Abstract
Fourteen patients with localized orbital mucosa-associated lymphoid tissue lymphoma diagnosed between 1998 and 2005 were reviewed. Five patients were males and 9 were females, with a mean age of 58 years. In 8 patients, the disease arose from the conjunctiva, and in 6 patients, it originated from the retrobulbar space. Patients were treated with radiotherapy alone at a dose range from 30 to 54 Gy. All patients with conjunctival lymphoma achieved complete remission (CR). Four patients with retrobulbar lymphoma obtained CR, and unconfirmed CR (CRu) was observed in 2 cases. Orbital extraconal lymphoma disappeared. However, intraconal cord-like tumor and mass involving the medial extraocular muscle remained with the absence of regrowth over the long term. There have been very few reports discussing the histology of residual mass after radiotherapy. Residual mass was suggested to be reactive lymphoid hyperplasia. As a dose of more than 40 Gy induced dry eye syndrome or cataract, the dose must not exceed 40 Gy in order to achieve safe treatment of orbital mucosa-associated lymphoid tissue lymphoma.
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Affiliation(s)
- Yoshio Monzen
- Department of Radiology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda Minami-ku, Hiroshima 734-8530, Japan.
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Ramulu P, Iliff NT, Green WR, Kuo IC. Asymptomatic conjunctival mucosa-associated lymphoid tissue-type lymphoma with presumed intraocular involvement. Cornea 2007; 26:484-6. [PMID: 17457201 DOI: 10.1097/ico.0b013e3180307667] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma with presumed intraocular involvement. METHODS Observational case report. RESULTS A 73-year-old white man presented for a routine eye examination and was found to have a salmon-colored bulbar conjunctival mass of the left eye. Ultrasound showed a low-reflective mass with diffuse thickening of the ciliary body and choroid. Immunohistochemistry and flow cytometry of an incisional biopsy specimen suggested a polyclonal lesion. Treatment with topical steroids yielded no clinical improvement, and excisional biopsy was performed. A diagnosis of MALT lymphoma was made after polymerase chain reaction (PCR) analysis of the immunoglobulin heavy chain (IgH) locus revealed a clonal B-cell population. CONCLUSIONS Conjunctival MALT lymphoma can present without symptoms and can extend intraocularly. PCR analysis of the IgH locus can identify lesion clonality when immunohistochemistry and flow cytometry fail to do so.
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Affiliation(s)
- Pradeep Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Aspiotis M, Gorezis S, Asproudis I, Tsanou E, Papadiotis E, Kamina S, Agnantis NJ, Bai M. Primary mantle cell lymphoma of the conjunctiva: a case report. Virchows Arch 2006; 449:472-5. [PMID: 16969632 DOI: 10.1007/s00428-006-0268-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 07/04/2006] [Indexed: 11/29/2022]
Abstract
Primary non-Hodgkin's lymphomas of the conjunctiva are uncommon. They are almost exclusively extranodal marginal zone B-cell lymphomas/mucosa-associated lymphoid tissue lymphomas. In this study, we report an extremely rare case of conjunctival mantle cell lymphoma in a 78-year-old man, presenting as a unilateral epibulbar mass.
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Affiliation(s)
- Miltiadis Aspiotis
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
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Abstract
We present two patients with low-grade non-Hodgkin MALT lymphoma (mucosa-associated lymphoid tissue) occurring years before clinical evidence of autoimmune disorders. While the strong association between autoimmune disorders, in particular Sjögren's syndrome and MALToma, is well described, the developement of MALToma years before the onset of an autoimmune disease is very unusual.
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Affiliation(s)
- C Oliveri
- The Louise Coote Lupus Unit, St Thomas' Hospital, London, UK
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Sullivan TJ, Whitehead K, Williamson R, Grimes D, Schlect D, Brown I, Dickie G. Lymphoproliferative disease of the ocular adnexa: a clinical and pathologic study with statistical analysis of 69 patients. Ophthalmic Plast Reconstr Surg 2005; 21:177-88. [PMID: 15942490 DOI: 10.1097/01.iop.0000159173.42243.ad] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical features, treatment, and outcomes of a cohort of patients with ocular adnexal lymphoproliferative disease classified according to the World Health Organization modification of the Revised European-American Classification of Lymphoid neoplasms and to perform a robust statistical analysis of these data. METHODS Sixty-nine cases of ocular adnexal lymphoproliferative disease, seen in a tertiary referral center from 1992 to 2003, were included in the study. Lesions were classified by using the World Health Organization modification of the Revised European-American Classification of Lymphoid neoplasms classification. Outcome variables included disease-specific survival, relapse-free survival, local control, and distant control. RESULTS Stage IV disease at presentation, aggressive lymphoma histology, the presence of prior or concurrent systemic lymphoma at presentation, and bilateral adnexal disease were significant predictors for reduced disease-specific survival, local control, and distant control. Multivariate analysis found that aggressive histology and bilateral adnexal disease had significantly reduced disease-specific survival. CONCLUSIONS The typical presentation of adnexal lymphoproliferative disease is with a painless mass, swelling, or proptosis; however, pain and inflammation occurred in 20% and 30% of patients, respectively. Stage at presentation, tumor histology, primary or secondary status, and whether the process was unilateral or bilateral were significant variables for disease outcome. In this study, distant spread of lymphoma was lower in patients who received greater than 20 Gy of orbital radiotherapy.
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Affiliation(s)
- Timothy J Sullivan
- Eyelid, Lacrimal and Orbital Clinic, Division of Ophthalmology, Department of Surgery, Royal Brisbane Hospital, Queensland, Australia.
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Sarraf D, Jain A, Dubovy S, Kreiger A, Fong D, Paschal J. Mucosa-associated lymphoid tissue lymphoma with intraocular involvement. Retina 2005; 25:94-8. [PMID: 15655452 DOI: 10.1097/00006982-200501000-00018] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the clinicopathologic features of a patient with mucosa-associated lymphoid tissue (MALT) lymphoma of the conjunctiva and associated intraocular involvement. METHODS This study is a retrospective clinicopathologic correlative case report summarizing the clinical, radiologic, and histopathologic findings of a patient with conjunctival MALT lymphoma and associated intraocular involvement. RESULTS Ophthalmic examination and fluorescein angiography demonstrated progressive conjunctival infiltration bilaterally, marked uveal effusions in the left eye, and cellular white infiltrates of the choroid in the right eye. MRI of the orbit revealed a diffusely infiltrating intra- and extraocular lesion extending around the globe and optic nerve in the left eye without evidence of intracranial extension. Conjunctival biopsy showed low-grade tumor cells, consistent with the diagnosis of MALT lymphoma. The patient was successfully treated with external beam radiation with marked clinical improvement. CONCLUSION Conjunctival MALT lymphomas, typically indolent and localized tumors, may extend into the orbit and invade local tissues such as the choroid with devastating consequences. A conjunctival biopsy can provide an easy diagnosis of this treatable entity.
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Affiliation(s)
- David Sarraf
- Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA 90095, USA.
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Lucas RS, Mortimore R, Sullivan TJ, Waldie M. Interferon treatment of childhood conjunctival lymphoma. Br J Ophthalmol 2003; 87:1191. [PMID: 12928301 PMCID: PMC1771832 DOI: 10.1136/bjo.87.9.1191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lee DH, Sohn HW, Park SH, Kang YK. Bilateral conjunctival mucosa-associated lymphoid tissue lymphoma misdiagnosed as allergic conjunctivitis. Cornea 2001; 20:427-9. [PMID: 11333335 DOI: 10.1097/00003226-200105000-00019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE This report aimed to discuss two nearly identical cases of primary conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma mimicking allergic conjunctivitis. METHODS Two patients were referred for intractability to conventional treatment of initial diagnoses of allergic conjunctivitis. On ocular examination, normally pigmented, giant papilla-like lesions were found bilaterally in the upper conjunctiva. Excisional biopsies were performed. RESULTS Histopathologic and immunohistochemical examination of the conjunctival biopsies indicated MALT lymphoma in both patients. The patients subsequently received radiation therapy and achieved complete remission with no evidence of recurrence during follow-up periods of 13 and 11 months. CONCLUSION Conjunctival low-grade lymphoma may share similar clinical features with allergic conjunctivitis. Ophthalmologists should be concerned that primary conjunctival low-grade malignant lymphoma can be misdiagnosed as allergic conjunctivitis
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Affiliation(s)
- D H Lee
- Department of Ophthalmology and Anatomic Pathology, Ilsan Paik Hospital, Ilsan, Korea.
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Abstract
This year, advances in the management of ocular adnexal lymphoid tumors have been based on the distinction between MALT and non-MALT lymphomas. MALT lymphomas have a more indolent course than non-MALT lymphomas, and in the conjunctiva a more conservative approach can be taken than has been recommended previously. In the orbit the likelihood of progression to systemic disease seems high, even with MALT lymphomas, and treatment with radiation is still recommended in all cases. The REAL classification system has replaced the Rappaport and Lukes-Collins system for classifying ocular adnexal lymphomas. Most ocular adnexal lymphomas are composed of neoplastic B-lymphocytes. Additional cases of T-cell lymphoma involving the orbit and conjunctiva were reported in the literature this past year.
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Affiliation(s)
- S A Lauer
- Montefiore Medical Center, Albert Einstein College of Medicine, Englewood Cliffs, New Jersey 07632, USA
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