Ocular adnexal mucosa-associated lymphoid tissue lymphoma: a narrative review

Deep learning-based intratumoral and peritumoral features for differentiating ocular adnexal lymphoma and idiopathic orbital inflammation

OBJECTIVES

To evaluate the value of deep-learning-based intratumoral and peritumoral features for differentiating ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI).

METHODS

Nighty-seven patients with histopathologically confirmed OAL (n = 43) and IOI (n = 54) were randomly divided into training (n = 79) and test (n = 18) groups. DL-based intratumoral and peritumoral features were extracted to characterize the differences in heterogeneity and tissue invasion between different lesions, respectively. Subsequently, an attention-based fusion model was employed to fuse the features extracted from intra- and peritumoral regions and multiple MR sequences. A comprehensive comparison was conducted among different methods for extracting intratumoral, peritumoral, and fused features. Area under the curve (AUC) was used to evaluate the performance under a 10-fold cross-validation and independent test. Chi-square and student's t-test were used to compare discrete and continuous variables, respectively.

RESULTS

Fused intra-peritumoral features achieved AUC values of 0.870-0.930 and 0.849-0.924 on individual MR sequences in the validation and test sets, respectively. This was significantly higher than those using intratumoral features (p < 0.05), but not significantly different than those using peritumoral features (p > 0.05). By combining multiple MR sequences, AUC values of the intra-peritumoral features were boosted to 0.943 and 0.940, higher than those obtained from each sequence alone. Moreover, intra-peritumoral features yielded higher AUC values compared to entire orbital cone features extracted by either the intra- or the peritumoral DL model, although no significant difference was found from the latter (p > 0.05).

CONCLUSION

DL-based intratumoral, peritumoral, and especially fused intra-peritumoral features may help differentiate between OAL and IOI.

KEY POINTS

Question What is the diagnostic value of the peritumoral region and its combination with the intratumoral region for radiomic analysis of orbital lymphoproliferative disorders? Findings Fused intra- and peritumoral features achieved significantly higher performance than intratumoral features, but had no significant difference to the peritumoral features. Clinical relevance Peritumoral contextual features, which characterize the invasion patterns of orbital lesions within the surrounding areas of the entire orbital cone, might serve as an independent imaging marker for differentiating between OAL and IOI.

A Case of Infraorbital B-cell Lymphoma Masquerading as an Abscess

Background/Aim

Primary ocular adnexal lymphomas pose a diagnostic challenge for physicians due to their nonspecific symptom presentation and resemblance to other periorbital masses, such as skin and soft tissue infections. Early diagnosis and appropriate management are crucial for optimizing outcomes and coordination of therapy.

Case Report

We present a case of a 67-year-old male with a history of infraorbital trauma, initially managed as a soft tissue infection, which was later revealed to be a large B-cell lymphoma. Despite multiple specialty evaluations, including dermatology, ophthalmology, plastic surgery, and ENT, among others, diagnosis was delayed, leading to worsening symptoms and vision impairment.

Conclusion

This case highlights the importance of considering ocular adnexal lymphomas in the differential diagnosis of periorbital masses and the need for interdisciplinary collaboration for timely recognition and treatment.

Single-cell RNA-sequencing reveals cellular heterogeneity and immune microenvironment characteristics between ocular adnexal mucosa-associated lymphoid lymphoma and IgG4-related ophthalmic disease

Introduction

The molecular pathogenesis of ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma and IgG4-related ophthalmic disease (IgG4-ROD) remains incompletely understood. Differentiating between the two diseases is vital given that the diagnostic evaluation and treatment approaches can vary significantly; this difficulty in distinction is exacerbated by the absence of specific biomarkers. This study aimed to investigate the differences between these two diseases based on their cellular composition, transcriptional heterogeneity, and the immune microenvironment using single-cell RNA transcriptional sequencing (scRNA-seq) technology.

Methods

We collected orbital lacrimal gland region tissue samples from three patients with MALT lymphoma and another three with IgG4-ROD and performed single-cell sequencing experiments. Subsequently, we conducted bioinformatics analyses, including cell subpopulation segmentation and inter-group comparison, tumor cell identification, functional enrichment analysis, and pseudotime trajectory analysis. Furthermore, we analyzed the cellular communication between tumor B-cell and T-cell subsets within the immune microenvironment of MALT lymphoma tissues. We performed immunofluorescence assays to verify the co-expression of receptor-ligand pairs.

Results

A total of six major cell subpopulations were identified, with B-cells and T-cells being the predominant cell types. All B-cell subpopulations in MALT lymphomas are malignant, exhibiting significant intratumoral and intertumoral heterogeneity. Reclustering of the T-cell subpopulation identified five major T-cell subpopulations. Pseudotime analysis revealed that CD4+ naive T-cells in MALT lymphoma patients were highly likely to differentiate into follicular helper T-cells, whereas, in IgG4-ROD patients, CD4+ naive T-cells were highly likely to differentiate into regulatory T-cells. Intercellular communication analysis revealed that the CD27-CD70 immune checkpoint receptor-ligand pair and CXCL13-CXCR5 chemokine receptor-ligand pair were significantly upregulated between malignant B-cells and T-cells subpopulations.

Conclusion

This study is the first to conduct a comparative single-cell transcriptome sequencing analysis of ocular adnexal MALT lymphoma and IgG4-ROD. Our results reveal the cellular composition, key pathways, and critical immune microenvironment implicated in the development of these two diseases. These findings provide important insights into the pathogenesis of these two diseases and highlight the differences between them.

Guiding function of positron emission tomography-computed tomography examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma

AIM

To explore the role of positron emission tomography-computed tomography (PET-CT) examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma (OAML).

METHODS

The general clinical data, postoperative PET-CT results, treatment regimens, and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected. Among the 21 patients, five patients underwent surgical treatment alone, 13 patients underwent surgical treatment combined with radiotherapy, and three patients underwent surgical treatment combined with chemotherapy.

RESULTS

The follow-up period ranged from 8 to 79mo, with four cases of recurrence and no deaths. Through PET-CT examination, two patients exhibited both local ocular metabolic elevation and systemic metastasis, and one of these patients had cervical lymph node metastasis, while the other had submandibular and parotid gland metastasis. Nine patients showed only local ocular metabolic elevation, while 10 patients had no abnormal metabolic activity locally.

CONCLUSION

PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection, aiding in precise disease staging, and facilitating the development of personalized treatment plans, ultimately improving patient prognosis.

Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO)

Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.

Radiomics analysis of T1WI and T2WI magnetic resonance images to differentiate between IgG4-related ophthalmic disease and orbital MALT lymphoma

BACKGROUND

Preoperative differentiation between IgG4-related orbital disease (IgG4-ROD) and orbital mucosa-associated lymphoid tissue (MALT) lymphoma has a significant impact on clinical decision-making. Our research aims to construct and evaluate a magnetic resonance imaging (MRI)-based radiomics model to assist clinicians to better identify IgG4-ROD and orbital MALT lymphoma and make better preoperative medical decisions.

METHODS

MR images and clinical data from 20 IgG4-ROD patients and 30 orbital MALT lymphoma patients were classified into a training (21 MALT; 14 IgG4-ROD) or validation set (nine MALT; six IgG4-ROD). Radiomics features were collected from T1-weighted (T1WI) and T2-weighted images (T2WI). Student's t-test, the least absolute shrinkage and selection operator (LASSO) and principal component analysis (PCA) were conducted to screen and select the radiomics features. Support vector machine (SVM) classifiers developed from the selected radiomic features for T1WI, T2WI and combined T1WI and T2WI were trained and tested on the training and validation set via five-fold cross-validation, respectively. Diagnostic performance of the classifiers were evaluated with area under the curve (AUC) readings of the receiver operating characteristic (ROC) curve, and readouts for precision, accuracy, recall and F1 score.

RESULTS

Among 12 statistically significant features from T1WI, four were selected for SVM modelling after LASSO analysis. For T2WI, eight of 51 statistically significant features were analyzed by LASSO followed by PCA, with five features finally used for SVM. Combined analysis of T1WI and T2WI features selected two and four, respectively, for SVM. The AUC values for T1WI and T2WI classifiers separately were 0.722 ± 0.037 and 0.744 ± 0.027, respectively, while combined analysis of T1WI and T2WI classifiers further enhanced the classification performances with AUC values ranging from 0.727 to 0.821.

CONCLUSION

The radiomics model based on features from both T1WI and T2WI images is effective and promising for the differential diagnosis of IgG4-ROD and MALT lymphoma. More detailed radiomics features and advanced techniques should be considered to further explore the differences between these diseases.

The Biology of Ocular Adnexal Marginal Zone Lymphomas

This review focuses on the biology of ocular adnexal marginal zone B-cell lymphomas of the mucosa-associated lymphatic tissue (MALT) (OAMZL) subtype. The ocular adnexa includes all structures and tissues within the orbit except for the eye bulb. In the region of the ocular adnexa, MALT lymphomas represent the most common subtype of lymphoma, accounting for around 8% of all non-Hodgkin lymphomas. These lymphomas are often preceded by inflammatory precursor lesions. Either autoantigens or infectious antigens may lead to disease development by functioning as continuous antigenic triggers. This triggering leads to a constitutive activation of the NF-κB signaling pathway. The role of antigenic stimulation in the pathogenesis of OAMZL is supported by the detection of somatic mutations (partially with further intraclonal diversity) in their rearranged immunoglobulin V genes; hence, their derivation from germinal-center-experienced B cells, by a restricted IGHV gene usage, and the validation of autoreactivity of the antibodies in selected cases. In the established lymphomas, NF-κB activity is further enforced by mutations in various genes regulating NF-κB activity (e.g., TNFAIP3, MYD88), as well as recurrent chromosomal translocations affecting NF-κB pathway components in a subset of cases. Further pathogenetic mechanisms include mutations in genes of the NOTCH pathway, and of epigenetic regulators. While gene expression and sequencing studies are available, the role of differential methylation of lymphoma cells, the role of micro-RNAs, and the contribution of the microenvironment remain largely unexplored.