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Rafizadeh SM, Ghahvehchian H, Rajabi MT, Heidari M, Rahmanikhah E. Anaplastic Large Cell Lymphoma With Intraocular or Ocular Adnexal Involvement: A Case Report and Systematic Review. Ophthalmic Plast Reconstr Surg 2024; 40:235-244. [PMID: 37721309 DOI: 10.1097/iop.0000000000002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
PURPOSE To review the existing literature on patients with anaplastic large cell lymphoma (ALCL) affecting the globe and/or ocular adnexa, and to present a report documenting the clinical course of a patient with ALCL that involved their globe and ocular adnexa. METHODS PubMed, Scopus, and Google scholar were systematically searched for all cases of ALCL involving intraocular or adnexal ocular structures from inception to May 2023. Moreover, a new reported case added to the cases found in searches. RESULTS The review identified 1680 studies, with 8 meeting inclusion criteria. A total of 9 patients were included with a mean age of 29.7 years (median: 30.0, range: 1.3-48). Primary ALCL was present in 5/9 (55.6%) patients. The most common ophthalmic manifestations included periorbital swelling (5/8), chemosis (5.8), and decreased vision (5/7). Misdiagnoses were initially made in 3 patients, and the lag time to correct diagnosis from 3 weeks to 3 months. CD30 expression was positive in all cases, and 6/9 patients were positive for anaplastic lymphoma kinase, resulting in 6/9 patients being diagnosed with anaplastic lymphoma kinase-positive ALCL. In terms of management modalities, chemotherapy was administered in 8/9 patients, while radiation therapy was utilized in 4/9 patients, and 2 underwent autologous stem cell transplantation. Five (55.6%) patients succumbed to ALCL while 4 (44.4%) were alive and disease-free at the last follow-up. The median times from the initial presentation of ALCL to death, ophthalmic presentation to death, and diagnosis to death were 4.12 months (range: 1.1-168.0), 2.62 months (range: 1.1-144), and 4.00 months (range: 0.10-168), respectively. The median follow-up duration was 21.0 months (range: 1.1-168.0). CONCLUSIONS ALCL involving the globe and ocular adnexa is a rare and highly malignant tumor that can mimic benign clinical conditions. Early biopsy and aggressive treatment with chemotherapy regimens such as CHOP and radiation therapy may be useful.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Department of Oculofacial Plastic and Orbital Surgery, Farabi Comprehensive Center of Excellence in Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Department of Oculofacial Plastic and Orbital Surgery, Farabi Comprehensive Center of Excellence in Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher Rajabi
- Department of Oculofacial Plastic and Orbital Surgery, Farabi Comprehensive Center of Excellence in Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Heidari
- Department of Oculofacial Plastic and Orbital Surgery, Farabi Comprehensive Center of Excellence in Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaham Rahmanikhah
- Department of Oculofacial Plastic and Orbital Surgery, Farabi Comprehensive Center of Excellence in Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
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Caranfa JT, Liang MC. Anaplastic Large-Cell Lymphoma With Vitreous Humor Involvement. J Vitreoretin Dis 2023; 7:545-547. [PMID: 37974916 PMCID: PMC10649443 DOI: 10.1177/24741264231191668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To describe a case of T-cell lymphoma with bilateral vitreous involvement. Methods: A case report was reviewed, and a literature review, including search terms such as "anaplastic large-cell lymphoma (ALCL)" and "T-cell lymphoma with ocular involvement", was performed. Results: A 56-year-old man presented with slurred speech, left-sided weakness, and floaters in his right eye. He was found to have an enhancing right frontal lobe mass with biopsy positive for ALCL. The right eye demonstrated 2+ vitreous cell, with a vitreous biopsy consistent with ALCL. His floaters resolved, and the patient was asymptomatic until he developed floaters in his left eye 1½ years later. A subsequent vitreous biopsy revealed recurrence of ALCL in the fellow eye. Conclusions: ALCL is a rare T-cell lymphoma uncommonly reported as having vitreous infiltration.
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Affiliation(s)
- Jonathan T. Caranfa
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Michelle C. Liang
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, MA, USA
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Kirkegaard MM, Coupland SE, Prause JU, Heegaard S. Malignant lymphoma of the conjunctiva. Surv Ophthalmol 2015; 60:444-58. [PMID: 26003619 DOI: 10.1016/j.survophthal.2015.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
Conjunctival lymphomas constitute 25% of all ocular adnexal lymphomas. The majority are B-cell non-Hodgkin lymphomas (NHLs) (98%), whereas conjunctival T-cell NHLs are rare (2%). The most frequent subtype of conjunctival B-cell lymphoma is extranodal marginal zone lymphoma (EMZL; 81%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%), and mantle cell lymphoma (3%). Extranodal marginal zone lymphoma occurs slightly more often in women and, along with follicular lymphoma, presents late in the seventh decade of life, whereas diffuse large B-cell lymphoma and especially mantle cell lymphoma have a predilection for the male gender and typically present in the eighth decade. Extranodal marginal zone lymphoma and follicular lymphoma present most frequently in the forniceal and bulbar conjunctiva. Conjunctival diffuse large B-cell lymphoma, mantle cell lymphoma and T-cell NHLs are characterized by a short duration of symptoms before the first ophthalmologic consultation. External beam radiotherapy is the treatment of choice for extranodal marginal zone lymphoma and follicular lymphoma, whereas diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell NHLs are mainly treated with chemotherapy. Conjunctival T-cell NHLs are associated with a particularly poor prognosis, with 50% of patients having progression or recurrence during a 1-year follow-up period.
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Affiliation(s)
- Marina M Kirkegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Jan U Prause
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Patel DS, Rundle P, Salvi SM, Fernando M, Mudhar HS. Conjunctival Angioimmunoblastic T-Cell Lymphoma. Ocul Oncol Pathol 2014; 1:71-6. [PMID: 27231687 DOI: 10.1159/000368247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) represents an uncommon variant of T-cell lymphomas and most often presents insidiously with systemic symptoms. This report constitutes the first documented case of conjunctival AITL, masquerading as nodular episcleritis, and describes both the clinical and pathological findings. Furthermore, conjunctival T-cell lymphoma in general remains a rare occurrence, and a survey of previously reported cases reveals a wide variation in clinical presentation. A high index of suspicion, thorough examination and conjunctival biopsy are essential to reaching the diagnosis of conjunctival lymphoma.
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Affiliation(s)
- Darshak S Patel
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Rundle
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Sachin M Salvi
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Malee Fernando
- Department of Histopathology, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
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Kirwan C, Ngan BY, Halliday W, Alexander S, Ali A. Primary conjunctival anaplastic large cell lymphoma in a child. J AAPOS 2013; 17:437-9. [PMID: 23896363 DOI: 10.1016/j.jaapos.2013.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/04/2013] [Accepted: 04/07/2013] [Indexed: 11/30/2022]
Abstract
Conjunctival tumors in children are uncommon and behave differently from those in adults. The vast majority of tumors are benign. Of the malignant lesions in this age group, lymphoma and melanoma are most commonly reported. Most lymphoid tumors in children represent lymphoid hyperplasia, not lymphoma. Clinical differentiation of these two entities is not possible and biopsy is required to establish the diagnosis. We present an unusual case of primary anaplastic large cell lymphoma of the conjunctiva in a young boy.
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Affiliation(s)
- Caitriona Kirwan
- Department of Ophthalmology and Vision Science, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Choi YJ, Jin HC, Kim NJ, Choung HK, Khwarg SI. A Case of Lymphomatoid Papulosis of the Eyelid. J Korean Ophthalmol Soc 2013. [DOI: 10.3341/jkos.2013.54.4.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Youn Joo Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chul Jin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Ju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Sciallis AP, Law ME, Inwards DJ, McClure RF, Macon WR, Kurtin PJ, Dogan A, Feldman AL. Mucosal CD30-positive T-cell lymphoproliferations of the head and neck show a clinicopathologic spectrum similar to cutaneous CD30-positive T-cell lymphoproliferative disorders. Mod Pathol 2012; 25:983-92. [PMID: 22388754 DOI: 10.1038/modpathol.2012.38] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CD30-positive T-cell lymphoproliferative disorders are classified as cutaneous (primary cutaneous anaplastic large cell lymphoma and lymphomatoid papulosis) or systemic. As extent of disease dictates prognosis and treatment, patients with skin involvement need clinical staging to determine whether systemic lymphoma also is present. Similar processes may involve mucosal sites of the head and neck, constituting a spectrum that includes both neoplasms and reactive conditions (eg, traumatic ulcerative granuloma with stromal eosinophilia). However, no standard classification exists for mucosal CD30-positive T-cell lymphoproliferations. To improve our understanding of these processes, we identified 15 such patients and examined clinical presentation, treatment and outcome, morphology, phenotype using immunohistochemistry, and genetics using gene rearrangement studies and fluorescence in situ hybridization. The 15 patients (11 M, 4 F; mean age, 57 years) had disease involving the oral cavity/lip/tongue (9), orbit/conjunctiva (3) or nasal cavity/sinuses (3). Of 14 patients with staging data, 7 had mucosal disease only; 2 had mucocutaneous disease; and 5 had systemic anaplastic large cell lymphoma. Patients with mucosal or mucocutaneous disease only had a favorable prognosis and none developed systemic spread (follow-up, 4-93 months). Three of five patients with systemic disease died of lymphoma after 1-48 months. Morphologic and phenotypic features were similar regardless of extent of disease. One anaplastic lymphoma kinase-positive case was associated with systemic disease. Two cases had rearrangements of the DUSP22-IRF4 locus on chromosome 6p25.3, seen most frequently in primary cutaneous anaplastic large cell lymphoma. Our findings suggest mucosal CD30-positive T-cell lymphoproliferations share features with cutaneous CD30-positive T-cell lymphoproliferative disorders, and require clinical staging for stratification into primary and secondary types. Primary cases have clinicopathologic features closer to primary cutaneous disease than to systemic anaplastic large cell lymphoma, including indolent clinical behavior. Understanding the spectrum of mucosal CD30-positive T-cell lymphoproliferations is important to avoid possible overtreatment resulting from a diagnosis of overt T-cell lymphoma.
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Sanka RK, Eagle RC, Wojno TH, Neufeld KR, Grossniklaus HE. Spectrum of CD30+ lymphoid proliferations in the eyelid lymphomatoid papulosis, cutaneous anaplastic large cell lymphoma, and anaplastic large cell lymphoma. Ophthalmology 2009; 117:343-51. [PMID: 19969358 DOI: 10.1016/j.ophtha.2009.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 06/12/2009] [Accepted: 07/07/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report the clinicopathologic features of 3 patients with CD30(+) lymphoid proliferations of the eyelid. DESIGN Retrospective case series. PARTICIPANTS Patients with cutaneous CD30(+) lymphoproliferative lesions of the eyelid. METHODS Three patients with CD30(+) non-mycosis fungoides T-cell lymphoid infiltrates of the eyelid were identified. The histories, clinical findings, pathologic features including immunohistochemical staining, treatments, and outcomes were reviewed and compared. MAIN OUTCOME MEASURES Pathologic findings including immunohistochemical analysis. RESULTS The patients included an 81-year-old man, an 18-year-old man, and a 42-year-old woman with CD30(+) lymphoid proliferations of the eyelid and adjacent soft tissue. The first patient had an isolated crateriform eyelid lesion that was classified as lymphomatoid papulosis (LyP). The second patient had an isolated multinodular lesion of the eyelid that was classified as cutaneous anaplastic large cell lymphoma (cALCL). The third patient presented with eyelid edema with an underlying mass and was found to have widely disseminated anaplastic large cell lymphoma (ALCL). Diagnoses were dependent on clinical findings. CONCLUSIONS The CD30(+) lymphoid proliferations represent a spectrum of conditions ranging from indolent LyP, to moderately aggressive cALCL, to highly aggressive ALCL. Interpretation of the pathologic findings in CD30(+) lymphoid proliferations is based in part on clinical findings. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any material discussed in this article.
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Affiliation(s)
- R Krishna Sanka
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Abstract
PURPOSE To report a case of anaplastic large cell lymphoma (ALCL) of the central nervous system (CNS) producing an optic neuropathy. METHODS Observational case report. RESULTS A 29-year-old male presented with new onset headaches. Magnetic resonance imaging (MRI) of the brain revealed a large enhancing parietal lobe mass. Ocular exam at that time was normal. Initial diagnoses included possible bacterial cerebritis and fungal abscess. Serial lumbar punctures showed increased white blood cells but cytology was negative. A brain biopsy was non-diagnostic. The patient then presented with a left optic neuropathy. Repeat MRI of the brain and orbits revealed infiltration of the clivus and left orbital apex including the optic nerve. The patient had elevated liver function studies and an abdominal ultrasound disclosed two hypoechoic lesions. Liver biopsy confirmed the diagnosis of ALK-1 positive ALCL. The patient was treated with chemotherapy but expired seven months after the initial presentation. CONCLUSION ALCL should be considered to be a very rare but potential cause of optic neuropathy. To our knowledge, this is the first reported case of ALCL causing an optic neuropathy.
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Affiliation(s)
- James G Howard
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Koreen IV, Cho RI, Frueh BR, Elner VM. Primary Cutaneous Anaplastic Large Cell Lymphoma of the Medial Canthus and Orbit. Ophthalmic Plast Reconstr Surg 2009; 25:63-5. [DOI: 10.1097/iop.0b013e3181936866] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mencía-Gutiérrez E, Gutiérrez-Díaz E, Salamanca J, Martínez-González MA. Cutaneous presentation on the eyelid of primary, systemic, CD30+, anaplastic lymphoma kinase (ALK)-negative, anaplastic large-cell lymphoma (ALCL). Int J Dermatol 2006; 45:766-9. [PMID: 16796648 DOI: 10.1111/j.1365-4632.2004.02412.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To report an unusual case of cutaneous presentation on the eyelid of systemic (or nodal), CD30+, anaplastic large-cell lymphoma (ALCL). METHODS A 39-year-old man presented with a rapidly growing exophytic mass on the left upper eyelid, with a protuberant, ulcerated aspect and with discharge. The patient showed lymph node involvement 3 months after the appearance of the lesion on the eyelid (the lesion itself appeared 1 week before examination). RESULTS The histopathologic and immunohistochemical diagnosis was ALCL, T-cell phenotype, strongly positive for CD43 and CD30, and negative for CD3, anaplastic lymphoma kinase (ALK), and B-cell antigens. Treatment was by radiotherapy and, later, chemotherapy (cyclophosphamide, adriamycin, vincristine, and prednisolone, CHOP) for skin recurrences and lymphadenopathies over 5 years. There has been no recurrence for more than 6 years. CONCLUSIONS Primary, systemic, CD30+, ALK-negative, ALCL presentations generally have a poor prognosis and tend to occur in older individuals, although the clinical outcome is highly variable and difficult to predict in individual cases. Only three cases of ALCL have been described in the ocular adnexae and none was ALK-negative.
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