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Athanasopoulos M, Nomikos G, Samara P, Mastronikolis S, Tsilivigkos C, Mastronikolis NS. Non‑Hodgkin's lymphomas of the lacrimal sac: Current insights and future directions (Review). MEDICINE INTERNATIONAL 2024; 4:43. [PMID: 38912417 PMCID: PMC11190882 DOI: 10.3892/mi.2024.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/31/2024] [Indexed: 06/25/2024]
Abstract
Non-Hodgkin's lymphoma (NHL) of the lacrimal sac is a rare, yet clinically significant entity within the spectrum of ocular malignancies. While primary lacrimal sac lymphoma is uncommon, it poses unique diagnostic and therapeutic challenges due to its anatomical location and potential for aggressive behavior. Despite advancements being made in the current understanding and treatment of NHL, research that specifically addresses the involvement of the lacrimal sac is currently lacking. Thus, the present review aimed to provide insight into the epidemiology, clinical presentation, diagnostic modalities, histopathological features, treatment strategies and prognosis of lacrimal sac NHL. Through a methodical analysis of previous literature, the present review highlights the diverse spectrum of NHL subtypes that affect the lacrimal sac, including diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, mantle cell lymphoma and follicular lymphoma. Moreover, the present review discusses the role of advanced imaging techniques in accurate staging and treatment planning, including computed tomography (CT), magnetic resonance imaging and positron emission tomography-CT. The present review also discusses evolving treatment approaches, such as surgical intervention, chemotherapy, radiotherapy, immunotherapy, combinations of the aforementioned treatments and targeted therapy. In addition, the present review highlights the significance of multidisciplinary collaboration in attaining optimal outcomes for individuals with lacrimal sac NHL. The present review aimed to provide a basis for 'further investigations into novel treatment modalities and prognostic markers that may aid in guiding personalized management strategies, ultimately improving outcomes for patients with NHL.
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Affiliation(s)
| | - Georgios Nomikos
- Department of Otolaryngology, General Hospital of Nikaia, Piraeus ‘Agios Panteleimon’, 18454 Athens, Greece
| | - Pinelopi Samara
- Children's Oncology Unit Marianna V. Vardinoyannis-ELPIDA, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | | | - Christos Tsilivigkos
- 1st Department of Otolaryngology, Hippocrateion Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Transcriptional Profiling Identifies Prognostic Gene Signatures for Conjunctival Extranodal Marginal Zone Lymphoma. Biomolecules 2023; 13:biom13010115. [PMID: 36671500 PMCID: PMC9855408 DOI: 10.3390/biom13010115] [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: 12/02/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
This study characterizes the transcriptional profile and the cellular tumor microenvironment of conjunctival extranodal marginal zone lymphoma (EMZL) and identifies prognostically relevant biomarkers. Ten formalin-fixed and paraffin-embedded conjunctival EMZL and eight healthy conjunctival specimens were analyzed by Massive Analysis of cDNA Ends (MACE) RNA sequencing. The 3417 upregulated genes in conjunctival EMZL were involved in processes such as B cell proliferation and Rac protein signaling, whereas the 1188 downregulated genes contributed most significantly to oxidative phosphorylation and UV protection. The tumor microenvironment, as determined by deconvolution analysis, was mainly composed of multiple B cell subtypes which reflects the tumor's B cell lineage. However, several T cell types, including T helper 2 cells and regulatory T cells, as well as innate immune cell types, such as anti-inflammatory macrophages and plasmacytoid dendritic cells, were also strongly enriched in conjunctival EMZL. A 13-biomarker prognostic panel, including S100A8 and S100A9, classified ocular and extraocular tumor recurrence, exceeded prognostic accuracy of Ann Arbor and American Joint Committee on Cancer (AJCC) staging, and demonstrated prognostic value for patient survival in 21 different cancer types in a database of 12,332 tumor patients. These findings may lead to new options of targeted therapy and may improve prognostic prediction for conjunctival EMZL.
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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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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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Peng F, Su W, Zhang A, Huo B, Song T, Wei Z, Geng Z, Wang L. Investigation of epidemiological characteristics and development of a nomogram to predict survival in primary ocular adnexal lymphoma. Clin Exp Ophthalmol 2022; 50:615-631. [PMID: 35656846 DOI: 10.1111/ceo.14122] [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: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies on the epidemiology and prognosis of primary ocular adnexal lymphoma (POAL) are scarce for its low occurrence. The goal of our research was to assess the epidemiologic characteristics, prognostic variables and survival of POAL patients. METHODS The Surveillance, Epidemiology and End Results (SEER) database was used to collect data on patients identified with POAL from 1975 to 2011 and the incidence rate of POAL from 1975 to 2017. To discover independent predictive markers for overall survival (OS) and disease-specific survival (DSS), multivariable Cox regression analysis was utilised. The independent prognostic factors found by multivariate Cox regression analysis were used to generate a nomogram. RESULTS A total of 2839 patients were diagnosed with POAL, with an average age of 64.1 years. The total incidence of POAL was 2.51/1000000 (according to the overall adjustment of the 2000 American standard) from 1975 to 2017, and the annual percentage change (APC) was 2.47 (95% confidence interval 1.64-3.32, p < 0.05), showing a sharp upward trend. After multivariate Cox regression analysis, age, gender, year of diagnosis, marital status, primary site, laterality, pathological type and treatment strategy were evaluated as independent prognostic factors of OS or DSS (p < 0.05). A nomogram was constructed to forecast the DSS of 1, 3, 5 and 10 years. The concordance index (C-index) and the calibration plots demonstrated the robustness and accuracy of the nomogram. CONCLUSIONS Although POAL is sporadic, the incidence has generally increased in the past 36 years. In recent years, survival rates have risen, and radiotherapy can render better OS and DSS. The nomogram specially made for POAL is robust and precise in predicting the DSS of 1, 3, 5 and 10 years.
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Affiliation(s)
- Fei Peng
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Su
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Anqi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingyue Huo
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Song
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Wei
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenxi Geng
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Auw-Hädrich C, Gasser L, Reinhard T. Bindehautdegenerationen und -neoplasien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1488-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungErhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium
und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese,
Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.
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Auw-Hädrich C, Gasser L, Reinhard T. [Conjunctival Degeneration and Neoplasia]. Klin Monbl Augenheilkd 2022; 239:823-845. [PMID: 35609810 DOI: 10.1055/a-1831-2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.
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TAHRI S, Alaoui H, Bachir H, Hamaz S, Serraj K. Chronic Inflammatory Orbitopathy Hiding Orbital Lymphoma. Cureus 2022; 14:e23040. [PMID: 35419232 PMCID: PMC8994675 DOI: 10.7759/cureus.23040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence of lymphoma is constantly increasing worldwide. The reasons for this increase are unclear and likely multiple. B cell lymphomas represent the majority of non-Hodgkin lymphomas. Primary orbital localization remains a rare entity to think about in order to avoid missing a therapeutic emergency. In this article, we report the case of a 52-year-old man who has been treated for five years for an inflammatory orbitopathy with steroids, but the worsening of the clinical condition and the installation of exophthalmia led to push investigations and the outcome was a primary orbital lymphoma marginal zone type. The patient was treated by systemic chemotherapy with immunotherapy (RCHOP protocol) with a very good evolution and complete disappearance of the lesion after chemotherapy.
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Chae H, Cho H, Sa HS, Kim KW, Chae EJ, Ryu JS, Park CS, Huh J, Jang S, Yoon DH, Suh C. The limited role of comprehensive staging work-up in ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALToma) with excellent prognosis. Br J Haematol 2021; 193:848-851. [PMID: 33779995 DOI: 10.1111/bjh.17411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Heejung Chae
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Center for Breast Cancer, National Cancer Center Korea, Goyang, South Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chan-Sik Park
- Department of Pathololgy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jooryung Huh
- Department of Pathololgy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Milman T, Fernández C, Henry R, Shields C, Bilyk J, Lally S, Eagle R. Ocular adnexal lymphoma: A single-institution retrospective study. Saudi J Ophthalmol 2021; 35:230-238. [PMID: 35601857 PMCID: PMC9116088 DOI: 10.4103/1319-4534.343368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To characterize demographic, clinical, and histopathologic features of ocular adnexal lymphoma (OAL) at a single institution. METHODS: Retrospective review of all patients with pathologic diagnosis of OAL between 2015 and 2020. RESULTS: There were 133 patients with OAL, with a median age of 65 years (range 23–97) and a slight female predominance (male: female = 1:1.46), (n = 79, 59%). The majority of tumors were non-Hodgkin B-cell lymphomas (n = 131, 99%), most frequently Extranodal Marginal Zone B-Cell Lymphoma (EMZL, n = 93, 70%), followed by follicular lymphoma (n = 21, 16%), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 7, 5%), diffuse large B-cell lymphoma (n = 5, 4%), and mantle cell lymphoma (n = 5, 4%). The most frequently involved sites included the orbit (n = 85, 64%) and conjunctiva (n = 43, 32%). Information was available on oncologic staging in 78 (59%), treatment in 82 (62%), and follow-up in 75 (56%) patients. By the Ann-Arbor classification system, patients were classified as IE (54/78, 69%), IIE (9/78, 12%), IIIE (6/78, 8%), and IVE (9/78, 12%). The most common treatments included external beam radiotherapy (standard and ultra-low-dose) (48/82, 59%), biologics (22/82, 27%), and surgical excision with cryotherapy (14/82, 17%) (some patients had >1 therapy). Median follow-up time was 24 months (range 0–221 months). Recurrence was observed in 13% (10/75) with a median time to recurrence of 60 months (95% confidence interval 47–73 months). Excision with cryotherapy as a sole treatment modality was associated with earlier recurrence (P = 0.003). CONCLUSION: In this largest single-center study of OAL, we found that most OAL were Ann-Arbor Stage IE EMZL, occurring in older patients with a female predominance. Early recurrence was noted in tumors treated with excision and cryotherapy alone.
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Ocular adnexal lymphoma: long-term outcome, patterns of failure and prognostic factors in 174 patients. J Hematop 2020. [DOI: 10.1007/s12308-020-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Palakkamanil MM, Mahmood MN, Chan A. Diagnostic and treatment challenges of a case of primary cutaneous signet-ring cell/histiocytoid carcinoma of the eyelid. BMC Ophthalmol 2020; 20:410. [PMID: 33054772 PMCID: PMC7556944 DOI: 10.1186/s12886-020-01685-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Primary cutaneous signet-ring cell/histiocytoid carcinoma of the eyelid is an extremely rare but aggressive neoplasm diagnosed primarily in elderly men. Until now there are 32 published cases of signet-ring cell carcinoma or histiocytoid carcinoma of the eyelid. We report the clinical, radiographic and histological features of the 33rd reported case of PCSRCC in the eyelid of a 73-year-old male, and review diagnostic and treatment challenges of this rare entity. Case presentation Our case highlights a 73-year-old male who was referred for surgical correction of right eye ptosis that was present for 2 years. Upon assessment, he was noted to have an upper lateral orbital rim mass. Computed tomography (CT) noted ill-defined soft tissue thickening anterior to the right globe, predominantly pre-septal but with slight post-septal extension. The pathology revealed diffusely and deeply infiltrating tumour cells extending through the dermis, subcutis, orbicularis muscle bundles and nerve fibers; the tumour cells were noted to have a monotonous histiocytoid appearance with foamy granular eosinophilic cytoplasm. At high magnification, intracytoplasmic vacuoles and occasional intermixed signet ring cells were identified. Immunohistochemical staining revealed the tumour cells to be AE1/AE3, CK7, GCDFP-15, E-cadherin, androgen receptor stain and GATA3 positive. Final pathology report confirmed the diagnosis of primary cutaneous signet-ring cell/histiocytoid carcinoma. Further imaging failed to identify a distant primary malignancy or metastatic disease. The decision was made to attempt surgical excision of the tumor. After the bulk of the grossly apparent tumor was removed, intraoperative frozen sections were sent. Superficial biopsies of the right periorbital region were performed, which revealed extension significantly further than the gross disease. Thereafter, the patient underwent a wide orbital exenteration with reconstruction using a temporary split-thickness skin graft. Due to positive margins on final permanent sections, the patient underwent further wide resection with free muscle-skin flap reconstruction followed by adjuvant radiation treatment. Conclusion Our case represents the 33rd case of primary signet-ring cell/histiocytoid carcinoma of the eyelid in a 73-year-old male, the first documented case with GATA3 positivity and the second documented case with androgen receptor stain positivity.
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Affiliation(s)
- Mathew M Palakkamanil
- Department of Ophthalmology and Visual Sciences; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. .,Royal Alexandra Hospital, 2319 -10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
| | - Muhammad N Mahmood
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Audrey Chan
- Department of Ophthalmology and Visual Sciences; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Hristov AC, Comfere NI, Vidal CI, Sundram U. Kappa and lambda immunohistochemistry and in situ hybridization in the evaluation of atypical cutaneous lymphoid infiltrates. J Cutan Pathol 2020; 47:1103-1110. [PMID: 32870521 DOI: 10.1111/cup.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atypical cutaneous lymphoid infiltrates are challenging lesions in dermatopathology. We present a summary of the literature regarding kappa and lambda immunohistochemistry (IHC) and in situ hybridization (ISH) in the evaluation of atypical cutaneous or mucosal lymphoid infiltrates. METHODS Relevant articles from 1967 to 2018 in the English language were identified and summarized. In the absence of larger studies, case series of n ≥ 3 were included. RESULTS Sixty-three articles assessing kappa and lambda IHC and/or ISH were identified. Most focused on marginal zone lymphomas. Other lymphomas included follicle center lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma, lymphoplasmacytic lymphoma, plasmablastic lymphoma, multiple myeloma, monoclonal gammopathy of undetermined significance, and polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS). Non-neoplastic lesions included reactive lymphoid hyperplasia, cutaneous plasmacytosis, connective tissue disease, IgG4-related disease, acrodermatitis chronic atrophicans, Zoon balanitis, dermatitides, and infiltrates around epithelial dysplasias/neoplasias. CONCLUSION Kappa and lambda IHC and ISH are useful tools in the evaluation of cutaneous B-cell lymphomas and plasma cell neoplasms. The literature supports that the detection of light-chain restriction by IHC and ISH is one of the most useful findings in the differential diagnosis of reactive lymphoid hyperplasia vs B-cell lymphoma with plasmacytic differentiation.
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Affiliation(s)
- Alexandra C Hristov
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nneka I Comfere
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia I Vidal
- Dermatology Center of Southern Indiana, Bloomington, Indiana, USA
| | - Uma Sundram
- Department of Pathology, Oakland University William Beaumont School of Medicine and Beaumont Health Systems, Royal Oak, Michigan, USA
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Huifeng S, Wenyong T, Haisheng H, Wenhui F, Fan B. Dosimetric study of the medical Agility grating system in radiotherapy of orbital lymphoma. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shi Huifeng
- Department of Oral and Maxillofacial Head and Neck OncologySchool of Stomatology, Shanghai Jiao Tong University School of MedicineNational Center for Clinical Research in Oral DiseasesShanghai Key Laboratory of StomatologyShanghai Institute of Stomatology Shanghai China
| | - Tu Wenyong
- Department of Oral and Maxillofacial Head and Neck OncologySchool of Stomatology, Shanghai Jiao Tong University School of MedicineNational Center for Clinical Research in Oral DiseasesShanghai Key Laboratory of StomatologyShanghai Institute of Stomatology Shanghai China
| | - Hu Haisheng
- Department of Oral and Maxillofacial Head and Neck OncologySchool of Stomatology, Shanghai Jiao Tong University School of MedicineNational Center for Clinical Research in Oral DiseasesShanghai Key Laboratory of StomatologyShanghai Institute of Stomatology Shanghai China
| | - Fan Wenhui
- Department of Oral and Maxillofacial Head and Neck OncologySchool of Stomatology, Shanghai Jiao Tong University School of MedicineNational Center for Clinical Research in Oral DiseasesShanghai Key Laboratory of StomatologyShanghai Institute of Stomatology Shanghai China
| | - Bi Fan
- Department of Oral and Maxillofacial Head and Neck OncologySchool of Stomatology, Shanghai Jiao Tong University School of MedicineNational Center for Clinical Research in Oral DiseasesShanghai Key Laboratory of StomatologyShanghai Institute of Stomatology Shanghai China
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Iqbal M, Castano YG, Sher T, Kharfan-Dabaja MA. Intraocular involvement of Mantle cell lymphoma: A case report and literature review. Hematol Oncol Stem Cell Ther 2019; 14:147-152. [PMID: 30978309 DOI: 10.1016/j.hemonc.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
Lymphomatous involvement of the ocular adnexal region (OAR) is generally rare; however, it constitutes the most common ocular malignancy. Most cases of ocular adnexal lymphomas are extra nodal marginal zone B cell lymphomas. Mantle cell lymphoma involvement (MCL) of the OAR is a less common presentation compared with other lymphomas and it has been reported anecdotally. Studies have suggested an association of OAR involvement with poor prognosis. Here, we report the case of a 61 year old man who started experiencing conjunctival erythema which was followed by development of bilateral proptosis. The diagnosis of Stage IV Mantle cell lymphoma with OAR involvement was confirmed 5 months after patient onset of symptomatology. He underwent treatment with systemic chemotherapy, which was followed by high-dose chemotherapy and autologous hematopoietic cell transplant. He is currently day +100 from his transplant and is in complete remission. A review of the literature regarding ocular involvement of MCL is also summarized.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.
| | - Yennifer Gil Castano
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Taimur Sher
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
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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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Seresirikachorn K, Norasetthada L, Ausayakhun S, Apivatthakakul A, Tangchittam S, Pruksakorn V, Wudhikarn K, Wiwatwongwana D. Clinical presentation and treatment outcomes of primary ocular adnexal MALT lymphoma in Thailand. Blood Res 2018; 53:307-313. [PMID: 30588468 PMCID: PMC6300677 DOI: 10.5045/br.2018.53.4.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 01/26/2023] Open
Abstract
Background Primary ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (POML) is the most common subtype of lymphoma involving the eyes in Thailand. We sought to assess the characteristics and treatment outcomes of patients with POML in Thailand. Methods We retrospectively reviewed patient data and included patients diagnosed with POML between January 2004 and December 2016 at Chiang Mai University Hospital and King Chulalongkorn Memorial Hospital, Thailand. We collected and analyzed patients' clinical characteristics and treatment outcomes. Results Among 146 patients with lymphoma involving the eyes, 121 (82%) were diagnosed with POML. Sixty-four (52.9%) were women with median age 58 (range, 22–86) years. The most common presenting symptom was orbital mass (71.1%). Common sites of origin were the orbit (46.3%) and lacrimal gland (34.7%). At presentation, 22.3% of patients had bilateral eye involvement. About half of patients had stage I disease (N=59, 56.2%) and 20% had stage IV. Most patients (73.3%) had a low-risk International Prognostic Index. Radiotherapy was the main treatment for patients with limited-stage disease (66.7% in stage I and 56.5% in stage II). The overall response rate was 100% with complete response rates 80%, 77.3%, and 64.7% for stages I, II, and IV, respectively. Five-year progression-free survival (PFS) and overall survival were 66.1% and 94.0%, respectively. For patients with limited-stage disease, radiotherapy significantly improved PFS compared with treatment not involving radiotherapy (5-year PFS 89.9% vs. 37.3%, P=0.01). Conclusion We revealed that POML has good response to treatment, especially radiotherapy, with excellent long-term outcome.
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Affiliation(s)
- Kasem Seresirikachorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakarin Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirima Tangchittam
- Department of Ophthalmology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vannakorn Pruksakorn
- Department of Ophthalmology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Damrong Wiwatwongwana
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Franco P, Filippi AR, Ricca I, Raucci C, Ricardi U. Eyelid Localization in Mantle Cell Lymphoma: Long-Lasting Complete Remission after Surface Brachytherapy. TUMORI JOURNAL 2018; 95:385-8. [DOI: 10.1177/030089160909500321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ocular adnexal lymphoma is the most frequent malignancy occurring in the eye region. With regard to the histology of these lesions, 2% to 7% of non-Hodgkin's lymphomas located in the periocular region are mantle cell lymphomas. A few cases of mantle cell lymphoma characterized by a fairly indolent course and prolonged survival have been described in the medical literature. We here report on a patient with indolent mantle cell lymphoma presenting at relapse with an isolated eyelid mass that was treated with lens-sparing surface brachytherapy resulting in durable locoregional complete remission.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
| | - Andrea Riccardo Filippi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
| | - Irene Ricca
- Oncology Unit, Cottolengo Hospital, Turin, Italy
| | - Carlo Raucci
- Oncology Unit, Cottolengo Hospital, Turin, Italy
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
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Sjö LD, Juhl BR, Buchwald C, Prause JU, Ralfkiaer E, Sjö NC, Heegaard S. Epstein-Barr Positive T-Cell Lymphoma in the Ocular Region. Eur J Ophthalmol 2018; 16:181-5. [PMID: 16496268 DOI: 10.1177/112067210601600132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To present two cases of rapidly growing tumors in the ocular adnexa. Both tumors were Epstein-Barr virus (EBV) positive peripheral T-cell lymphoma. Methods Case 1 was a 60-year-old man with a non-tender ulcerating tumor involving the lateral third of both upper and lower right eyelid. Case 2 was a 55-year-old man with a swelling of the left eyelid expanding cranially and dislocating the left eye, resulting in proptosis and diplopia. Both patients underwent incisional biopsy that did not disclose the malignant nature of the tumors. Clinical evaluation resulted in suspicion of malignancy and surgical excision was performed. Results The tumors were found to be consistent with EBV-positive peripheral T-cell lymphoma. Conclusions Peripheral T-cell lymphoma is uncommon but a diagnosis to be considered in a patient with a tumorous lesion in the eye region. Furthermore, peripheral T-cell lymphoma may be EBV-positive.
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Affiliation(s)
- L D Sjö
- Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
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20
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Krishna Y, Irion LD, Karim S, Dharmsena A, McCormick A, Coupland SE. Chronic Lymphocytic Leukaemia/ Small-Cell Lymphocytic Lymphoma of the Lacrimal Sac: A Case Series. Ocul Oncol Pathol 2017; 3:224-228. [PMID: 29071273 DOI: 10.1159/000455148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lymphomas of the lacrimal sac are rare, accounting for less than 10% of lacrimal sac malignant tumours. They may present with symptoms typical of secondary acquired nasolacrimal duct obstruction and are thus often misdiagnosed. METHODS Case series and literature review. RESULTS Herein we describe 3 cases of chronic lymphocytic leukaemia (CLL)/small-cell lymphocytic lymphoma (SLL) of the lacrimal sac with immunohistochemical and in 1 case molecular confirmation. CONCLUSION Lymphomas of the lacrimal sac should be suspected in patients with known CLL presenting with epiphora and dacryocystitis. During dacryocystorhinostomy, an incisional biopsy of the lacrimal sac is essential for confirming CLL/SLL involvement and may guide treatment.
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Affiliation(s)
- Yamini Krishna
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - Luciane D Irion
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sozan Karim
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Aruna Dharmsena
- Department of Ophthalmology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Austin McCormick
- Department of Ophthalmology, Aintree University Hospital, Liverpool, UK
| | - Sarah E Coupland
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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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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Ocular/adnexal lymphoma: dissimilar to systemic lymphoma. Surv Ophthalmol 2017; 63:381-388. [PMID: 28837797 DOI: 10.1016/j.survophthal.2017.08.005] [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: 02/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/31/2022]
Abstract
Ocular adnexal lymphoma and intraocular lymphoma, whether occurring simultaneously or sequentially, are often similar to associated systemic lymphoma. We describe 4 cases of ocular adnexal lymphoma or intraocular lymphoma with a dissimilar systemic lymphoma. Two of the cases represent Richter transformation of chronic lymphocytic leukemia/small-cell lymphoma into diffuse large B-cell lymphoma. In the third patient, conjunctival extranodal marginal zone lymphoma developed following treatment for Hodgkin lymphoma. The fourth patient had a remote history of systemic diffuse large B-cell lymphoma with a subsequent diagnosis of orbital extranodal marginal zone lymphoma. Clinical-pathological correlation is reported for all cases in addition to pertinent review of the literature.
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Characteristics of primary extranodal marginal zone B-cell lymphoma in Korea: conjunctiva versus other ocular adnexa. Br J Ophthalmol 2017; 102:502-508. [DOI: 10.1136/bjophthalmol-2017-310741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/27/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022]
Abstract
AimsTo compare the clinical characteristics and prognosis of primary conjunctival versus other ocular adnexal extranodal marginal zone B-cell lymphoma (EMZL).MethodsRetrospective review of clinical records for all consecutive patients with primary ocular adnexal EMZL treated from March 1995 to December 2015.Results198 patients were evaluated including 81 with primary conjunctival and 117 with other ocular adnexal EMZL. Conjunctival EMZL was found at a younger age (40.3±10.3vs 54.3±13.4 years, p<0.0001) with a female predilection (75.3%vs35.9%, p<0.0001) and had a higher rate of bilaterality (40.7%vs11.1%, p<0.0001) and a lower rate of systemic involvement (1.2%vs9.4%, p=0.030) compared with other ocular adnexal EMZLs. Conjunctival EMZL also showed a higher rate of complete response to primary treatment (98.8%vs89.5%, p=0.016) than other ocular adnexal EMZLs; however, recurrence and lymphoma-related death rates were not different between the two groups (p>0.05). Kaplan-Meier estimates for disease-specific survival at 5 and 10 years were 98.2% and 98.2% in conjunctival and 98.6%, respectively, and 95.2% in other ocular adnexal EMZLs. Univariate analysis showed that systemic involvement was negatively associated with conjunctival tumour location and positively associated with age (OR=0.35 and OR=1.05, p=0.045 and p=0.012, respectively), and treatment response was positively associated with conjunctival tumour location and negatively associated with age (OR=3.02 and OR=0.95, p=0.035 and p=0.009, respectively).ConclusionsConjunctival EMZL shows unique demographic characteristic compared with other ocular adnexal EMZLs. Long-term follow-up is required due to late recurrence in ocular adnexal EMZL.
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Lymphoma of the Eyelid - An International Multicenter Retrospective Study. Am J Ophthalmol 2017; 177:58-68. [PMID: 28209503 DOI: 10.1016/j.ajo.2017.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE To document subtype-specific clinical features of lymphoma of the eyelid, and their effect on patient outcome. DESIGN Retrospective observational case series. METHODS Patient data were collected from 7 international eye cancer centers from January 1, 1980 through December 31, 2015. The cases included primary and secondary lymphomas affecting the eyelid. Overall survival, disease-specific survival (DSS), and progression-free survival were the primary endpoints. RESULTS Eighty-six patients were included. Mean age was 63 years and 47 (55%) were male. Non-Hodgkin B-cell lymphomas constituted 83% (n = 71) and T-cell lymphomas constituted 17% (n = 15). The most common subtypes were extranodal marginal-zone lymphoma (EMZL) (37% [n = 32]), follicular lymphoma (FL) (23% [n = 20]), diffuse large B-cell lymphoma (DLBCL) (10% [n = 9]), mantle cell lymphoma (MCL) (8% [n = 7]), and mycosis fungoides (MF) (9% [n = 8]). EMZL had a female predilection (69% [22 of 32]), whereas MCL (71% [5 of 7]) and MF (88% [7 of 8]) had a male predominance. MCL (57% [4 of 7]), DLBCL (56% [5 of 9]), and MF (88% [7 of 8]) were frequently secondary lymphomas. Localized EMZL and FL were mostly treated with external beam radiation therapy, whereas DLBCL, MCL, and high Ann Arbor stage EMZL and FL were frequently treated with chemotherapy. DLBCL and MCL had a poor prognosis (5-year DSS, 21% and 50%, respectively), whereas EMZL, FL, and MF had a good prognosis (5-year DSS, 88%, 88% and 86%, respectively). CONCLUSIONS Lymphoma of the eyelid consists mainly of the lymphoma subtypes EMZL, FL, DLBCL, MCL, and MF. High-grade DLBCL and MCL, as well as MF, are frequently secondary eyelid lymphomas. The main predictor of outcome was the histologic subtype: EMZL, FL, and MF had a significantly better prognosis than MCL and DLBCL.
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25
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Lymphoma of the eyelid. Surv Ophthalmol 2017; 62:312-331. [DOI: 10.1016/j.survophthal.2016.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
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Richards H, Ramsden C, Naidoo R, Yvon C, Jacob E, Mohamedbhai S. Ocular adnexal lymphomas: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1280394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Huw Richards
- North Middlesex University Hospital NHS Trust, London, UK
| | - Conor Ramsden
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Camille Yvon
- Institute of Ophthalmology, University College London, London, UK
- Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, UK
| | | | - Sajir Mohamedbhai
- North Middlesex University Hospital NHS Trust, London, UK
- University College Hospital NHS Foundation Trust, London, UK
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27
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Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study. Blood 2017; 129:324-332. [DOI: 10.1182/blood-2016-05-714584] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022] Open
Abstract
Key Points
POAML (specifically Ann Arbor stage I disease) has an excellent clinical outcome, with only a few patients succumbing to lymphoma. POAML patients face a continuous risk of distant relapse, including in the central nervous system, and transformation to aggressive lymphoma.
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Mupas-Uy J, Kitaguchi Y, Takahashi Y, Takahashi E, Kakizaki H. Cystic mucosa-associated lymphoid tissue lymphoma of lacrimal gland associated with vision loss: A case report. Am J Ophthalmol Case Rep 2016; 5:59-62. [PMID: 29503949 PMCID: PMC5758011 DOI: 10.1016/j.ajoc.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 11/04/2022] Open
Abstract
Purpose To report an atypical case of cystic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of lacrimal gland associated with vision loss. Observations An 89-year-old woman was presented with a rapidly progressing proptosis, lagophthalmos, and vision loss. Endophthalmitis was also present. Computed tomography scan images showed a hyperdense mass with hypodense cystic areas occupying the superolateral orbit, which displaced the globe antero-inferiorly with optic nerve compression and stretching. An erosion to the adjacent superior and lateral orbital walls was also demonstrated. Complete tumor excision was performed via upper transconjunctival orbitotomy concurrently with enucleation. The immunohistopathological diagnosis was MALT lymphoma. Conclusions and importance This case emphasizes the importance of considering lymphoma in the differential diagnosis of a cystic superolateral orbital mass.
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Affiliation(s)
- Jacqueline Mupas-Uy
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Yoshiyuki Kitaguchi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Emiko Takahashi
- Department of Pathology, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, Japan
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Wajda BN, Rabinowitz MP. A rare case of orbital hodgkin lymphoma demonstrating therapeutic response to a novel systemic medication. Orbit 2016; 36:52-54. [PMID: 27824517 DOI: 10.1080/01676830.2016.1243133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Orbital Hodgkin lymphoma is infrequent, representing less than 1% of adult orbital malignancies. It is typically seen in the setting of terminally advanced systemic disease. This case highlights orbital, head, and neck disease in a systemically stable individual treated with the novel anti-CD30 monoclonal antibody brentuximab vedotin.
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Affiliation(s)
- Brynn N Wajda
- a Ophthalmology Residency Program , Wills Eye Hospital, Thomas Jefferson University Hospital , Philadelphia , Pennsylvania , USA
| | - Michael P Rabinowitz
- b Department of Oculoplastic and Orbital Surgery , Wills Eye Hospital , Philadelphia , Pennsylvania , USA
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Akuaku-Dogbe E, Ekem I, Mensah B. ORBITAL AND ADNEXAL LYMPHOMAS AMONG ADULT PATIENTS IN GHANA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2016; 6:136-154. [PMID: 29181369 PMCID: PMC5667725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Non Hodgkin's lymphomas (NHLs) present variously in different ethnic communities. Orbital and adnexal disorders have been reported among NHLs in Africa. They can involve the orbit, the eyelid, the conjunctiva, alone or in combinations. To our knowledge there are no reports in the literature about the clinical presentation of lymphomas in Ghana. AIM To explored orbital and adnexal disorders among adult patients attending the Korle-Bu Teaching hospital, Accra. METHODOLOGY Histological case notes of patients reporting to the orbital clinic of Korle-Bu Teaching Hospital, Eye Department from November 2004 to October 2016 with orbital and adnexial lympho-proliferative tumors were retrieved. Histopathology was performed at Sheffield Teaching hospital. Data collected included age, sex, symptoms at presentation and anatomic site of involvement. Histology and immune histochemistry data were generated. RESULTS A total of 18 patients were examined and entered into the study. The male to female ratio was 1.25:1. Twelve patients (70.6) presented with proptosis and 14 (77.8%) had orbital involvement. Two patients had isolated eyelid disease. Of those with orbital disease, three had simultaneously upper eyelid involvement. Out of the 18 cases, 11 (61.1%) were mucosa-associated lymphoid tissue (MALT) lymphomas. Only males 40 years and above were affected, compared with females who presented at any age. Patients above 60 years reported early (i.e. <3 months) compared with patients below 40 years who mostly reported after 1 year. CONCLUSION This study reports pattern of epidemiological and clinical presentation of orbital and adnexal lymphomas as seen in Ghana, West Africa. Though there were some variations in the clinical presentation the histological subtypes represented seem to be similar to those reported in other parts of the world.
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Affiliation(s)
- E Akuaku-Dogbe
- Department of Opthalmology, University of Ghana Medical School, University of Ghana
| | - I Ekem
- Department of Haematology, School of Medical Sciences, University of Cape Coast, Ghana
| | - B Mensah
- Department of Haematology, Korle Bu Teaching Hospital, Ghana
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Primary Diffuse Large B-Cell Lymphoma Localized to the Lacrimal Sac: A Case Presentation and Review of the Literature. Case Rep Hematol 2016; 2016:5612749. [PMID: 27672460 PMCID: PMC5031814 DOI: 10.1155/2016/5612749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
We report a rare case of diffuse large B-cell lymphoma (DLBCL) of the lacrimal sac in a 50-year-old male. The incidence of primary ocular lymphoma is low and it is considered a rare disease. Moreover, reports of ocular DLBCL are uncommon and the disease remains poorly characterized. Our patient presented for management of osteomyelitis and was incidentally found to have a painless swelling and cyst around his right eye. A PET/CT scan revealed hypermetabolic activity within the lacrimal sac and a subsequent excisional biopsy of the mass yielded histopathology consistent with DLBCL. Consequently, the patient underwent treatment with R-CHOP therapy. The patient responded well to chemotherapy with a substantial shrinkage in tumor burden and the disease remained localized. Herein, we present a rare case of primary ocular lymphoma, highlight the importance of early diagnosis, and review current treatment modalities.
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Review article: Mucosa-associated lymphoid tissue (MALT)-type lymphoma of ocular adnexa. Biology and treatment. Crit Rev Oncol Hematol 2016; 100:37-45. [DOI: 10.1016/j.critrevonc.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
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Abstract
Ocular adnexal lymphoma (OAL) is a relatively common lesion in the practice of ophthalmic oncology. Although OALs are usually primary tumors, secondary involvement of the ocular adnexae by systemic lymphoma is also possible. The clinical and radiological features of OAL are non-specific. Thorough morphological evaluation, aided by immunostaining, cytogenetic studies and molecular testing, are necessary for accurate diagnosis.
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Affiliation(s)
- Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology (NRCOP), Centre For Sight, Hyderabad, India.
| | - Santosh G Honavar
- Oculoplastics, Facial Aesthetics and Ocular Oncology, Centre For Sight, Hyderabad, India
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Ramsden CM, Yvon C, Jacob E, Kam R, Anikina E, Khan I. Mantle cell lymphoma masquerading as chalazia, a case report. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1162096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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35
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Kim HW, Sung YM, Baik JS, Yang SW. A Case of Lacrimal Gland MALT Lymphoma in a Patient with Primary Sjögren's Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyo Won Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Mi Sung
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Sun Baik
- Department of Ophthalmology and Visual Science, 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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Abstract
AIMS To investigate potential diagnostic pitfalls associated with the identification of low grade lymphoma in the orbit and lacrimal gland region. METHODS To systemically review all cases diagnosed as low grade lymphoma of orbit and lacrimal gland within a 2 year period at a specialist ophthalmic centre. To ascertain the frequency of diagnostic errors in this group of cases, in particular to look for known pitfalls associated with follicular colonisation by marginal zone lymphoma and the recently identified atypical variant of follicular lymphoma (FL). A series of 21 cases were reviewed. RESULTS We identified two diagnostic errors; one case of extra nodal marginal zone lymphoma (ENMZL) which showed follicular colonisation and was misinterpreted as a FL and a case of missed mantle cell lymphoma (MCL). We identified no cases of atypical FL. CONCLUSION Within the orbit and lacrimal gland the term "low grade lymphoma" encompasses the following types of lymphoma: ENMZL, FL, MCL and chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL). The typical and atypical immunophenotype of these entities is discussed. The diagnosis of ENMZL, by far the most common low grade lymphoma to occur in these areas, is to some extent a difficult diagnosis and is often one of exclusion. The pitfalls of follicular colonisation and the concept of atypical follicular lymphoma are discussed.
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Affiliation(s)
- Sepideh Amin
- Institute of Ophthalmology, University College London , London , United Kingdom and
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Hassan WM, Alfaar AS, Bakry MS, Ezzat S. Orbital tumors in USA: difference in survival patterns. Cancer Epidemiol 2014; 38:515-22. [PMID: 25052531 DOI: 10.1016/j.canep.2014.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is a wide range of tumors affecting the orbital adnexa. Key such tumors include lymphomas, carcinomas, melanomas and rhabdomyosarcomas. Several studies have proposed that these histological subtypes differ in their survival outcomes. In this study we aim to describe the difference in survival outcomes between such subtypes. METHODS The SEER database was used to gather patient information. All 18 SEER registries were used. Patients diagnosed from 1996 to 2005 were included in the analysis. Observed five-year survival rate was calculated using the SEER*Stat software version 8.1.2. Data were extracted into IBM SPSS version 20 to generate Kaplan Meier curve for each group. RESULTS There were 2180 patients in the SEER databases who met the selection criteria. Lymphomas were the most common histology in adults. The overall five-year observed survival for all lymphoma patients was 75.9% (95% CI: 73.7-78.1). There was statistically significant difference between observed survival rates of lymphoma subtypes. Carcinomas were the second most common tumors. Their five-year observed survival rate in our study was 60.4%. There was no statistically significant difference between carcinoma subtypes' observed survival rates in the 20-49 age group, while, in the older age group, the difference was found to be statistically significant. Rhabdomyosarcomas were the most common tumors in children. The overall five-year observed survival rate for rhabdomyosarcomas patients was 89.8%. There was no statistically significant difference between observed survival rates of rhabdomyosarcomas subtypes. There was no statistically significant difference between relative survival rates according to gender and treatment received except within melanomas. CONCLUSION In adults, lymphomas have better survival rates than carcinomas. Whereas the lymphoma subtype can be used as a determinant prognostic factor in any age, the carcinoma subtype can be used as such a determinant in older age groups only. In children, rhabdomyosarcomas are the predominant tumors affecting the orbital adnexa. Further studies are needed to determine if the difference between embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma observed survival rates are statistically significant.
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Affiliation(s)
- Waleed M Hassan
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Ahmad S Alfaar
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; Cairo University School of Medicine, Cairo, Egypt; Ulm University, 89069 Ulm, Baden-Württemberg, Germany.
| | - Mohamed S Bakry
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Sameera Ezzat
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; National Liver Institute, Menoufiya University, Shebin Elkom, Egypt.
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Sahu KK, Uthamalingam P, Sampath S, Jinagal J, Das A, Prakash G, Malhotra P, Varma SC. Ocular adnexal lymphomas: report of 2 cases of mantle cell lymphomas and short review of literature. Indian J Hematol Blood Transfus 2014; 30:163-8. [PMID: 25114401 DOI: 10.1007/s12288-014-0389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/03/2014] [Indexed: 11/26/2022] Open
Abstract
Mantle cell lymphoma in ocular region is a rare phenomenon which can be either primary or secondary. Most of these cases are usually diagnosed after excisional biopsy of the involved area with first visit being in the Ophthalmology OPD. We share our experience of two such cases being referred from Ophthalmology OPD. 1st case is about a 52-year-old man who came for complaints of redness of left eye with excessive lacrimation. Examination revealed congestion of left temporal bulbar conjunctiva and a small pinkish outgrowth 2 × 2 cm adherent to temporal bulbar conjunctiva. 2nd case is a 55-year-old gentlemen who presented with complaints for 8 months duration of swelling left eyelid. Excisional biopsy and histopathological examination in both the cases were done to confirm the diagnosis. CECT head and neck were done at baseline and during follow up. These cases are being presented due to the rarity and dramatic response to chemotherapy.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Preithy Uthamalingam
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Santhosh Sampath
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Jitender Jinagal
- Department of Opthalmology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Ashim Das
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Subhash Chander Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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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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Asynchronous presentation of follicle center lymphoma and reactive lymphoid hyperplasia of the ocular adnexa. Am J Dermatopathol 2014; 36:e87-92. [PMID: 24394299 DOI: 10.1097/dad.0b013e3182a36541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although ocular lymphoproliferative diseases may be rarely encountered by dermatopathologists, the frequency may increase particularly as more and more subspecialties rely on dermatopathology services. Emerging data suggest that there are some similarities between ocular and cutaneous lymphoproliferative diseases with respect to their clinical behavior, prognosis, and cytogenetics. In this case report, a patient with ocular follicle center lymphoma who subsequently developed ocular reactive lymphoid hyperplasia is presented with an accompanying review of the literature on the subjects. The encounter of both follicular center lymphoma and reactive lymphoid hyperplasia in the same patient provides a rare opportunity to compare and contrast the clinical, histological, and immunohistochemical findings of the respective lymphoproliferative diseases situated at opposite ends of the spectrum.
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Shin SA, Kim SD, Yun KJ. A Case of Primary Signet Ring Cell Carcinoma of the Lower Eyelid. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.4.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seon Ae Shin
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Ki Jung Yun
- Department of Pathology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
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Abstract
Primary signet ring cell carcinoma of the eyelid (PSCE) is a very rare tumour. Only a few cases having been reported to date. The majority of patients have been middle-age to elderly men. Different treatment modalities have been applied in cases of PSCE. Here, we report a case of PSCE in a man treated with orbital exenteration and radiotherapy.
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Affiliation(s)
- Jennifer S L Tan
- Orbital, Plastic & Lacrimal Service, The Royal Victorian Eye and Ear Hospital , Melbourne , Australia and
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Clinical characteristics of 95 patients with ocular adnexal and uveal lymphoma: treatment outcomes in extranodal marginal zone subtype. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:203-10. [PMID: 24417911 DOI: 10.1016/j.clml.2013.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphoma rarely presents in the ocular adnexa but is usually extranodal marginal zone (ENMZ) lymphoma when it does. Involved-field radiotherapy (IFRT) is the standard of care for unilateral disease, but the optimal management of more extensive disease is unclear. PATIENTS AND METHODS We retrospectively evaluated the clinical characteristics and outcomes of 95 patients with ocular adnexal lymphoma (OAL) or uveal lymphoma treated or diagnosed at our institution. All patients identified were included in the risk factor analysis for progression-free survival (PFS). The initial treatment-related outcomes were assessed for ENMZ OAL only (n = 62). RESULTS With a median follow-up of 32 months, significant risk factors for PFS after initial treatment were age (hazard ratio, 1.33; 95% confidence interval, 1.02-1.74), female gender (hazard ratio, 2.04; 95% confidence interval, 1.04-4.00), and a history of lymphoma (hazard ratio, 2.31; 95% confidence interval, 1.12-4.78). In ENMZ, IFRT was associated with improved PFS (median, 5.4 years; P < .001). Progression occurred in 7 of 39 (23%), with 6 of the 7 (86%) at systemic sites. Single-agent rituximab was typically used for bilateral ocular or systemic presentations of ENMZ OAL. Progression occurred in 7 of 11 (64%), with no progression at systemic sites. All progression events in those initially treated with rituximab occurred in the ocular adnexa. CONCLUSION The results of the present study have confirmed IFRT as the standard for unilateral ENMZ OAL. Single-agent rituximab was an effective agent for bilateral ocular or systemic ENMZ OAL, particularly for systemic control, but ocular progression should be closely monitored. Combined modality therapy should be studied further in bilateral and systemic ENMZ OAL.
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Zanni M, Moulin-Romsee G, Servois V, Validire P, Bénamor M, Plancher C, Rouic LLL, Dendale R, Vincent-Salomon A, Asselain B, Sahli R, Decaudin D. Value of18FDG PET scan in staging of ocular adnexal lymphomas: a large single-center experience. Hematology 2013; 17:76-84. [DOI: 10.1179/102453312x13221316477813] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Manuela Zanni
- Department of Clinical HematologyInstitut Curie, Paris, France
| | | | | | | | - Myriam Bénamor
- Department of Nuclear MedicineInstitut Curie, Paris, France
| | | | | | - Rémi Dendale
- Department of Radiation OncologyInstitut Curie, Paris, France
| | | | | | - Rafika Sahli
- Department of Clinical HematologyInstitut Curie, Paris, France
| | - Didier Decaudin
- Department of Clinical HematologyInstitut Curie, Paris, France
- Laboratory of Preclinical InvestigationTranslational Research Department, Institut Curie, Paris, France
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Ponzoni M, Govi S, Licata G, Mappa S, Giordano Resti A, Politi LS, Spagnuolo L, Di Cairano E, Doglioni C, Ferreri AJM. A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma. Oncologist 2013; 18:876-84. [PMID: 23814042 DOI: 10.1634/theoncologist.2012-0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
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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
PURPOSE Lymphoma is the most common malignancy of the ocular adnexa. Most of the ocular adnexa lymphomas are non-Hodgkin B-cell lymphomas. The most common type of ocular adnexa lymphoma is primary extranodal marginal zone B-cell lymphoma of the MALT (mucosa-associated lymphoid tissue). Most of these neoplasms are primary extranodal lymphomas, although 10% to 32% are secondary tumors from disseminated disease. CASE REPORT A 58-year-old woman presented for a comprehensive examination, with the chief complaint of ocular discomfort in both eyes. Anterior segment examination revealed bilateral salmon-colored lesions of the inferior and superior conjunctivae. The patient was referred for systemic evaluation and histopathology of the conjunctival lesions. She was diagnosed as having marginal zone lymphoma of the MALT and underwent radiation therapy (RT). CONCLUSIONS Ocular lymphoma may present on routine examination or with mild symptoms. Although most commonly a primary extranodal neoplasm, the condition may be associated with disseminated lymphoma and requires thorough evaluation and staging of the disease for determination of appropriate treatment. The primary eye care provider plays an important role in the identification and staging of the disease, as well as managing complications from RT. It is also important to recognize that concurrent conditions requiring treatment with topical medications, such as glaucoma, may be complicated after treatment because of the inflammation and ocular surface irritation after RT. The necessity and benefit of the addition of intraocular pressure medications during that time should be measured on a case-by-case basis. Patients should be followed closely after treatment for relapse of disease and identification of complications from ocular RT.
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