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Vest SD, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Hindso TG, Holm F, Honavar SG, Khong JJ, Kirkegaard MK, McKelvie PA, Mikkelsen LH, Mulay K, Rasmussen PK, Siersma V, Sjö LD, Sniegowski MC, Thuro BA, Vemuganti GK, Heegaard S. Specific location of ocular adnexal lymphoma and mortality: an international multicentre retrospective study. Br J Ophthalmol 2023; 107:1231-1238. [PMID: 35512851 DOI: 10.1136/bjophthalmol-2021-320466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine whether the specific location of ocular adnexal lymphoma (OAL) and the American Joint Committee on Cancer (AJCC) TNM tumour stage are prognostic factors for mortality in the main OAL subtypes. METHODS Clinical and survival data were retrospectively collected from seven international eye cancer centres. All patients from 1980 to 2017 with histologically verified primary or secondary OAL were included. Cox regression was used to compare the ocular adnexal tumour locations on all-cause mortality and disease-specific mortality. RESULTS OAL was identified in 1168 patients. The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=688, 59%); follicular lymphoma (FL) (n=150, 13%); diffuse large B-cell lymphoma (DLBCL) (n=131, 11%); and mantle cell lymphoma (MCL) (n=89, 8%). AJCC/TNM tumour-stage (T-stage) was significantly associated with disease-specific mortality in primary ocular adnexal EMZL and increased through T-categories from T1 to T3 disease. No associations between AJCC/TNM T-stage and mortality were found in primary ocular adnexal FL, DLBCL, or MCL. EMZL located in the eyelid had a significantly increased disease-specific mortality compared with orbital and conjunctival EMZL, in both primary EMZL and the full EMZL cohort. In DLBCL, eyelid location had a significantly higher disease-specific mortality compared with an orbital or lacrimal gland location. CONCLUSION Disease-specific mortality is associated with AJCC/TNM T-stage in primary ocular adnexal EMZL patients. Lymphoma of the eyelid has the highest disease-specific mortality in primary EMZL, and in the full cohort of EMZL and DLBCL patients.
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Affiliation(s)
- Stine Dahl Vest
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York City, New York, USA
| | - Gerardo F Graue
- The New York Eye Cancer Center, New York City, New York, USA
| | - Hans E Grossniklaus
- Section of Ocular Oncology, Emory University Eye Center, Atlanta, Georgia, USA
| | | | - Frederik Holm
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Santosh G Honavar
- Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Lene Dissing Sjö
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Matthew C Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Geeta K Vemuganti
- Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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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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Wang Z, Liu Y, Mo J, Cao X, Xu X, Shen L, Wang H, Wei W. Mucosal associated Lymphoid Tissue Lymphoma of the uvea: an analysis of 3 cases. BMC Ophthalmol 2022; 22:371. [PMID: 36123589 PMCID: PMC9484074 DOI: 10.1186/s12886-022-02598-2] [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: 04/30/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ocular mucosa-associated lymphoid tissue (MALT) lymphoma involving orbit and conjunctiva usually has an indolent clinical course with “salmon patch” mass as typical presentation. This study is to report a series of rare cases and investigate the clinical and pathological features of ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis. Methods This retrospective, observational study was conducted at Beijing Tongren Hospital. From 2018 to 2020, 3 cases of 3 eyes (2 female patients and 1 male patient) with ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis were included in the study. All patients had complaints of red eyes with blurred vision. The average age was 56.33 ± 2.08 years old and the average time from initial diagnosis to pathological diagnosis was 3.00 ± 1.73 months. Ophthalmic examinations including best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp microscope examinations, fundus photography, B-scan ultrasonography, ultrasound biomicroscope (UBM), optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were conducted. Systemic workups including orbital magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and blood autoimmune antibody tests were also conducted. Pathological tissue from patients were obtained through surgeries. Biopsy examinations were performed to accurately determine pathological diagnosis. All the information of clinical, imaging and pathological changes were collected and analyzed. Results At the initial diagnosis, the BCVA of involved eyes decreased seriously while the IOP were normal. All involved eyeball showed extensive hyperemia and local thickening in the wall of eyeballs. B-scan ultrasonography showed mass with abundant blood and irregular cysts inside the eyeball wall and in the retrobulbar orbit, surrounding the ocular wall and optic nerve. UBM showed solid lesions with low and medium echo under the conjunctiva and inside the ciliary body of 2 cases. OCT showed posterior polar wavy rise of RPE and local neuroepithelial detachment in all cases. FFA and ICGA showed vascular abnormalities (patch-like strong fluorescence and fluorescence leakage) and local thickening in retina and choroid (Rectangle-like weak fluorescence below the macula). The posterior wall of the eyeball was thickened and enhanced in MRI. PET-CT also showed thickening of posterior wall of eyeballs and increased metabolic activity but there was no sign of autoimmune disease. All patients were diagnosed as MALT lymphoma through pathologic examinations of biopsy tissue. Conclusions The onset of primary ocular MALT lymphoma in uvea is hidden. The early clinical manifestations are lack of specificity and misleading. B-scan ultrasonography has characteristic manifestations and is valuable in diagnosis. However, pathological diagnosis through tissue biopsy is irreplaceable. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02598-2.
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Affiliation(s)
- Zhenyu Wang
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Yueming Liu
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Jing Mo
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Xusheng Cao
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Xiaolin Xu
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Lin Shen
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Hong Wang
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China.
| | - Wenbin Wei
- Beijing Ophthalmology & Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China.
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Han SH, Kim Y, Jang J, Park JW, Young SM, Woo KI. Clinical characteristics and treatment outcomes of diffuse large B-cell lymphoma involving the eye and ocular adnexa in East Asia. Acta Ophthalmol 2021; 99:773-782. [PMID: 33421300 DOI: 10.1111/aos.14725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the clinical features and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the eye and ocular adnexa in an East Asian population and emphasize the importance of prompt biopsy and treatment in unusually progressive ocular adnexal DLBCL for better visual outcomes. METHODS Retrospective case series of 38 patients diagnosed with DLBCL involving the eye and ocular adnexa between 1995 and 2018 at a single tertiary institution. RESULTS There were 38 patients (22 men, 16 women), 22 (57.9%) of which had ocular adnexal lymphoma (OAL) and 16 (42.1%), vitreoretinal lymphoma (VRL). The OAL group showed higher rates of unilateral involvement (p = 0.01) and localized disease presentation (p = 0.01). Thirteen (59.1%) of 22 OAL patients were primary diseases and 9 (40.9%) were secondary. Between primary and secondary OAL groups, there was no statistical difference in clinical characteristics such as age, gender and laterality (p = 0.47, p = 0.19 and p = 0.66, respectively). All secondary OAL cases were either disseminated or relapsed by definition and only two cases (15%) of primary OAL showed disseminated presentation (p < 0.01). Six (37.3%) of 22 OAL patients showed a rapid decrease in visual acuity within 15 days and the visual recovery was irreversible in 3 of them. CONCLUSION OA-DLBCL has a grave prognosis and its visual outcomes largely depend on the timing of diagnosis and treatment. When a high-grade lymphoma is suspected, prompt biopsy and treatment should be performed to ensure optimal visual, clinical and survival outcomes.
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Affiliation(s)
- Sun Hyup Han
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Yoon‐Duck Kim
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
- Nune Eye Hospital Seoul Korea
| | | | | | - Stephanie M Young
- Department of Ophthalmology National University Hospital Singapore City Singapore
| | - Kyung In Woo
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Zschoche M, Zimpfer A, Scheef BO, Jünemann AM, Guthoff RF, Junghanss C, Hildebrandt G, Emmert S, Erbersdobler A, Kundt G, Kakkassery V. Histopathological Features and Ann Arbor Stage in Periocular Lymphoma. In Vivo 2021; 34:1965-1974. [PMID: 32606168 DOI: 10.21873/invivo.11993] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate biodata, symptoms/signs, lymphoma type, localization, stage level, treatment choice and outcome of ocular adnexal lymphoma (OAL). PATIENTS AND METHODS A single-center retrospective analysis of 56 patients with OAL was performed from 1998 to 2018. RESULTS OAL involved the orbit in 44.6%, the conjunctiva in 32.1%, the lacrimal apparatus in 14.3% and the eyelid in 8.93%. Extranodal marginal zone B-cell lymphoma (EMZL) was found in 60.7%, follicular lymphoma (FL) in 21.4%, diffuse large B-cell lymphoma in 7.14%, mantle cell lymphoma in 5.36% and chronic lymphatic leukaemia in 5.36% patients. No relapse was seen in 76%. EMZL and FL had a significantly better overall survival compared to other lymphoma types (p=0.002). Patients with Ann Arbor stage IE had a significantly better prognosis than those with stages higher than IE (p=0.048). CONCLUSION Our data suggest that clinicopathological features such as Ann Arbor stage influence survival.
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Affiliation(s)
- Marco Zschoche
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany
| | - Annette Zimpfer
- Institute of Pathology, University Medical Center Rostock, Rostock, Germany
| | - Björn O Scheef
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany
| | - Anselm M Jünemann
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany
| | | | - Guido Hildebrandt
- Department of Radiotherapy, University Medical Center Rostock, Rostock, Germany
| | - Steffen Emmert
- Clinic and Polyclinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | | | - Günther Kundt
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University of Rostock, Rostock, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany .,Department of Ophthalmology, University-Hospital Schleswig-Holstein, University of Luebeck, Luebeck, Germany
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[Ocular lymphoma : Precise diagnostics and classification as key for successful personalized treatment]. Ophthalmologe 2020; 117:499-507. [PMID: 31811368 DOI: 10.1007/s00347-019-01020-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Personalized medicine is nowadays the standard of care for patients with oncological diseases. A prime example is the lymphoma, which has substantial points of contact with ophthalmological care due to the intraocular and periocular involvement. OBJECTIVE This article provides a description of the current personalized diagnostics and treatment of ocular lymphomas. METHODS This article constructs a relationship between the current knowledge in the literature, guidelines and recommendations and the clinical experience with ocular lymphomas. It explains in particular the molecular and also individual personalized treatment concepts. RESULTS The primary suspicion of lymphatic or other ocular oncological diseases is raised by an ophthalmologist based on clinical symptoms. The exact diagnostic procedure is carried out with molecular biological techniques, such as immunohistology and polymerase chain reaction analyses. A staging of the mass is indispensable and the stage classification according to the Ann Arbor criteria for a correct assignment of the lymphoma is of clinical importance. Based on these precise diagnostics an individualized choice of treatment and subsequent personalized follow-up care are carried out. During the complete process from the diagnostic procedure to treatment and aftercare, psycho-oncological support should be offered to the patient. CONCLUSION Personalized medicine is already actively performed in the care of ocular lymphomas. The patient is in the forefront and plays a decisive role. By considering the special features of the tumor and patient parameters, the life expectation and relapse-free interval as well as quality of life have been improved for many types of lymphoma. It must be assumed that these advantages also apply to ophthalmology.
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Konjunktivale Malignome. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00450-w] [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]
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Moustafa GA, Topham AK, Aronow ME, Vavvas DG. Paediatric ocular adnexal lymphoma: a population-based analysis. BMJ Open Ophthalmol 2020; 5:e000483. [PMID: 32596505 PMCID: PMC7312335 DOI: 10.1136/bmjophth-2020-000483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the incidence, clinicopathological characteristics and survival of ocular adnexal lymphoma (OAL) in the paediatric population. Methods and analysis In this retrospective case series, the Surveillance, Epidemiology and End Results database was accessed to identify individuals with OAL ≤18 years of age, diagnosed between 1973 and 2015. OAL located in the eyelid, conjunctiva, lacrimal apparatus and orbit were included. Main outcome measures were the age-adjusted incidence rates (IRs) per 1 000 000 population at risk (calculated for the period 2000–2015) and descriptive statistics of demographic and clinicopathological features. Results The IR of paediatric OAL was 0.12 (95% CI 0.08 to 0.16) per 1 000 000. Males (0.15; 95% CI 0.10 to 0.22) and blacks (0.24; 95% CI 0.13 to 0.42) had a higher tendency for OAL development. A total of 55 tumours in 54 children were identified. The majority were localised (78.4%), conjunctival (49.1%) lymphomas. Extranodal marginal zone lymphoma (EMZL, 45.5%, n=25) was the most frequent subtype, followed by diffuse large B-cell lymphoma (DLBCL, 9.1%, n=5), B lymphoblastic lymphoma (7.3%, n=4), follicular lymphoma (5.5%, n=3), Burkitt lymphoma (5.5%, n=3), anaplastic large cell lymphoma (ALCL, 3.6%, n=2), small lymphocytic lymphoma (1.8%, n=1), diffuse large B-cell lymphoma, immunoblastic (1.8%, n=1) and panniculitis-like T-cell lymphoma (1.8%, n=1). Localised, low-grade, conjunctival lymphomas were frequently treated with complete excision with or without radiation, while high-grade and distant tumours usually received chemotherapy. Only 29.1% of paediatric OAL cases were treated with radiation. Three out of five (60%) patients with DLBCL died of lymphoma at a median follow-up of 21 (range 10–86) months, and 1 out of 2 (50%) patients with ALCL died of lymphoma at 23 months from diagnosis. Conclusion OAL in the paediatric population is rare. The majority of OAL are EMZL and are characterised by excellent prognosis. The histological subtype was found to be the main predictor of outcome with cancer-specific deaths observed in patients with DLBCL and ALCL.
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Affiliation(s)
- Giannis A Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Ophthalmology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Allan K Topham
- Coalition of Cancer Cooperative Groups Inc, Philadelphia, Pennsylvania, USA
| | - Mary E Aronow
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Kwon M, Lee JS, Lee C, Yoon DH, Sa HS. Prognostic factors for relapse and survival among patients with ocular adnexal lymphoma: validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM classification. Br J Ophthalmol 2020; 105:279-284. [DOI: 10.1136/bjophthalmol-2020-315875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/20/2020] [Accepted: 04/04/2020] [Indexed: 12/28/2022]
Abstract
Background/AimsTo validate the prognostic performance of the American Joint Committee on Cancer (AJCC) eighth edition classification for ocular adnexal lymphoma (OAL).MethodsWe performed a retrospective review of 140 consecutive patients treated for primary OAL between March 2010 and September 2017. Associations between T/N/M categories at presentation and disease-related outcomes, including relapse, progression-free survival (PFS) and overall survival (OS) were evaluated.ResultsSeventy-nine women and 61 men (median age, 52 (range 20–84) years; median follow-up, 57 (range 7–131) months) were included. Histological subtypes included mucosa-associated lymphoid tissue lymphoma (92.1%, n=129), diffuse large B-cell lymphoma (5.0%, n=7), follicular lymphoma (1.4%, n=2) and mantle cell lymphoma (1.4%, n=2). Patients with ≥T2 disease had significantly higher risks of overall relapse (unadjusted HR)=4.32, p=0.016), decreased PFS (uHR=5.19, p=0.004) and decreased OS (uHR=9.21, p=0.047). Patients with ≥N1 disease had significantly higher risks of overall relapse (uHR=9.17, p<0.001) and decreased PFS (uHR=9.24, p<0.001). M1 disease was significantly associated with higher risks of overall relapse (uHR=3.62, p=0.036), decreased PFS (uHR=5.13, p=0.001) and decreased OS (uHR=9.24, p=0.013). On considering TNM categories as continuous data, the uHRs for per level increase in T, N and M categories were 1.77, 1.83 and 2.30 for overall relapse and 1.72, 1.87 and 2.78 for decreased PFS, respectively (p<0.05 for each comparison).ConclusionThe T, N and M categories of the AJCC eighth edition classification have prognostic value for relapse and survival among patients with primary OAL. Particularly, nodal/metastatic involvement at presentation indicated less favourable outcome.
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Abstract
Conjunctival malignancies are rare. However, some of these tumors are among the most aggressive malignancies in ophthalmology and require radical forms of therapy that may lead to blindness or loss of the ipsilateral eye and tumor-associated death. The most relevant primary conjunctival malignancies for oncologists are squamous cell carcinoma, malignant melanoma and malignant lymphoma. Surgical therapy is the primary treatment for squamous cell carcinoma and malignant melanoma. An adjuvant therapy in the form of topical chemotherapy or radiation is necessary in most cases. The isolated malignant lymphoma of the conjunctiva is biopsied excisionally if possible. However, if an incisional biopsy was unavoidable, additional irradiation should be performed; malignant lymphoma generally responds very well to relatively low irradiation doses with a good prognosis quad vitam. More aggressive forms, such as diffuse large cell B‑cell lymphoma or mantle cell lymphoma, must also be treated systemically at an early stage.
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Affiliation(s)
- Claudia Auw-Hädrich
- Klinik für Augenheilkunde Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Thomas Reinhard
- Klinik für Augenheilkunde Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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White VA. Understanding and Classification of Ocular Lymphomas. Ocul Oncol Pathol 2019; 5:379-386. [PMID: 31768360 PMCID: PMC6872993 DOI: 10.1159/000499845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lymphomas that involve the tissues of the ocular adnexae and the eye itself can be confusing for both the new and seasoned learner alike. In this review, I present a simple way of classifying these disorders that will help to facilitate understanding of these myriad entities. SUMMARY Classifications of lymphomas have changed significantly over the last 40 years, but in recent decades, the basic structure of the WHO classification has remained the same, facilitating understanding. KEY MESSAGES The ocular lymphomas can be divided into those that are external to the eye (ocular adnexae) and those that are internal (vitreoretinal and uveal). At each of these sites specific subtypes of lymphoma are common. Focusing on these common subtypes can aid the learner to create a scaffold that enables current understanding and upon which they can build for the future.
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Affiliation(s)
- Valerie A. White
- WHO/IARC Classification of Tumours Group, International Agency for Research on Cancer, Lyon, France
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12
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Tanenbaum RE, Galor A, Dubovy SR, Karp CL. Classification, diagnosis, and management of conjunctival lymphoma. EYE AND VISION 2019; 6:22. [PMID: 31372366 PMCID: PMC6660942 DOI: 10.1186/s40662-019-0146-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/15/2019] [Indexed: 02/06/2023]
Abstract
Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. Approximately 5-15% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. Ninety-eight percent of conjunctival lymphomas arise from B-lymphocytes. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma (80%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%) and mantle cell lymphoma (3%). Natural killer and T cells (NK/T) are rare causes of lymphoma. While most conjunctival lymphomas are localized to the ocular adnexa at the time of presentation, systemic examination and management are of key importance in the long-term care of the patient. This review outlines the classification, etiology, presentation, diagnosis, and management of conjunctival lymphoma. The novel use of high resolution optical coherence tomography, both as a diagnostic tool and as a means for ongoing evaluation during treatment, is illustrated. Treatment options discussed include external beam radiation, chemotherapy, immunotherapy, antibiotic therapy, and combination regimens. Future investigation of the etiology and pathogenesis of conjunctival lymphoma is expected to reveal opportunities for innovative and individualized therapeutic agents. Collaboration between multiple disciplines is key in the advancement of the field.
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Affiliation(s)
- Rebecca E Tanenbaum
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
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Significant expression of CHK1 and p53 in bladder urothelial carcinoma as potential therapeutic targets and prognosis. Oncol Lett 2017; 15:568-574. [PMID: 29391889 DOI: 10.3892/ol.2017.7344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023] Open
Abstract
Checkpoint kinase 1 (CHK1) and p53 are involved in cell-cycle checkpoint, and cellular response to DNA damage. CHK1 and p53 are overexpressed in bladder urothelial carcinoma (BUC); however, a clear elucidation on their interaction and influence in the progress of BUC is absent. The aim of the present study was to examine the correlation between CHK1 and p53 in BUC, and analyze their value as therapeutic targets and prognostic indicators in BUC. A clinically annotated cohort of 110 patients with BUC was identified retrospectively. EnVision-based immunohistochemistry and western blot analysis of the aforementioned DNA repair proteins were conducted on formalin-fixed-paraffin-embedded or frozen tissues from the primary tumor. A total of 45 peritumoral tissue cases were assessed similarly as the control group. In the cohort of 110 patients with BUC, a significant overexpression of CHK1 and p53 was observed in primary compared with the peritumoral tissues (P<0.05). CHK1 and p53 demonstrated a positive correlation in BUC, and both were positively associated with the histological grade, clinical pathological staging, lymphatic metastasis and the 5-year survival rate (P<0.05). However, CHK1 and p53 were not associated with sex, age, tumor diameter, single/multiple sites or incipient/recurrence. The overexpression of CHK1 and p53, and their synergistic interaction were putatively correlated with the physiology of BUC that may be deemed as potential therapeutic targets and prognostic indicators.
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Parikh VS, Jagadeesh D, Fernandez JM, Hsi ED, Singh AD. Orbital diffuse large B-cell lymphoma with combined variable immunodeficiency. Orbit 2017; 36:340-343. [PMID: 28718689 DOI: 10.1080/01676830.2017.1337170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
Common variable immunodeficiency (CVID) is a primary immunodeficiency manifesting as a reduction in the level of total immunoglobulin (Ig) G, a reduction in the level of either IgA or IgM, poor response to polysaccharide vaccine, and usually frequent infections. The association of CVID with an increased risk of malignancy, specifically lymphoma, is well known. A 63-year-old female with a past medical history significant for CVID presented with a 1-month history of dull, left eye pain with proptosis, hypoglobus, and left upper lid fullness without a discrete palpable mass. Magnetic resonance imaging (MRI) of the orbits revealed a diffuse infiltrating orbital mass superonasally with extension into the superior rectus muscle, medial rectus muscle, and optic nerve up to the orbital apex and ethmoid sinus. A superonasal orbital biopsy with a caruncular approach was performed and demonstrated a sparse lymphoid infiltrate that was suggestive for a large B-cell neoplasm. Positron emission tomography (PET) scan demonstrated a hypermetabolic right lymph node, anterior to the right submandibular gland, which was biopsied and histopathology confirmed diffuse large B-cell lymphoma (DLBCL). Our patient achieved a very good response to chemotherapy with minimal residual disease on PET scan at the end of treatment. She attained a complete remission after radiation therapy. In conclusion, patients with new orbital and adnexa masses in the setting of a primary immunodeficiency can have an aggressive malignancy such as DLBCL and early diagnosis and systemic treatment carries a good prognosis.
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Affiliation(s)
- Vishal S Parikh
- a Department of Ophthalmology, Cole Eye Institute , Cleveland Clinic Foundation , Cleveland , Ohio , USA
| | - Deepa Jagadeesh
- b Department of Hematology and Medical Oncology, Taussig Cancer Institute , Cleveland Clinic Foundation , Cleveland , Ohio , USA
| | - James M Fernandez
- c Department of Allergy/Immunology, Respiratory Institute , Cleveland Clinic Foundation , Cleveland , Ohio , USA
| | - Eric D Hsi
- d Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute , Cleveland Clinic Foundation , Cleveland , Ohio , USA
| | - Arun D Singh
- a Department of Ophthalmology, Cole Eye Institute , Cleveland Clinic Foundation , Cleveland , Ohio , USA
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Abstract
Conjunctival biopsies constitute a fairly large number of cases in a typical busy ophthalmic pathology practice. They range from a single biopsy through multiple mapping biopsies to assess the extent of a particular pathological process. Like most anatomical sites, the conjunctiva is subject to a very wide range of pathological processes. This article will cover key, commonly encountered nonneoplastic and neoplastic entities. Where relevant, sections will include recommendations on how best to submit specimens to the ophthalmic pathology laboratory and the relevance of up-to-date molecular techniques.
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16
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Ma WL, Yao M, Liao SL, Tang JL, Wang YC, Kuo SH, Cheng AL. Chemotherapy alone is an alternative treatment in treating localized primary ocular adnexal lymphomas. Oncotarget 2017; 8:81329-81342. [PMID: 29113392 PMCID: PMC5655287 DOI: 10.18632/oncotarget.18500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 05/29/2017] [Indexed: 12/25/2022] Open
Abstract
This study investigated the treatment efficacy and long-term adverse effects of various treatment modalities for primary ocular adnexal lymphomas (POALs). We retrospectively reviewed 107 patients who received first-line chemotherapy, radiotherapy, and other treatment modalities from 1990 to 2015. Nighty-three (87%) patients were diagnosed with mucosa-associated lymphoid tissue (MALT) lymphoma, with the orbit being the most common site (49 patients, 46%). Among 91 patients with stage I–IIE1 disease, 26 underwent chemotherapy, 34 underwent radiotherapy, and 31 received other treatment modalities. For chemotherapy, radiotherapy, and other treatment modalities, the 5-year event-free survival (EFS) rates were 90.0%, 89.7%, and 85.8% and the 5-year overall survival (OS) rates were 100%, 90.4%, and 87.5%, respectively. Moreover, among 80 patients with stage I–IIE1 MALT lymphoma, the complete remission, 5-year EFS and OS rates were not significantly different between patients receiving chemotherapy and those receiving radiotherapy. Among 16 patients with stage IIE2–IVE disease, the 5-year EFS rates for chemotherapy alone (n = 11) and combined radiotherapy and chemotherapy (n = 5) were 61.7% and 80%, respectively, whereas the 5-year OS rate for both groups was 80.0%. Neutropenia (15.2%) was the most common side effect in patients who received chemotherapy, whereas cataract (16.3%) was the most common late sequela in patients who received radiotherapy. Multivariate analysis revealed that old age (> 60 y) and an advanced stage (stage III/IV) were prognostic factors for poor OS. Our results indicate that chemotherapy yields satisfactory disease control and fewer side effects, and acts as an alternative therapy for patients with localized POALs.
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Affiliation(s)
- Wei-Li Ma
- Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.,Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ching Wang
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
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17
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Wajda BN, Rabinowitz MR, Nyquist GG, Mardekian SK, Rosen MR, Rabinowitz MP. Paranasal sinus lymphoma: Retrospective review with focus on clinical features, histopathology, prognosis, and relationship to systemic lymphoma. Head Neck 2017; 39:1065-1070. [PMID: 28339134 DOI: 10.1002/hed.24686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/26/2016] [Accepted: 11/17/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Paranasal sinus lymphoma is a rare clinical entity. METHODS We conducted a retrospective case series of 68 patients with biopsy-confirmed paranasal sinus lymphoma with attention on systemic disease association. RESULTS Of 63 patients with paranasal sinus lymphoma, 35 (56%) had systemic involvement. Four patient groups were identified: (1) primary paranasal sinus lymphoma (44%); (2) systemic disease occurring concurrently with paranasal sinus lymphoma (25%); (3) paranasal sinus lymphoma with relapse of preexisting systemic lymphoma (22%); and (4) progression to systemic disease after primary paranasal sinus lymphoma (8%). Most of the patients with systemic disease were diagnosed at 50 + years and had positive smoking histories. There was a trend toward disease activity in the neighboring ocular location. For patients with preexisting systemic lymphoma, the mean time to paranasal sinus lymphoma was 65 months. When systemic lymphoma developed after localized paranasal sinus lymphoma, mean time to progression was 23 months. Diffuse large B cell lymphoma was the most common paranasal sinus lymphoma. CONCLUSION There is a risk of systemic involvement during the disease course of paranasal sinus lymphoma. Biopsy is the preferred first management step and should precede debulking or mass resection in nonemergent cases. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1065-1070, 2017.
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Affiliation(s)
- Brynn N Wajda
- Wills Eye Hospital Ophthalmology Residency Program, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mindy R Rabinowitz
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gurston G Nyquist
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stacey K Mardekian
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Marc R Rosen
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael P Rabinowitz
- Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Philadelphia, Pennsylvania
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18
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Guffey Johnson J, Terpak LA, Margo CE, Setoodeh R. Extranodal Marginal Zone B-cell Lymphoma of the Ocular Adnexa. Cancer Control 2017; 23:140-9. [PMID: 27218791 DOI: 10.1177/107327481602300208] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Low-grade B-cell lymphomas located around the eye present unique challenges in diagnosis and treatment. Extranodal marginal zone B-cell lymphoma is the most common lymphoma of the ocular adnexa (conjunctiva, orbit, lacrimal gland, and eyelid). METHODS A systematic search of the relevant literature was performed. Material pertinent to the diagnosis, prognosis, pathogenesis, and treatment of extranodal marginal zone B-cell lymphoma of the ocular adnexa was identified, reviewed, and analyzed, focusing on management strategies for primary localized disease. RESULTS The primary cause of extranodal marginal zone B-cell lymphoma of the ocular adnexa remains elusive, although an infectious agent is suspected. Radiotherapy is the most common initial treatment for localized disease. Initial treatment with chemotherapy, immunotherapy, and antibiotics has shown promising results, but the number of series is limited and controlled trials do not exist. CONCLUSIONS Although the long-term outcome of localized extranodal marginal zone B-cell lymphoma of the ocular adnexa is good, optimal treatment remains a goal. The variation in rates of local and systemic relapse among treated stage 1E tumors suggests that critical factors affecting outcomes are not fully understood. Radiotherapy is the standard of care; at this time, the evidence is insufficient to recommend chemotherapy, immunotherapy, or antibiotics for initial treatment of extranodal marginal zone B-cell lymphoma localized to the ocular adnexa. Well-controlled comparative studies are needed.
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Affiliation(s)
- Jean Guffey Johnson
- Department of Pathology and Cell Biology, Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa 33612, USA.
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Shields CL, Chien JL, Surakiatchanukul T, Sioufi K, Lally SE, Shields JA. Conjunctival Tumors: Review of Clinical Features, Risks, Biomarkers, and Outcomes--The 2017 J. Donald M. Gass Lecture. Asia Pac J Ophthalmol (Phila) 2017; 6:109-120. [PMID: 28399347 DOI: 10.22608/apo.201710] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 11/08/2022] Open
Abstract
Conjunctival tumors encompass a broad range of diagnoses. The 3 most important malignant tumors include ocular surface squamous neoplasia (OSSN) (14%), melanoma (12%), and lymphoma (7%). Conjunctival malignancies are rarely found in children. Regarding OSSN, pre-disposing conditions include chronic solar radiation, immune deficiency (HIV), organ transplant, autoimmune conditions, xeroderma pigmentosum, and chronic exposure to cigarette smoke. OSSN is managed surgically or with topical/injection immunotherapy or chemotherapy. Metastasis occurs in <1%. Regarding melanoma, predisposing conditions include primary acquired melanosis (PAM), chronic nevus, and chronic solar radiation. Treatment of PAM or nevus can prevent melanoma. Melanoma management involves surgical resection with clean margins and avoidance of direct tumor manipulation ("no touch" technique). The first surgery is most important, to minimize tumor seeding. Biomarkers including BRAF, TERT, and PTEN provide information regarding risk for metastasis and allow for targeted antibiomarker therapies. Ten-year risk for melanoma metastasis is 25%. Tumors >2 mm thickness or those located in fornix, caruncle, or orbit are at highest risk for metastasis. Regarding lymphoma, predisposing conditions include benign reactive lymphoid hyperplasia, immune deficiency (HIV), immune dysfunction, and chronic inflammation/infection (Helicobacter pylori, Chlamydia psittaci). The 4 most important subtypes include extranodal marginal zone lymphoma (ENMZL), follicular lymphoma, mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma. Treatment includes surgical resection, cryotherapy, radiotherapy, systemic chemotherapy, or targeted anti-B-cell therapy (rituximab). Lymphoma-related survival (5-year) depends on subtype and ranges from 97% (ENMZL) to 9% (MCL). Recognizing conjunctival tumors and understanding predisposing factors, biomarkers, and treatment strategies are vital to patient outcomes.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jason L Chien
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | | | - Kareem Sioufi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
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Honavar SG, Manjandavida FP. Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016. Asia Pac J Ophthalmol (Phila) 2017; 6:153-158. [PMID: 28399335 DOI: 10.22608/apo.201736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this review article is to provide an update of the current literature on orbital tumors. The authors conducted a PubMed literature search of English language articles published between January 2014 and December 2016 using the following search items: orbit, tumors, lacrimal gland, lymphoma, hemangioma, lymphangioma. The authors included reviews, original articles, case series, and case reports with relevant new information. There is new information about the clinical spectrum of orbital tumors, capillary hemangioma, cavernous hemangioma, lymphangioma, orbital venous malformation, lacrimal gland tumors, and orbital lymphoma. This review highlights the current understanding, practice, and guidelines in the diagnosis and management of common tumors of the orbit.
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Affiliation(s)
- Santosh G Honavar
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Center for Sight, Hyderabad
| | - Fairooz P Manjandavida
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, HORUS Specialty Eye Care, Bangalore, India
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21
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Verdijk RM. Lymphoproliferative Tumors of the Ocular Adnexa. Asia Pac J Ophthalmol (Phila) 2017; 6:132-142. [PMID: 28399341 DOI: 10.22608/apo.2016209] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/17/2017] [Indexed: 11/08/2022] Open
Abstract
The ocular adnexa include the eyelids, conjunctiva, lacrimal apparatus, and orbital soft tissue. One percent of all lymphomas and approximately 8% of all extranodal lymphomas arise in the ocular adnexa and their incidence is increasing. Reactive lymphoid hyperplasia comprises 16% of all lymphoproliferative tumors of the ocular adnexa. The relative frequencies of ocular adnexal lymphoma presentation are in the orbit, 37%; conjunctiva, 29%; lacrimal apparatus, 20%; and eyelid, 14%. The most frequent primary lymphoma types of the ocular adnexa are extranodal marginal zone lymphoma, 62%; follicular lymphoma, 17%; and diffuse large B-cell lymphoma, 10%. The eyelids show the highest proportion of secondary lymphoma involvement, 49% of all eyelid lymphoproliferative lesions, compared with 24% in all ocular adnexa. The specific aspects of the site, histologic, immunohistochemical, cytogenetic, and molecular findings of the most relevant lymphoma types occurring in the various parts of the ocular adnexa will be discussed in relation to clinical parameters and relevance for therapy choice. Furthermore, the implications of the updated version of the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues in relation to ocular adnexal lymphoma are reviewed.
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Affiliation(s)
- Robert M Verdijk
- Department of Pathology, section Ophthalmic Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam; and Rotterdam Eye Hospital, Rotterdam, Netherlands
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22
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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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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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Abstract
BACKGROUND Lymphomas of the ocular adnexa are heterogeneous and demonstrate a wide range of clinical, histological, immunohistochemical and molecular genetic characteristics. AIM The aim of this article is to give an overview of the interdisciplinary diagnostics and individually adapted lymphoma subtype-based therapy. DIAGNOSTICS Depending on the lymphoma localisation, i.e. whether in the eyelid, the conjunctiva or in the orbit, a photograph or a radiological scan is required to record the tumor extent. Visual function is more likely to be impacted when the lymphoma arises in the posterior orbit, close to the optic nerve and imaging diagnostics are therefore necessary. Histological investigations are essential for confirming the lymphoma diagnosis and give information about the particular subtype, which in turn will determine subsequent patient management, Clinical staging investigations for determining the systemic extent of the lymphoma manifestation (e.g. imaging, blood analyses as well as bone marrow biopsy) are mandatory. THERAPY External beam radiation, local and systemic chemotherapy or in some cases antibiotics are treatment options after surgical excision in isolated ocular adnexal lymphoma. The TNM classification of the American Joint Committee on Cancer or the Ann Arbor staging system, as well as the guidelines of the German Society of Hematology and Medical Oncology are all tools to aid the choice of the appropriate individually adapted therapy for systemic disease, which includes psycho-oncological care.
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Abstract
Lymphoproliferative diseases of the orbit account for majority of orbital tumors. The pathologies range from reactive lymphoid hyperplasia to specific IgG4-related inflammation to malignant lymphomas. This review summarizes current concepts regarding pathology, clinical presentation, diagnosis, staging, and treatment strategies of major orbital lymphoproliferative diseases based on updated and relevant bibliography.
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Affiliation(s)
- Emmy Y Li
- From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; †Hong Kong Eye Hospital; and ‡Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
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Outcomes of primary lymphoma of the ocular adnexa (orbital lymphoma) treated with radiotherapy. Clin Oncol (R Coll Radiol) 2014; 27:153-9. [PMID: 25455843 DOI: 10.1016/j.clon.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 09/16/2014] [Accepted: 09/24/2014] [Indexed: 12/27/2022]
Abstract
AIMS Low-grade ocular adnexal lymphoma is a rare disease and often treated with local radiotherapy to varying doses. Most previously reported studies have a very heterogeneous patient population and treatments. We report the outcomes from a 10 year cohort of patients at our institution treated with primary radiation therapy. MATERIALS AND METHODS We analysed a retrospective case series of patients with stage IE low-grade ocular adnexal lymphoma including a review of case notes, histological reports and radiotherapy charts. We assessed local and distant tumour control and relapse rates in addition to toxicity. Disease-free survival was estimated using the Kaplan-Meier method. RESULTS In total, 81 patients and 85 orbits were treated with primary radiotherapy to a median dose of 30 Gy in 15 fractions over 3 weeks. Seventy-nine per cent were treated with standard MV external beam radiotherapy to the whole orbit and 21% with a lens-sparing technique. The median follow-up was 4.4 years (range 0.2-10.4). Local control rates were 100%, with 5% of patients experiencing disease relapse elsewhere. No patients died from lymphoma. Cumulative acute toxicity rates were 51% (mainly erythema and conjunctivitis) and late toxicity rates were 8% (mainly cataract). The lens-sparing technique was associated with a significant reduction in cataract rate (P = 0.013) and an increase in acute toxicity (P < 0.001). CONCLUSIONS This study has shown excellent local control rates and acceptable toxicity from the treatment of stage IE low-grade ocular adnexal lymphoma with localised radiotherapy to a median dose of 30 Gy in 15 fractions over 3 weeks.
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