1
|
Moussa K, Everett L. Ocular lymphoproliferative disorders. Curr Opin Ophthalmol 2021; 32:541-548. [PMID: 34411030 DOI: 10.1097/icu.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Ocular lymphoproliferative disorders are a heterogenous group of pathologic disorders with significant impact on quality of life and, at times, may be life-threatening. Due to the rarity of these disorders, information regarding proper diagnosis, treatment, and prognosis is limited. This review summarizes the key features of the unique diseases within this group of lymphoproliferative disorders, with a focus on disease presentation, diagnostic considerations, and treatment and prognosis. RECENT FINDINGS High-quality data from recent studies have provided answers regarding clinical outcomes for subsets of ocular lymphoproliferative disorders and are included herein. New diagnostic techniques are also discussed as well as current treatment strategies. SUMMARY Ocular lymphoproliferative disorders are a rare group of diseases. Key features of each disease is presented in this review in a concise and readable format, as well as updated information regarding diagnostic considerations and treatment options.
Collapse
Affiliation(s)
- Kareem Moussa
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California
| | - Lesley Everett
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
2
|
Shimizu N, Oshitari T, Yotsukura J, Yokouchi H, Baba T, Yamamoto S. Ten-year epidemiological study of ocular and orbital tumors in Chiba University Hospital. BMC Ophthalmol 2021; 21:344. [PMID: 34556080 PMCID: PMC8459513 DOI: 10.1186/s12886-021-02108-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study is to determine the epidemiology of tumors of the ocular adnexa and orbit in Japan. Methods We conducted a retrospective study on the histopathological reports in the medical records of the Chiba University Hospital from April 2009 to March 2019. Three hundred and seventy two records were examined. In addition, we examined the annual changes in the major types of tumors including malignant lymphomas and IgG4-related diseases (IgG4-RDs). Results There were 270 conjunctival or eyelid tumors with 166 benign and 104 malignant. There were 102 orbital tumors with 55 benign, 47 malignant tumors, and 21 cases of IgG4-RDs. Ten cases of adenoma (2.7%), another benign tumor, was also diagnosed. The major malignant tumors were malignant lymphoma in 74 cases, sebaceous gland carcinoma (SGC) in 28 cases, basal cell carcinoma in 15 cases, and squamous cell carcinoma in 8 cases. The SGCs were the most common malignant eyelid tumor at 54%. Among the malignant lymphomas, extranodal marginal zone lymphomas of the mucosa-associated lymphoid tissue type, MALT lymphomas, was the most common at 51 cases and the second most common was the diffuse large B-cell lymphoma at 11 cases. The ratio of MALT lymphomas to that of all malignant lymphomas increased significantly with years. The serum IgG4 values were measured more often in the last 5 years (70%) than in the former 5 years (33%). Conclusions We conclude that malignant lymphoma is a major malignant tumor in Japan and pathological biopsies should be done proactively to prevent missing IgG4-positive MALT lymphomas. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02108-w.
Collapse
Affiliation(s)
- Norihiro Shimizu
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Toshiyuki Oshitari
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan. .,Department of Ophthalmology, International University of Health and Welfare, School of Medicine, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.
| | - Jiro Yotsukura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaka Yokouchi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| |
Collapse
|
3
|
Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Indian J Ophthalmol 2019; 67:1930-1948. [PMID: 31755426 PMCID: PMC6896532 DOI: 10.4103/ijo.ijo_2040_19] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.
Collapse
Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Ahn J, Park MH, Yoo JM, Seo SW. A Case of Orbital Lymph Node Misdiagnosed as a Dermoid. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.7.672] [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)
- Jayoung Ahn
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Mi Hwa Park
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji Myong Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| |
Collapse
|
5
|
Freitag SK, Cunnane ME, Yoon MK, Barnes JA, Winkfield KM, Sohani AR. Case records of the Massachusetts General Hospital. Case 18-2015. A 41-year-old woman with decreased vision in the left eye and diplopia. N Engl J Med 2015; 372:2337-45. [PMID: 26061839 DOI: 10.1056/nejmcpc1415170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
6
|
Lukashevich M, Mayer C, Rudelius M. [Unclear tumor under the upper eyelid]. Ophthalmologe 2013; 110:773-5. [PMID: 23695290 DOI: 10.1007/s00347-013-2860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Lukashevich
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | | | | |
Collapse
|
7
|
Lee SJ, Jung JH, Choi HY. Analysis of Clinical Features and Prognostic Factor Analysis of Orbital and Adnexal Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Jun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
8
|
Olbertz L, Lima L, Langohr I, Werner J, Teixeira L, Montiani-Ferreira F. Supposed primary conjunctival lymphoma in a dog. Vet Ophthalmol 2012; 16 Suppl 1:100-4. [PMID: 22524231 DOI: 10.1111/j.1463-5224.2012.01027.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 7-year-old, male mixed-breed dog was presented for evaluation of a well-delineated, pink, oval and slightly firm mass with a smooth regular surface that was expanding approximately 60% of the lower eyelid conjunctiva and the lateral canthus. The dog had a supposed primary B-cell lymphoma at the temporal canthus of the upper eyelid conjunctiva of the same eye that had been removed approximately 3 years earlier. No metastases were detected at either presentation. Histologically, the conjunctival lamina propria was effaced by a well-delineated, unencapsulated and expansile highly cellular neoplasm composed of sheets of round cells that were immunohistochemically positive for CD20 and CD79a negative for CD3. Based on the microscopic and immunohistochemical findings, a diagnosis of supposed primary B cell conjunctival lymphoma was made. Primary ocular and adnexal ocular lymphomas in dogs are rarely reported and their behavior is poorly characterized. Further tumor recurrence was not observed one year post operatively. This case was considered unusual because of its conjunctival involvement and the clinical course with recurrence after three years of a surgical therapeutic procedure.
Collapse
Affiliation(s)
- Letícia Olbertz
- Veterinary Medicine Department, Federal University of Paraná State, Curitiba, Brazil Diagnostic Center for Population and Animal Health, Michigan State University, East Lansing, MI, USA
| | | | | | | | | | | |
Collapse
|
9
|
Mombaerts I. Efficacy of radiotherapy in the treatment of orbital pseudotumor: in regards to Matthiesen et al. (Int J Radiat Oncol Biol Phys 2011;79:1496-502). Int J Radiat Oncol Biol Phys 2011; 81:901; author reply 901-2. [PMID: 21982206 DOI: 10.1016/j.ijrobp.2011.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Indexed: 11/25/2022]
|
10
|
Levy J, Ilsar M, Deckel Y, Maly A, Pe'er J. Lesions of the caruncle: a description of 42 cases and a review of the literature. Eye (Lond) 2008; 23:1004-18. [PMID: 18927596 DOI: 10.1038/eye.2008.316] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Lesions of the caruncle are uncommon. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. Clinical preoperative diagnosis is very difficult and reached only in about half of the cases. The vast majority of lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare but can be potentially fatal. Although malignancy is clinically overestimated, any suspected malignant lesion should be excised and examined histopathologically by an experienced pathologist. This study presents the clinical and histological data of 42 consecutive caruncular lesions processed at our laboratory and reviews previously reported cases of caruncular lesions.
Collapse
Affiliation(s)
- J Levy
- Department of Ophthalmology, Soroka University Medical Centre, Beer-Sheva, Israel
| | | | | | | | | |
Collapse
|
11
|
Lagoo AS, Haggerty C, Kim Y, Hammons M, Neufeld K, Redher C, Woodward J, Klintworth GK. Morphologic Features of 115 Lymphomas of the Orbit and Ocular Adnexa Categorized According to the World Health Organization Classification: Are Marginal Zone Lymphomas in the Orbit Mucosa-Associated Lymphoid Tissue–Type Lymphomas? Arch Pathol Lab Med 2008; 132:1405-16. [DOI: 10.5858/2008-132-1405-mfolot] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Marginal zone lymphomas (MZLs) are the most common lymphomas encountered in the orbit and ocular adnexa. The accurate categorization of these lymphomas is critical to avoid undertreatment or overtreatment.
Objective.—To identify features of orbital MZLs that distinguish them from other lymphomas and reactive lymphoid infiltrates and support the categorization of orbital MZL as mucosa-associated lymphoid tissue (MALT)–type MZLs.
Design.—Biopsies from 149 patients with lymphoid lesions of ocular adnexa were examined. Additional immunohistochemical stains and fluorescence in situ hybridization study for the MALT1 locus were performed in selected cases, and patient charts were reviewed.
Results.—A total of 115 lymphomas and 34 reactive infiltrates were identified, of which B-cell lymphomas constituted 92% and MZLs constituted 54% of all lymphomas. Certain clinical features (young age, race, bilaterality) favored a reactive infiltrate, but none were diagnostic. Histologic features, such as infiltrative lesions, reactive B-cell follicles, and lymphoepithelial lesions, overlapped between reactive infiltrates and conjunctival MZL. In contrast to conjuctival MZL, orbital MZL infrequently showed reactive follicles, rarely showed epithelial tissue, and did not show lymphoepithelial lesions. Cytogenetic abnormality involving the MALT1 locus was demonstrated in only 15% of ocular adnexal MZLs.
Conclusion.—Many MZLs of orbital soft tissue lack key features associated with MALT-type MZL, and the designation MALT lymphoma should be avoided in their diagnosis.
Collapse
Affiliation(s)
- Anand S. Lagoo
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Christopher Haggerty
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Young Kim
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Matthew Hammons
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Kenneth Neufeld
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Catherine Redher
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Julie Woodward
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Gordon K. Klintworth
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| |
Collapse
|
12
|
Orbital lymphoproliferative tumors: analysis of clinical features and systemic involvement in 160 cases. Ophthalmology 2008; 115:1626-31, 1631.e1-3. [PMID: 18440641 DOI: 10.1016/j.ophtha.2008.02.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 01/31/2008] [Accepted: 02/06/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the risk for systemic lymphoma (SL) in the patients with orbital lymphoproliferative tumor (OLT). DESIGN Observational, retrospective case series. PARTICIPANTS One hundred sixty consecutive cases with OLT. METHODS Clinical features and treatment method were collected retrospectively. Data from 106 patients without systemic disease at presentation were analyzed for their impact on the main outcome measure using univariate and multivariate regression models. MAIN OUTCOME MEASURE Occurrence of SL diagnosed based on the 6 monthly systemic evaluation. RESULTS Of 106 patients with OLT alone, SL subsequently developed in 16% of patients and 84% patients remained free of SL. Of 17 patients in whom SL developed subsequently, 29% had marginal zone, B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT), 24% had small lymphocytic lymphoma (SLL), 24% had atypical lymphoid hyperplasia (ALH), 6% each had mantle cell, follicular, and diffuse large B-cell lymphoma (DLCL). In these 17 patients, systemic disease appeared after a mean interval of 152 months, and the involved systemic sites were abdominal lymph nodes (LN) in 44% patients, pelvic LN in 40%, and head and neck LN in 31%. Of 17 patients, 53% had the same SL classification with orbital tumor and 47% had a different SL classification. Among 8 patients with different systemic and orbital lymphoma classifications, systemic SLL developed in 4 patients with orbital ALH and in 2 patients with MALT. Two patients with orbital SLL manifested systemic DLCL. Using Kaplan-Meier estimates of 106 OLT patients without systemic involvement, SL developed in 14% at 3 years, in 17% at 5 years, and in 33% at 10 years. Using Kaplan-Meier estimates of 24 patients with bilateral OLT alone, SL developed in 18% at 3 years, in 29% at 5 years, and in 72% at 10 years. In 82 patients with unilateral OLT alone, SL developed in 12% at 3, 5, and 10 years. Multivariate analysis showed that bilateral involvement at presentation was the only significant factor predictive of SL. CONCLUSIONS In patients with OLT alone at presentation, SL eventually developed in 33% by 10 years in this retrospective case series. Classification of SL can be the same or different from OLT. Development of SL is significantly associated with bilateral involvement.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Numerous conjunctival tumors can occur in children, originating from tissues of choristomatous, epithelial, melanocytic, vascular, fibrous, xanthomatous and lymphoid. Overall, 97% prove to be benign and only 3% are malignant. RECENT FINDINGS The most common malignancies include conjunctival lymphoma and melanoma. In our experience, the most common conjunctival tumors in children include nevus (64%), dermolipoma (5%), lymphangioma (3%) and capillary hemangioma (3%). Conjunctival nevi can manifest as a darkly pigmented (65%), lightly pigmented (19%) and completely nonpigmented (16%) mass. Most nevi occurred at the nasal or temporal limbus, without involvement of the cornea. Occasionally, they are located in the caruncle, but rarely are nevi found in the fornix or tarsal conjunctival surface. Intralesional cysts are visible in 65% of nevi. Change in nevus color over time has been noted in 5% of cases and change in nevus size has been documented in 7%. Evolution of conjunctival nevus into malignant melanoma is extremely low (<1%). SUMMARY Conjunctival nevus is the most common conjunctival tumor in children and fewer than 1% evolve into melanoma over time.
Collapse
Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
| | | |
Collapse
|
14
|
Faridpooya K, Mulder MMS, Merks JHM, de Smet MD, Pals ST, Saeed P. Precursor B lymphoblastic lymphoma of the orbit in a child: an unusual presentation of a non-Hodgkin lymphoma. Orbit 2006; 25:153-7. [PMID: 16754229 DOI: 10.1080/01676830600575501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The majority of ocular adnexal lymphomas are marginal zone lymphomas, which occur rarely in children. This case report describes a 6 years old child with a precursor B lymphoblastic lymphoma presenting in the ocular adnexa. The combination of multi-agent chemotherapy with adjuvant radiotherapy seems to be necessary in order to achieve a complete remission of this subtype of lymphoma's in ocular adnexa. DESIGN Retrospective case study. METHOD A review of the clinical, pathological, radiological findings and follow-up in a patient from the files available at our center, which were reviewed between the years 1974 and 2004.
Collapse
Affiliation(s)
- K Faridpooya
- Department of Ophthalmology, Orbital Centre, Academic Medical Centre, Amsterdam, Holland.
| | | | | | | | | | | |
Collapse
|
15
|
Benabid L, Desablens B, Brevet M, Malthieu D, Milazzo S, Turut P. Les lymphomes malins non hodgkiniens conjonctivo-orbitaires. J Fr Ophtalmol 2005; 28:1058-64. [PMID: 16395197 DOI: 10.1016/s0181-5512(05)81138-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although the number of non-Hodgkin's lymphoma (NHL) cases continues to grow throughout the world, orbital NHL is still a rare tumor that is difficult to diagnose. The objective of our study was to analyze the different orbital NHLs diagnosed in our Ophthalmology Department during the last 20 years. MATERIAL AND METHODS [corrected] We conducted a retrospective study of conjunctive-orbital lymphomas diagnosed in the Amiens Ophthalmology Department between 1982 and 2002. The pathological reports of 22 cases were investigated, notably the mode of onset, the clinical and radiological description, the diagnostic mode, pathological results, and the type of treatment provided for these tumors. RESULTS Every NHL was type B. They were for the most part low grade in terms of malignancy, isolated, primitive, orbital and inactive. DISCUSSION Insidious, slow-growing lesions are often found, and biopsy can be difficult. This may explain delayed diagnosis. The first differential diagnosis is inflammatory pseudotumor. Only a good biopsy can confirm the diagnosis of NHL. CONCLUSION New immunohistochemistry and genetic diagnostic methods make it increasingly possible to screen for NHL, even if the clinical history can be misleading. Moreover, treatments that are more and more precisely targeted to the immunohistochemical type of NHL seem to be giving very promising results. Several studies are ongoing.
Collapse
Affiliation(s)
- L Benabid
- Service d'Ophtalmologie, Centre Hospitalier Universitaire, Amiens.
| | | | | | | | | | | |
Collapse
|
16
|
Telander DG, Lee TZ, Pambuccian SE, Huang AJW. Subconjunctival corticosteroids for benign lymphoid hyperplasia. Br J Ophthalmol 2005; 89:770-1. [PMID: 15923517 PMCID: PMC1772705 DOI: 10.1136/bjo.2004.051342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Sullivan TJ, Whitehead K, Williamson R, Grimes D, Schlect D, Brown I, Dickie G. Lymphoproliferative disease of the ocular adnexa: a clinical and pathologic study with statistical analysis of 69 patients. Ophthalmic Plast Reconstr Surg 2005; 21:177-88. [PMID: 15942490 DOI: 10.1097/01.iop.0000159173.42243.ad] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical features, treatment, and outcomes of a cohort of patients with ocular adnexal lymphoproliferative disease classified according to the World Health Organization modification of the Revised European-American Classification of Lymphoid neoplasms and to perform a robust statistical analysis of these data. METHODS Sixty-nine cases of ocular adnexal lymphoproliferative disease, seen in a tertiary referral center from 1992 to 2003, were included in the study. Lesions were classified by using the World Health Organization modification of the Revised European-American Classification of Lymphoid neoplasms classification. Outcome variables included disease-specific survival, relapse-free survival, local control, and distant control. RESULTS Stage IV disease at presentation, aggressive lymphoma histology, the presence of prior or concurrent systemic lymphoma at presentation, and bilateral adnexal disease were significant predictors for reduced disease-specific survival, local control, and distant control. Multivariate analysis found that aggressive histology and bilateral adnexal disease had significantly reduced disease-specific survival. CONCLUSIONS The typical presentation of adnexal lymphoproliferative disease is with a painless mass, swelling, or proptosis; however, pain and inflammation occurred in 20% and 30% of patients, respectively. Stage at presentation, tumor histology, primary or secondary status, and whether the process was unilateral or bilateral were significant variables for disease outcome. In this study, distant spread of lymphoma was lower in patients who received greater than 20 Gy of orbital radiotherapy.
Collapse
Affiliation(s)
- Timothy J Sullivan
- Eyelid, Lacrimal and Orbital Clinic, Division of Ophthalmology, Department of Surgery, Royal Brisbane Hospital, Queensland, Australia.
| | | | | | | | | | | | | |
Collapse
|
18
|
Yan J, Wu Z, Li Y. The differentiation of idiopathic inflammatory pseudotumor from lymphoid tumors of orbit: analysis of 319 cases. Orbit 2005; 23:245-54. [PMID: 15590527 DOI: 10.1080/01676830490487980] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To analyze the clinical, morphologic, immunophenotypic, and molecular genetic differences between idiopathic inflammatory pseudotumor and lymphoid tumors of the orbit. METHODS 209 patients with IOIP and 110 patients with lymphoid tumors seen between January 1, 1978 and December 31, 1999 in Zhongshan Ophthalmic Center, Sun Yat-sen University were evaluated retrospectively. RESULTS More patients with lymphoid tumors had palpable mass than patients with idiopathic orbital inflammatory pseudotumor (IOIP) (P < 0.0001), with the percentage of 90% and 65%, respectively, whereas more patients with IOIP had swollen eyelid, eyelid or conjunctival congestion, pain, retinal folds or hamorrhage, and optic nerve atrophy than patients with lymphoid tumors, with the percentage of 55% and 40% (P = 0.014), 42% and 24% (P = 0.001), 24% and 1% (P < 0.0001), 14% and 4% (P = 0.004), 7% and 2% (P = 0.043), respectively. Ultrasound and computed tomography/magnetic resonance image (CT/MRI) scan usually could not differentiate IOIP from lymphoma. Nearly one third of patients with IOIP could not be easily differentiated pathologically from lymphoid tumor. Immunophenotypic, and molecular genetic analyses can differentiate IOIP from lymphoid tumor based on polyclonal or monoclonal proliferation of lymphocytes with the IOIP being polyclonal and lymphoma monoclonal. CONCLUSIONS Idiopathic orbital inflammatory pseudotumor and lymphoid tumor showed distinguishing clinical, morphologic, immunophenotypic, and molecular genetic characteristics.
Collapse
Affiliation(s)
- Jianhua Yan
- Zhongshan Ophthalmic Center, the Section of Ocular Oncology & Orbital Disease, Sun Yat-sen University, Guangzhou, the People's Republic of China.
| | | | | |
Collapse
|
19
|
Abstract
A bilateral conjunctival neoplasm was surgically removed from a 13-year-old Domestic Short-haired female cat and examined by histopathology. The neoplasm was infiltrative, nonencapsulated and composed of large sheets of densely packed, round to polygonal cells. Neoplastic cells were variably sized with scant to modest amounts of cytoplasm and oval to round nuclei. On immunohistochemistry the neoplastic cells stained positively for BLA.36 and negative for CD-3 antibodies. On the basis of histopathology and immunohistochemical findings, a diagnosis of conjunctival B-cell lymphoma was made. This is the first case with immunohistochemical characterization of conjunctival lymphoma in a cat.
Collapse
Affiliation(s)
- Zaher A Radi
- Veterinary Diagnostic & Investigational Laboratory, College of Veterinary Medicine, The University of Georgia, 43 Brighton Road, Tifton, GA 31793-1389, USA.
| | | | | |
Collapse
|
20
|
Abstract
Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.
Collapse
Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | | |
Collapse
|
21
|
Strauss EC, Warren JF, Margolis TP, Holsclaw DS. Diagnosis of conjunctival B-cell lymphoma by polymerase chain reaction heteroduplex analysis. Am J Ophthalmol 2003; 136:207-9. [PMID: 12834702 DOI: 10.1016/s0002-9394(03)00081-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a case initially assessed as giant papillary conjunctivitis and subsequently as B-cell lymphoma by the molecular technique of polymerase chain reaction heteroduplex analysis. DESIGN Observational case report. METHODS Clinical, histologic, immunohistochemical, and polymerase chain reaction heteroduplex analysis findings are presented. RESULTS A 32-year-old man developed unilateral blepharoptosis secondary to an extensive palpebral conjunctival follicular-like process. Excisional biopsy showed a dense small lymphocyte infiltrate consistent with benign lymphoid hyperplasia by histology and immunohistologic marker studies. Polymerase chain reaction heteroduplex analysis revealed low-grade B-cell lymphoma, however. Systemic examination was negative. Focal radiation therapy was performed, and preliminary results show no signs of lymphoma. CONCLUSIONS Polymerase chain reaction heteroduplex analysis established a diagnosis of conjunctival B-cell lymphoma in the absence of supporting histology and immunohistochemistry studies. This technique may provide independent, diagnostic distinction between benign lymphoid hyperplasia and low-grade B-cell lymphoma of the ocular adnexa.
Collapse
Affiliation(s)
- Erich C Strauss
- Department of Ophthalmology, University of California San Francisco Medical Center, California, San Francisco, USA.
| | | | | | | |
Collapse
|
22
|
Shields CL, Shields JA, Carvalho C, Rundle P, Smith AF. Conjunctival lymphoid tumors: clinical analysis of 117 cases and relationship to systemic lymphoma. Ophthalmology 2001; 108:979-84. [PMID: 11320031 DOI: 10.1016/s0161-6420(01)00547-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the clinical features of conjunctival lymphoid tumors and factors predictive of systemic lymphoma. DESIGN Retrospective, observational case series. SETTING Clinical practice of ocular oncology. PARTICIPANTS The participants included 117 consecutive patients with lymphoid tumors of the conjunctiva treated at the Oncology Service of Wills Eye Hospital between 1974 and 1999. MAIN OUTCOME MEASURE The main outcome measure was the development of systemic lymphoma. Cox proportional regression models were used to calculate the risk of eventual systemic lymphoma. Kaplan-Meier survival estimates were used to analyze the development of systemic lymphoma as a function of time. RESULTS There were 55 males (47%) and 62 females (53%); 110 patients (94%) were white and 7 patients (6%) were African AMERICAN: The mean age at ocular presentation was 61 years, and the conjunctival lymphoid infiltrate was unilateral in 72 patients (62%) and bilateral in 45 patients (38%). In 8 patients (7%), initial unilateral conjunctival disease evolved into bilateral involvement over a mean of 32 months. Additional sites of ocular involvement were found in 27 patients (23%) and included lymphoid tumor in the eyelid in 3 cases, orbit in 18, choroid in 5, and vitreous in 1. Systemic lymphoma was known to exist before ocular diagnosis in 16 patients; (14%; for a mean of 51 months) and was found subsequent to ocular diagnosis in 20 patients (17; at a mean of 21 months). Therefore, of 117 patients with conjunctival lymphoid infiltration, 36 (31%) had or eventually developed systemic lymphoma, and 81 (69%) did not manifest systemic lymphoma during the mean follow-up of 38 months. Of the 64 patients with unilateral conjunctival involvement, 11 (17%) manifested systemic lymphoma, and of the 53 patients with bilateral involvement, 25 (47%) manifested systemic lymphoma. By univariate analysis, the clinical factors at date first seen predictive of the presence or development of systemic lymphoma included location of the tumor at an extralimbal site (fornix or midbulbar conjunctiva; P = 0.02) and increasing number of conjunctival tumors (P = 0.02). Using Kaplan-Meier life table analysis of those 101 patients who had conjunctival lymphoid tumor(s) and no evident systemic lymphoma at presentation, systemic lymphoma was eventually discovered in 7% of patients at 1 year, 12% at 2 years, 15% at 5 years, and 28% at 10 years. Overall, only one patient (<1%) died of systemic lymphoma, at 28 months after the diagnosis of the ocular disease. CONCLUSIONS Lymphoid tumors of the conjunctiva are associated with systemic lymphoma in 31% of patients. Systemic lymphoma is found more often in those patients with forniceal or midbulbar conjunctival involvement and in those with multiple conjunctival tumors. Long-term systemic follow-up is advised, because related systemic lymphoma can manifest many years later.
Collapse
Affiliation(s)
- C L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA
| | | | | | | | | |
Collapse
|
23
|
Cockerham GC, Hidayat AA, Bijwaard KE, Sheng ZM. Re-evaluation of "reactive lymphoid hyperplasia of the uvea": an immunohistochemical and molecular analysis of 10 cases. Ophthalmology 2000; 107:151-8. [PMID: 10647734 DOI: 10.1016/s0161-6420(99)00025-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Cases of uveal lymphoid proliferation previously classified as reactive lymphoid hyperplasia (RLH) were studied to correlate pathologic features with clinical outcome. DESIGN Retrospective case series. PARTICIPANTS Ten cases of RLH of the uvea on file at the Armed Forces Institute of Pathology with sufficient formalin-fixed, paraffin-embedded tissue for analysis. METHODS Clinical, histologic, immunohistochemical, and molecular (polymerase chain reaction [PCR]) characteristics of uveal lymphoid proliferations were studied. MAIN OUTCOME MEASURES Morphologic, immunohistochemical, and PCR characteristics of study cases. RESULTS Patient age ranged from 40 to 73 years at time of enucleation, with a mean age of 55 years. Retinal detachment was noted clinically in nine patients and glaucoma in eight. All patients were treated with enucleation, and three received radiotherapy. Histologically, two cases were interpreted as RLH and eight were well-differentiated small-cell lymphoma (WDSCL). Systemic lymphoid infiltrate developed in two patients, but there were no deaths with a mean follow-up of 9.9 years. Mature lymphocytes were noted in the iris and angle structures; the atypical cells of uveal lymphoma were found in the choroid and ciliary body. Eight cases were monoclonal by B-cell and T-cell markers and/or immunoglobulin light chain restriction. Amplifiable DNA was present in 6 of 10 cases by PCR. Three cases monoclonal by cell markers were also monoclonal by PCR, but two cases monoclonal by cell markers could not be confirmed by PCR. Lymphoid follicles with germinal centers were found in two cases of RLH and five cases of WDSCL. Nine specimens demonstrated extraocular lymphoid involvement of the episclera and orbit; most appeared more benign morphologically than the choroidal infiltrates. Extraocular infiltrates of WDSCL were monoclonal by immunohistochemistry in five cases, polyclonal in one case, and indeterminate in two cases. CONCLUSIONS Most cases (8 of 10) previously described as RLH were low-grade B-cell lymphomas histologically and by immunohistochemistry. PCR results agreed with histologic diagnosis in four of six cases. Open-angle glaucoma was common and related mostly to lymphocytic infiltration of the angle structures. Extraocular involvement is common but may not be representative of the choroidal lesion. Prognosis is excellent in low-grade uveal lymphoid neoplasia.
Collapse
MESH Headings
- Adult
- Aged
- B-Lymphocytes/pathology
- DNA, Neoplasm/analysis
- Eye Enucleation
- Female
- Glaucoma, Open-Angle/complications
- Humans
- Immunoenzyme Techniques
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Pseudolymphoma/genetics
- Pseudolymphoma/immunology
- Pseudolymphoma/pathology
- Pseudolymphoma/therapy
- Radiotherapy, Adjuvant
- Retinal Detachment/complications
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction
- T-Lymphocytes/pathology
- Uveal Neoplasms/genetics
- Uveal Neoplasms/immunology
- Uveal Neoplasms/pathology
- Uveal Neoplasms/therapy
Collapse
|