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Dhodapkar RM, Spadaro JZ, Heng JS, Sinard JH, Lee YH, Habib LA, Pointdujour-Lim R. NK/T-cell Lymphoma With Orbital Involvement: A Case Report and Systematic Review of the Literature. Ophthalmic Plast Reconstr Surg 2023; 39:316-327. [PMID: 36692957 DOI: 10.1097/iop.0000000000002317] [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: 01/25/2023]
Abstract
PURPOSE To present the clinical course of a patient with recurrent NK/T-cell lymphoma (NKTL) involving the orbit and to review the literature on patients with NKTL involving the orbit. METHODS The PubMed database was searched for all cases of NKTL involving orbital, intraocular, or adnexal ocular structures. RESULTS Ninety-six patients were included in the final analysis. The mean age of diagnosis was 48.1 ± 16.8 years. The patients were 53/96 (55.2%) male and 43/96 (44.8%) female. Tumor location varied and included the orbit in 80/96 (83.3%), nasosinus in 56/96 (58.3%), uvea in 11/96 (11.5%), lacrimal gland in 9/96 (9.4%), lacrimal drainage system in 11/96 (11.5%), and conjunctiva in 7/96 (7.3%) cases. Management included surgical debulking in 29/96 (30.2%) cases, radiotherapy in 52/96 (54.2%) cases, and chemotherapy in 82/96 (85.4%) cases. Median survival was 6 months (95% CI: 5-9). Chemotherapy (hazard ratio = 0.80, 95% CI: 0.67-0.95, p = 0.013), radiotherapy (hazard ratio = 0.75, 95% CI: 0.64-0.87, p < 0.001), and orbital involvement being a recurrence of disease (hazard ratio = 0.79, 95% CI: 0.67-0.95, p = 0.009) were associated with improved survival. Advanced Ann Arbor stage (III-IV) at diagnosis (hazard ratio = 1.22, 95% CI: 1.08-1.38, p = 0.001), vision loss (hazard ratio = 1.18, 95% CI: 1.04-1.34, p = 0.009), proptosis (hazard ratio = 1.15, 95% CI: 1.01-1.30, p = 0.035) and periorbital swelling (hazard ratio = 1.15, 95% CI: 1.00-1.33, p = 0.048) were associated with poor survival. CONCLUSIONS NK/T-cell lymphoma involving the orbit, globe, or ocular adnexa heralds a poor prognosis where early diagnosis and therapy are critical. The use of radiotherapy and chemotherapy is associated with improved survival.
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Affiliation(s)
- Rahul M Dhodapkar
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - John H Sinard
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Larissa A Habib
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Jing D, You D, Liu Z, Wang W. Primary Orbital Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type, without Nasal Involvement. J Clin Med 2022; 11:jcm11237010. [PMID: 36498585 PMCID: PMC9737387 DOI: 10.3390/jcm11237010] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) usually occurs in the nose or the nasopharynx, but extranasal and disseminated disease can occur. In this disease, orbital involvement is more commonly seen, but without nasal involvement is rare. A 61-year-old woman was referred with a one-month history of a remarkably enlarging salmon-colored mass arising in the right inner canthus, with redness and painlessness. The motility of the right eye was limited in the medial direction, with external deviation of the eyeball. A magnetic resonance imaging (MRI) scan of the orbits showed a mass of irregular shape located in the right inner canthus, without any sinus involvement. A histopathological examination concluded a diagnosis of primary orbital extranodal natural killer/T-cell lymphoma, nasal type. Her orbital mass significantly reduced to near disappeared after chemotherapy. From the first visit to the present, the survival duration of this patient was more than 1 year. This patient was still alive with a high quality of life and with no systemic metastasis. Extranodal natural killer/T-cell lymphoma, nasal type may primarily arise in the orbit without nasal involvement. Early discovery, early biopsy and diagnosis and early appropriate treatment can successfully control tumors and improve prognosis.
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Affiliation(s)
- Dalan Jing
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Debo You
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
| | - Wei Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
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Chen B, Yang S, Su W. First observation of intraocular extranodal natural killer/T-cell lymphoma secondary to a retroperitoneal tumour: a case report and comparative review. BMC Ophthalmol 2022; 22:141. [PMID: 35346113 PMCID: PMC8962092 DOI: 10.1186/s12886-022-02362-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vitreoretinal lymphomas are difficult to diagnose due to their insidious onset and inaccessible focal points. Natural killer/T-cell derived malignancies are rare as intraocular lymphomas and usually have a rapid progression and a poor prognosis. Therefore, it is essential to make a definite diagnosis, especially differentially with B-cell-derived lymphomas, which account for most cases of vitreoretinal lymphomas. Case presentation This case report describes a 55-year-old female reporting a 10-month history of painless decline in her vision of the right eye. Optical coherence tomography of the patient revealed hyperreflective nodules and irregular humps in the retinal pigment epithelium layer. The right vitreous was aspirated for diagnostic assessment, revealing an interleukin-10 level of 39.4 pg/mL and an interleukin-10/interleukin-6 ratio of 1.05. The right vitreous humor was positive for Epstein–Barr virus DNA. Upon a systemic examination, a high metabolic nodule was found in the retroperitoneal area and proven to be positive for Epstein–Barr virus-encoded mRNA, CD2, CD3ε, TIA-1, and Ki-67. Considering the homology of the two lesions, the patient was diagnosed with metastatic vitreoretinal lymphoma secondary to retroperitoneal extranodal natural killer/T-cell derived lymphoma. The patient received systemic chemotherapy and regular intravitreal injections of methotrexate. Her visual acuity of the right eye had improved from 20/125 to 20/32 at the latest follow-up. No new lesions were found. Conclusions A definitive diagnosis of vitreoretinal lymphoma is challenging. On some occasions in which pathological evidence is missing, the available examination results and clinical observations must be comprehensively considered. This study herein summarized pertinent pieces of literature and reports and reviewed available practicable methods to make a definitive diagnosis of intraocular extranodal natural killer/T-cell lymphoma, which was particularly distinct from the common diffuse large B-cell lymphomas.
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Affiliation(s)
- Binyao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China. .,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Han R, Jiang Y, Bian A, Meng Z, Chen H, Ye J. Extranodal natural killer/T-cell lymphoma nasal type with extensive ocular tissue involvement: a case report. Diagn Pathol 2021; 16:104. [PMID: 34763717 PMCID: PMC8582105 DOI: 10.1186/s13000-021-01167-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background To report a rare case of extranodal natural killer/T-cell lymphoma (ENKTL), nasal type related to extensive ocular tissue, including conjunctiva, ciliary body, vitreous and retina. Case presentation A 52-year-old woman who had been treated by radiotherapy for ENKTL, nasal type in the right nasal cavity presented with a dramatic deterioration of vision in right eye. Physical and accessory examination showed extensive ocular tissue related, including conjunctiva, ciliary body, vitreous and retina. Vitreous specimen and conjunctiva biopsy revealed the presence of ENKTL, nasal type in the right eye. She was treated with systemic and ophthalmic chemotherapy, her ocular symptoms significantly improved, and systemic condition remained stable 7 months after the diagnosis. Conclusions Extranodal natural killer/T-cell lymphoma, nasal type is an aggressive disease and may relate extensive ocular tissue and course dramatic vision deterioration. It is important to observe ocular related and begin aggressive combined therapy as early as possible after diagnosis.
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Affiliation(s)
- Ruoan Han
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yang Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hao Chen
- Department of Pathology, The Second Affiliated Hospital of Guangxi Medical University, Guangxi, 530005, China
| | - Junjie Ye
- Department of Ophthalmology, Peking Union Medical College Hospital, Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Wei C, Zhang L, Zhang W, Zhou D. Extranodal NK/T-Cell Lymphoma Occurring Primarily in the Eyes and with Central Nervous System Relapse. Cancer Manag Res 2021; 13:6579-6583. [PMID: 34447273 PMCID: PMC8384145 DOI: 10.2147/cmar.s326414] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
A 56-year-old man complaining of blurred vision was referred to the ophthalmologist. He was initially diagnosed with uveitis and showed no response to steroid treatment. Diagnostic vitrectomy and skin lesion biopsy performed later confirmed the diagnosis of extranodal NK/T cell lymphoma (ENKTL), nasal type. Despite sufficient systemic chemotherapy, the patient developed central nervous system (CNS) relapse 3 months after achieving systemic remission. The diagnosis and treatment of this patient required multidisciplinary teamwork between ophthalmologists, pathologists, and hematologists. This report focused on the diagnostic planning and optimal treatment strategy for this patient.
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Affiliation(s)
- Chong Wei
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Homsy S, Kamel R, Raden M, Skaradinskiy Y. Recurrent Nasal-Type Extranodal Natural Killer/T-Cell Lymphoma with Meningeal Involvement. Case Rep Hematol 2021; 2021:9972694. [PMID: 34350041 DOI: 10.1155/2021/9972694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma nasal type (NNKTL) is a type of non-Hodgkin's lymphoma that has been associated with Epstein–Barr virus (EBV). It has an aggressive behavior, known for predilection to metastasize to different organs. Central nervous system (CNS) spread from a primary location has been reported. Different modalities of treatment such as chemotherapy and radiation therapy have been employed in the management of this disease. Severe toxicities of currently available treatment have made clinicians seek more targeted therapies using molecular profiling. We present a 44-year-old Hispanic patient who was diagnosed with an early-stage NNKTL and treated with the modified SMILE regimen for 6 cycles. His EBV DNA PCR turned undetectable and remained so throughout the treatment. He sustained complete right vision loss due to right optic nerve invasion by the tumor, leading to prophylactic intravitreal methotrexate to the contralateral eye. The patient achieved good response with minimal residual disease. He was supposed to start radiation as a sequential therapy. However, the acute development of severe headache and confusion lead to a complete workup showing leptomeningeal spread. He eventually succumbed to the disease.
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Qian Y, Shen J, Che X, Yuan Y, Wang Z. Bilateral iris mass as the first manifestation of NK cell lymphoma: A case report. Eur J Ophthalmol 2021; 32:NP65-NP68. [PMID: 34254538 DOI: 10.1177/11206721211029136] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Natural killer (NK) cell lymphoma is a progressive non-Hodgkin's lymphoma with rare prevalence. Intraocular involvement of NK cell lymphoma is very rare, with only case reports to date. CASE PRESENTATION Here, we report a case of intraocular involvement of NK cell lymphoma which was presented with bilateral uveitis, iris mass, and diffuse infiltration into the center nerve system (CNS), skin, and possibly myocardium. CONCLUSIONS Iris mass and uveitis which is not responsive to steroids may be ocular manifestations of intraocular lymphoma, such as NK cell lymphoma. Ophthalmological and systemic examinations should be required for early diagnosis and treatment.
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Affiliation(s)
- Yiwen Qian
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Jun Shen
- Department of Cadiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Xin Che
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Yan Yuan
- Department of Hematology, Huashan Hospital of Fudan University, Shanghai, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
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8
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Abstract
RATIONALE Extranodal natural killer T-cell lymphoma nasal type (ENKL) is an extremely rare tumor with a very low survival rate. In recent decades, only a few ENKL cases have been published. Presenting a special ENKL case lead the authors to emphasize the primary features of ENKL in early diagnosis and therapy. Here we report an unusual ENKL case which was initially found in the eyes and presented as masqueraded uveitis PATIENT CONCERNS:: A 55 years old female, with vision loss in the right eye for approximately 6 months, and vision blurry, redness and pain in the left eye for 2 weeks, was referred to our hospital. DIAGNOSIS Clinical examinations and images demonstrated bilateral anterior uveitis, retinal and choroidal detachment, and secondary glaucoma. After 3 months, the patient began to present a sore throat, fever, and headaches. The computed tomography (CT) and magnetic resonance imaging (MRI) of her skull demonstrated nothing positive. One month later, a neoplasm was found in her nasopharynx and tonsil, which was confirmed, by histopathology, as ENKL INTERVENTIONS:: This patient was prescribed with steroid for 3 months because of the first diagnosis by the ophthalmologist. After the other symptoms like a sore throat, fever and headaches occurred, symptomatic treatment was given. Unfortunately, when the real cause was found, the patient could not tolerate the other treatment for ENKL. OUTCOMES Since the patient was treated with steroid without improvement, she died due to the septic shock and multiple organ failure. LESSONS Clinicians should always be cautious to ENKL which can be easily be misdiagnosed in the early stage. Early diagnosis and appropriate treatment are keys to raise the survival rate of ENKL patients.
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Affiliation(s)
- Feng Zhang
- Department of Ophthalmology, The Second Xiangya Hospital
| | - Xuanchu Duan
- Department of Ophthalmology, The Second Xiangya Hospital
- Aier School of Ophthalmology, Central South University
- Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Ke Liu
- Department of Ophthalmology, The Second Xiangya Hospital
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Abstract
Among the variants of non-Hodgkin's lymphoma (NHL), peripheral T-cell lymphomas (PTCLs) are the least occurring. An aggressive subtype is the extranodal natural killer/T-cell lymphoma (ENKTCL) which commonly affects the nasal cavity. Ocular complications of the disease could arise due to anatomical adjacency yet it is seldom reported. We present the case of a 42-year-old male diagnosed with ENKTCL, nasal type stage IV-B with central nervous system involvement. The patient underwent three cycles of chemotherapy to which there was a complete response until relapse occurred in the form of progressive vision loss and right optic nerve infiltration. A diagnostic vitrectomy was performed, and vitreous fluid flow cytometry revealed the presence of natural killer (NK) cells. Ocular manifestations are rarely reported in the literature, yet this could be crucial to follow up on. A regular ophthalmological examination should be warranted for all cases of ENKTCL with the aim of detecting recurrence and prevention of vision loss.
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Affiliation(s)
- Lujain Alqurashi
- Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdullah Alqahtani
- Oncology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Brovkina AF. [Clinical features of malignant orbital lymphoma]. Vestn Oftalmol 2019; 135:4-12. [PMID: 31714507 DOI: 10.17116/oftalma20191350514] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The occurrence of malignant lymphoma (ML) among patients with malignant orbital tumors ranges between 10 and 37.3% making early diagnosis clarification crucial for timely treatment. PURPOSE To study clinical features of ML with consideration of its morphological type and localization in the orbit. MATERIAL AND METHODS Clinical picture of primary malignant orbital lymphoma of 34 patients (36 orbits) was examined retrospectively with consideration of the tumor's morphotype. Median observation time was 6 years. Patients aged between 34 and 84 years, female to male ratio was 1.27:1. RESULTS The final diagnoses were: small cell MALT-type ML (23 patients), large cell B-lymphoma (5 patients), diffuse malignant lymphoma (5 patients), T-cell lymphoma (1 female patient). Systemic changes developed in 29.41% of cases after 6.7 years on average. 23.53% of patients has died. Clinical signs of MALT-type ML were described with consideration of tumor's localization in the orbit, and clinical features of B-cell, large cell, diffuse and T-cell lymphoma were shown. Signs helping differentiate ML from false tumor, composite tear gland tumor and malignant orbital tumor were established. CONCLUSION Despite the higher prevalence of malignant MALT-type lymphoma, primary malignant orbital lymphoma is characterized by unfavorable vital prognosis: in a third of all cases, signs of systemic lesion develop in 6.7 years on average. Clinical picture of MALT-type ML is defined by tumor's localization in the orbit. Recurrence of MALT-type ML after combined treatment (surgical, radiotherapy, polychemotherapy) happens in every fourth case among patients with tumor primarily localized in the orbital cellular tissues or in the tear gland. Describing clinical features of primary malignant orbital lymphoma allows faster diagnosis clarification reducing the number of orbital diseases that require differential diagnositcs.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Continuous Professional Education, Department of Ophthalmology, 2/1 Barricadnaya St., Moscow, Russian Federation, 125993
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Thompson AC, McCall CM, Proia AD. Beneath the Retinal Pigment Epithelium: Histopathologic Findings in Metastatic Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type. Ocul Oncol Pathol 2018; 4:388-394. [PMID: 30574492 DOI: 10.1159/000487268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/21/2017] [Revised: 01/26/2018] [Indexed: 01/03/2023] Open
Abstract
Purpose To report a case of extranodal natural killer/T-cell lymphoma (ENKTCL), nasal type metastatic to the space beneath the retinal pigment epithelium (RPE) with coincident paraneoplastic lymphoma-associated retinopathy. Methods Findings of clinical and histopathologic examination are presented with differential diagnoses and a literature review. Case Report A 53-year-old man presented with bilateral blindness and had exudative retinal detachments overlying subretinal masses in both eyes. Flow cytometry of pericardial fluid revealed malignant T lymphocytes. After two cycles of chemotherapy, the patient was hospitalized and quickly expired. Autopsy revealed lymphoma involving the eyes, heart, right lung, and two subcarinal lymph nodes focally. Histopathologic examination of the eyes revealed intraocular metastases from ENKTCL, nasal type. Expression of CD3 and CD56, along with expression of Epstein-Barr virus by in situ hybridization, confirmed the diagnosis. Lymphomatous infiltrates were confined to the space beneath the neurosensory retina and between the RPE and the Bruch membrane, sparing the uveal tissue, similar to other metastatic T-cell lymphomas. Extensive RPE and photoreceptor loss in regions with and without underlying tumor was typical of a concurrent paraneoplastic lymphoma-associated retinopathy. Conclusion Patients diagnosed with ENKTCL should be evaluated by an ophthalmologist, as ophthalmic involvement portends a poor prognosis.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Okada A, Harada Y, Inoue T, Okikawa Y, Ichinohe T, Kiuchi Y. A case of primary extranodal natural killer/T-cell lymphoma in the orbit and intraocular tissues with cerebrospinal fluid involvement. Am J Ophthalmol Case Rep 2018; 11:37-40. [PMID: 29978138 PMCID: PMC6026719 DOI: 10.1016/j.ajoc.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 12/01/2022] Open
Abstract
Purpose To report a rare case of primary orbital natural killer (NK)/T-cell lymphoma without nasal lesions but with cerebrospinal fluid involvement. Observations A 73-year-old woman was referred to the uveitis clinic with suspected unilateral acute uveitis in her right eye and a right orbital tumor. Epstein–Barr virus DNA was detected in the aqueous humor in her right eye, and orbital biopsy revealed the presence of extranodal NK/T-cell lymphoma (ENKTL), nasal type. Positron emission tomography showed significant 18F-fluorodeoxyglucose uptake in the right orbit, with no other signs of systemic involvement. Cerebrospinal fluid analysis demonstrated lymphoma cell infiltration. She was diagnosed with stage IV ENKTL and treated with orbital radiotherapy and systemic chemotherapy, with subsequent remission. However, the lymphoma relapsed in her left vitreous at 10 months after therapy, suggesting metastasis of lymphoma cells to the contralateral eye via the vitreous and cerebrospinal fluid. Conclusions and importance A few cases of ocular-tissue ENKTL have been reported, mostly involving invasion or dissemination of primary nasal lesions; in contrast, primary orbital and intraocular ENKTL has rarely been reported. To the best of our knowledge, this is the first report of a primary orbital ENKTL metastasizing to the vitreous of the contralateral eye. Although ENKTL is rare in the orbit and intraocular tissues, it should be considered as a possible differential diagnosis in patients with orbital tumors or intraocular inflammation resistant to steroid therapy because ENKTL has a very poor prognosis in the advanced stage.
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Affiliation(s)
- Arisa Okada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoko Inoue
- Department of Hematology and Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Okikawa
- Department of Hematology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Lee GI, Kim YD, Young SM, Shin S, Woo KI. Clinical characteristics and treatment outcomes of natural killer/T-cell lymphoma involving the ocular adnexa. Br J Ophthalmol 2018; 103:269-273. [PMID: 29706604 DOI: 10.1136/bjophthalmol-2017-311704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/03/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate the clinical characteristics and treatment outcomes of natural killer/T-cell lymphoma (NKTL) involving the ocular adnexa. METHODS Retrospective, comparative, observational case series. A total of 350 patients with NKTL, including 27 patients with NKTL involving the ocular adnexa from 1999 to 2016. The patients were grouped into two groups: group 1 comprised patients presenting with ophthalmic symptoms, and group 2 comprised patients presenting with symptoms from other organs but subsequently developed ophthalmic involvement. RESULTS Group 1 comprised 12 patients (44.4%) and group 2 comprised 15 (55.6%). Mean duration of symptoms in group 1 was 1.8±1.2 months, while the time from diagnosis of NKTL to development of ophthalmic symptoms in group 2 was 45.3±65.6 months. Periorbital swelling was the most common presenting symptom in both groups (83.3% in group 1 and 73.3% in group 2). Symptoms mimicking cellulitis and pseudotumor were present in 50.0% and 16.7% of cases, respectively. The 5-year overall survival rate was 18.5% in group 1 and 26.4% in group 2, while the 5-year progression-free survival rate was 0% and 13.3%, respectively. CONCLUSIONS Our series is to our knowledge the largest cohort study on NKTL reported to date and demonstrates that ocular adnexal NKTL is a rare but seriously fatal disease. It is characterised by acute inflammatory signs as present in as many as two-thirds of our patients in this series. It should be considered as a differential diagnosis in patients presenting with rapidly progressing proptosis and diagnosed promptly for optimal management.
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Affiliation(s)
- Ga-In Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Stephanie Ming Young
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seonae Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Haruta M, Taguchi C, Yamakawa R. MACULAR HOLE FORMATION AFTER PARS PLANA VITRECTOMY FOR PRIMARY VITREORETINAL LYMPHOMA. Retin Cases Brief Rep 2020; 14:243-6. [PMID: 29176526 DOI: 10.1097/ICB.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of primary vitreoretinal lymphoma in which a macular hole developed after a diagnostic pars plana vitrectomy. METHODS A retrospective interventional case report. RESULTS A 65-year-old woman presented with worsening vision in the left eye. Fundus examination showed vitreous haze and multifocal, yellow-white infiltrates in the retina and under the retinal pigment epithelium in the left eye. She underwent a diagnostic pars plana vitrectomy in that eye. Undiluted vitreous specimen showed an increased interleukin-10 level (1,470 pg/mL) with an elevated interleukin-10 to interleukin-6 ratio of 15.1; cytologic analysis of the vitreous showed atypical lymphoid cells with large irregular nuclei and scanty cytoplasm. The retinal and sub-retinal pigment epithelial infiltrates responded well to intravitreal methotrexate injections, but a macular hole developed in the left eye. The second pars plana vitrectomy with internal limiting membrane peeling and 20% sulfur hexafluoride gas tamponade successfully closed the macular hole. CONCLUSION Macular hole closure can be accomplished in eyes receiving intravitreal methotrexate injections for treating primary vitreoretinal lymphoma.
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Lyons LJ, Vrcek I, Somogyi M, Taheri K, Admirand JH, Chexal S, Loukas DF, Nakra T. Natural killer/T-cell lymphoma invading the orbit and globe. Proc (Bayl Univ Med Cent) 2017; 30:447-449. [PMID: 28966461 DOI: 10.1080/08998280.2017.11930224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Natural killer/T-cell lymphomas are extremely rare and carry high mortality rates. Epidemiologically, these cancers tend to affect mainly Asian and South American patients and are associated with Epstein-Barr virus seropositivity. This report details a 78-year-old Vietnamese woman who presented initially with vitritis of unknown cause, but later developed proptosis and conjunctival involvement as her disease spread. Biopsies of the orbit, ethmoid sinus, and conjunctiva were found to be significant for natural killer/T-cell lymphoma. The case highlights the diagnostic difficulty of this tumor given its rarity and ability to mimic other disorders.
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Affiliation(s)
- Lance J Lyons
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Ivan Vrcek
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Marie Somogyi
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Kevin Taheri
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Joan H Admirand
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Saradha Chexal
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Demetrius F Loukas
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
| | - Tanuj Nakra
- University of Texas at Austin Dell Medical School, Austin, Texas (Lyons); TOC Eye and Face, Austin, Texas (Vrcek, Somogyi, Nakra); ENT and Allergy Center of Austin, Round Rock, TX (Taheri); Seton Medical Center Austin, Austin, Texas (Admirand); Retina Consultants of Austin, Austin, Texas (Chexal); and Texas Oncology, Austin, Texas (Loukas)
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Jiménez-Pérez JC, Jakobiec FA, Zakka FR, Yoon MK. Dacryoadenitis as the Initial Presentation of a Natural Killer T-Cell Lymphoma. Ophthalmic Plast Reconstr Surg 2017; 33:e147-50. [PMID: 28328558 DOI: 10.1097/IOP.0000000000000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary orbital natural killer T-cell lymphoma (NKTCL) is a rare condition with only a few published cases in the literature. Over 1 month, an 81-year-old man developed progressive left periocular inflammation unresponsive to treatment. Clinical examination and imaging studies demonstrated a left lacrimal gland enlargement. Bilateral anterior uveitis and erythematous nontender cutaneous lesions were also found. Biopsies of the skin and lacrimal gland on the back revealed histopathologic and immunohistochemical findings confirming Epstein-Barr virus-positive NKTCL. Metastatic work up disclosed multifocal involvement in the pancreas, stomach, and chest wall. Palliative treatment consisting of nonanthracycline-based chemotherapy and radiation was instituted, but the patient died 5 months after the onset of symptoms. This is the first example of acute dacryoadenitis, and the second of bilateral anterior uveitis, in the setting of NKTCL. Absence of naso-sinus involvement in the current case is rare in NKTCL. Despite treatment, the prognosis remains dismal. Orbital specialists should include NKTCL in the differential diagnosis of lacrimal gland/orbital masses and perform an incisional biopsy if the clinical scenario so dictates.
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Abstract
Natural killer T-cell lymphoma (NKTCL) is a rare and aggressive condition with a high mortality rate. It is most commonly seen in the nasal sinuses, generally affecting the orbit by direct extension. Primary orbital NKTCL is even more rare, with only a few published cases with occasional secondary nasal involvement. This malignancy can present as a "masquerade syndrome," delaying proper diagnosis and treatment. Biopsy is required for diagnosis, which shows specific histopathological characteristics. Radiation and chemotherapy are the mainstay of treatment. Newer chemotherapies show improved prognosis.
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Affiliation(s)
- Juan C Jiménez-Pérez
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Michael K Yoon
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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Matsuo T, Tanaka T, Ichimura K, Meguri Y. Intraocular Relapse with Hypopyon and Retinal Infiltrates after Chemotherapy and Peripheral Blood Stem Cell Transplantation for Extranodal NK/T-Cell Lymphoma. J Clin Exp Hematop 2016; 55:157-61. [PMID: 26763364 DOI: 10.3960/jslrt.55.157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We report a case of intraocular relapse of extranodal NK/T-cell lymphoma with anterior chamber hypopyon and retinal infiltrates. A 55-year-old man developed fever, malaise, anorexia, and hepatosplenomegaly, and was diagnosed with NK/T-cell lymphoma by liver biopsy. He underwent 2 courses of SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) chemotherapy, followed by myeloablative peripheral blood stem cell transplantation, donated by his brother. Two months later, he developed high-grade fever, hepatosplenomegaly, and peritoneal lymphadenopathy, and the relapse with hemophagocytic syndrome was diagnosed by bone marrow biopsy. He underwent 2 courses of SMILE salvage chemotherapy, followed by non-myeloablative peripheral blood stem cell transplantation, donated by his son. Two months later, he noticed blurred vision in both eyes. The right eye had aqueous cells and keratic precipitates, but no retinal lesions. The left eye had hypopyon in the anterior chamber with numerous aqueous cells, and retinal white infiltrates with retinal hemorrhages. The aqueous cells, obtained by anterior chamber paracentesis, were positive for CD3, CD56, and Epstein-Barr virus-encoded RNA, but negative for CD20 by immunocytochemical staining. Head magnetic resonance imaging demonstrated white matter lesions in the anterior to parietal lobes on the right side. The patient underwent intrathecal methotrexate injection and external beam radiation at 40 Gy, covering the entire brain and both eyes. The retinal lesions and hypopyon disappeared. Two months later, the patient died of renal failure, and autopsy demonstrated multi-organ involvement of lymphoma cells. In conclusion, we report a case of NK/T-cell lymphoma relapse with intraocular lesions, after combined chemotherapy and hematopoietic stem cell transplantation.
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Affiliation(s)
- Toshihiko Matsuo
- Departments of Ophthalmology, Okayama University Hospital and Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Meel R, Dhiman R, Wadhwani M, Kashyap S, Sharma S, Gogia A. Isolated Extranodal Natural Killer T-Cell Lymphoma of the Orbit in a Young Patient: Complete Regression with the SMILE Regimen. Ocul Oncol Pathol 2016; 3:45-48. [PMID: 28275603 DOI: 10.1159/000449227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/22/2016] [Revised: 08/17/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Natural killer T-cell lymphoma (NKTL) is a highly malignant tumor that typically arises in the nose and/or paranasal sinuses. Isolated orbital involvement by NKTL is extremely rare, and only few case reports exist in the literature. Herein, we report a case of primary orbital NKTL in a young patient who showed very good response to chemotherapy with the SMILE regimen. METHODS A 28-year-old healthy female presented to us with epiphora and fullness of the lower eyelid. She had previously been diagnosed as orbital pseudotumor and was prescribed oral steroids. However, there was no response to the treatment. She also had a history of recurrent sinusitis. An incision biopsy revealed NKTL. A systemic workup did not reveal any other site of involvement. The patient received 6 cycles of chemotherapy (SMILE) and external beam radiotherapy. RESULTS The tumor showed complete regression after 2 cycles of chemotherapy. The patient is disease free at 24 months of follow-up. CONCLUSION Reported median survival for primary orbital NKTL is extremely poor. This is perhaps the first report of a primary orbital NKTL demonstrating a remarkable treatment response to a newer chemotherapy regimen (SMILE) in combination with radiotherapy.
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Affiliation(s)
- Rachna Meel
- Oculoplasty and Ocular Oncology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Oculoplasty and Ocular Oncology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meenakshi Wadhwani
- Oculoplasty and Ocular Oncology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Ocular Pathology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Ocular Radiology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Oculoplasty and Ocular Oncology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, New Delhi, India
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Abstract
Natural killer/T-cell (NK/T-cell) lymphoma-nasal subtype, is a rare form of non-Hodgkin's lymphoma, most common in South East Asia, and can have an ophthalmological presentation. This report describes a 51-year-old Caucasian man with uveitis, recurrent retinal detachment and paraneoplastic features subsequently diagnosed as NK/T-cell lymphoma.
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Affiliation(s)
- Emily Hughes
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Helen Fogarty
- Department of Haematology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Anne Fortune
- Department of Haematology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Keegan
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Maruyama K, Kunikata H, Sugita S, Mochizuki M, Ichinohasama R, Nakazawa T. First case of primary intraocular natural killer t-cell lymphoma. BMC Ophthalmol 2015; 15:169. [PMID: 26585973 PMCID: PMC4653874 DOI: 10.1186/s12886-015-0158-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/14/2015] [Indexed: 12/02/2022] Open
Abstract
Background Natural killer cell tumors can be broadly divided by origin into mature-cell and progenitor-cell types. The invasion of nasal-origin natural killer cells into the ophthalmologic field is sometimes observed in patients, but primary ocular natural killer cell tumors are a rare occurrence. Case presentation A 66 year-old woman without any systemic disease presented with blurred vision due to a severe vitreous opacity in the right eye. Flow cytometric analysis of the vitreous fluid suggested a natural killer cell tumor. Moreover, cytologic examination of vitreal and retinal specimens revealed the infiltration of a natural killer cell tumor, while PCR and immunocytochemistry revealed Epstein-Barr virus infection. The results of a gene rearrangement analysis were positive for IGH, while TCR beta chains were all negative. We examined the patient with whole-body magnetic resonance imaging and positron emission tomography, and performed a bone marrow examination. These examinations returned no abnormal results. Conclusion Thorough analysis of vitreal samples is essential when performing vitrectomies for vitreous opacities of unknown cause. Flow cytometric, cytologic, and PCR analysis of vitreal and retinal samples may reveal the presence and cause of severe illness.
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Affiliation(s)
- Kazuichi Maruyama
- Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Hiroshi Kunikata
- Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Sunao Sugita
- RIKEN Center for Development Biology, Kobe, Japan.
| | - Manabu Mochizuki
- Department of Ophthalmology, Tokyo Dental and Medical University, Tokyo, Japan.
| | - Ryo Ichinohasama
- Department of Hematopathology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Toru Nakazawa
- Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Cruz AA, Valera FC, Carenzi L, Chahud F, Barros GE, Elias J. Orbital and central nervous system extension of nasal natural killer/T-cell lymphoma. Ophthalmic Plast Reconstr Surg. 2014;30:20-23. [PMID: 24398482 DOI: 10.1097/iop.0b013e3182a7500e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To describe a case series of nasal natural killer (NK)/T-cell lymphoma (NKTL) with orbital and central nervous system extension. METHODS This is a retrospective study. The medical records of 9 patients with a diagnosis of NKTL were reviewed. All patients had a positive biopsy for CD3, CD56, T-cell-restricted intracellular antigen-1, and granzyme expression and CT imaging of nose, sinuses, orbits, and brain. Five patients were also examined with MRI. RESULTS Orbital extension occurred in 6 patients. All had extraocular muscle enlargement and 5 showed signs of perineural spread. CONCLUSIONS NKTL is a polymorphous disease. Extraocular muscle involvement and perineural spread are overlooked features that explain dissemination of the tumor to both the orbit and the central nervous system.
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Termote K, Dierickx D, Verhoef G, Jorissen M, Tousseyn T, Mombaerts I. Series of extranodal natural killer/T-cell lymphoma, nasal type, with periorbital involvement. Orbit 2014; 33:245-51. [PMID: 24831171 DOI: 10.3109/01676830.2014.902478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical presentation, diagnosis and treatment of periorbital extranodal natural killer/T-cell lymphoma, nasal type. METHODS Case series of three patients with periorbital involvement of extranodal natural killer/T-cell lymphoma, nasal type, of whom clinical data, orbital imaging and immunohistochemical analysis were collected. For the purpose of this study, all histopathological and immunohistochemical slides were re-examined. RESULTS All patients presented with painless eyelid swelling and a history of sinonasal disease, of whom one with bilateral panuveitis, not responding to systemic antibiotics. Extraocular muscle involvement was present in 2 cases upon presentation and in 1 case later on. Initial paranasal and orbital biopsies were negative in 2 patients, with only the second orbital biopsy leading to the diagnosis. Natural killer/T-cell and cytotoxic markers were present in all cases, as well as Epstein-Barr virus encoded RNA in situ hybridization. The patients died respectively 5, 9 and 35 months from diagnosis despite treatment with chemotherapy and radiotherapy. CONCLUSION Extranodal natural killer/T-cell lymphoma, nasal type, should be suspected in a painless periorbital cellulitis with chronic sinusitis, not responding to conventional therapy. A high index of suspicion is necessary in biopsies showing angiodestruction and necrosis. Epstein-Barr virus encoded RNA in situ hybridization and expert hematopathologist consultation is necessary to decrease the delay in diagnosis.
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Luemsamran P, Pornpanich K, Uiprasertkul M, Sakolsatayadorn N, Vangveeravong S. NK/T-cell lymphoma of the nasal cavity causing contralateral dacryoadenitis. Orbit 2013; 32:250-2. [PMID: 23663138 DOI: 10.3109/01676830.2013.788665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a case of NK/T-cell lymphoma of the nasal cavity with contralateral lacrimal gland involvement. METHODS Observational case report. RESULTS A 39-year-old woman with a 5-month history of right fungal rhinosinusitis was referred to our hospital. A nasal mucosal biopsy performed before referral was consistent with Aspergillus sp. Despite surgical and parenteral antifungal treatment, the symptoms continued to deteriorate. On admission, the ophthalmic evaluation showed inflammation over the left lacrimal gland area. The fundus examination revealed bilateral subretinal infiltration. Computed tomography scans of the orbits and sinuses showed mucosal thickening of the right nasal mucosa and sinuses. There was heterogeneous enhancement and infiltration of the left lacrimal gland. Lacrimal gland biopsy and repeated biopsies of the nasal cavity and sinus tissue were performed. Immunohistopathology of the lacrimal glands and nasal mucosa showed extranodal nasal-type NK/T-cell lymphoma. The patient was treated with cyclophosphamide, vincristine, adriamycin, prednisolone (3 cycles), and intrathecal methotrexate. The patient developed sepsis and died 2 months after initiation of chemotherapy. CONCLUSION Dacryoadenitis can be a clinical manifestation of NK/T-cell lymphoma. To our knowledge, this is the first reported case of nasal NK/T-cell lymphoma with contralateral dacryoadenitis.
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Affiliation(s)
- Panitee Luemsamran
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Bonnin N, Cornut PL, Chaise F, Labeille E, Manificat HJ, Feldman A, Perard L, Bacin F, Chiambaretta F, Burillon C. Spontaneous closure of macular holes secondary to posterior uveitis: case series and a literature review. J Ophthalmic Inflamm Infect 2013; 3:34. [PMID: 23514634 PMCID: PMC3605119 DOI: 10.1186/1869-5760-3-34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/25/2013] [Indexed: 12/25/2022] Open
Abstract
The occurrence of a macular hole due to posterior uveitis is infrequently reported. We report the evolution of three cases of macular holes secondary to posterior segment inflammation. A complete inflammatory and infectious assessment found one case of toxocariasis, one of sarcoidosis, and one of syphilis. After medical etiological treatment, macular hole closure was rapidly obtained in all the cases and confirmed by spectral domain optic coherence tomography, with visual acuity improvement. Fibrous scarring developed in two cases, and foveal photoreceptor complex normalization was observed in the sarcoidosis case. These observations demonstrate that macular holes secondary to posterior uveitis frequently resolve without surgical intervention and so could be underdiagnosed if the patient is not evaluated at the time of onset before spontaneous hole closure.
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Affiliation(s)
- Nicolas Bonnin
- Service d'Ophtalmologie, Pôle Médecine Interne-Ophtalmologie-ORL, CHU Clermont-Ferrand, Clermont-Ferrand, 63003, France.
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Türker B, Uz B, Işık M, Bektaş O, Demiroğlu H, Sayınalp N, Uner A, Ozcebe Oİ. Nasal Natural Killer/T-cell Lymphoma with Skin, Eye, and Peroneal Nerve Involvement. Turk J Haematol 2012; 29:413-9. [PMID: 24385732 PMCID: PMC3781633 DOI: 10.5505/tjh.2012.03360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 10/06/2011] [Indexed: 11/15/2022] Open
Abstract
Nasal-type natural killer (NK)/T-cell lymphoma (NKTL) is a rare disease strongly associated with Epstein-Barr virus and is often localized to the upper aerodigestive tract at presentation. Extranodal NKTL may involve any extranodal site and disease beyond the nasal cavity is highly aggressive, with short survival time and poor response to therapy. Herein we present a 57-year-old male that had been treated with systemic chemotherapy and cranial radiotherapy for nasaltype NKTL in the palate with skin, right eye, and right peroneal nerve involvement. He was given salvage chemotherapy consisting of 3 cycles of ICE and his response to the therapy was satisfactory, except for persistent right drop foot. About 6 weeks later, the patient presented with bilateral total loss of vision and proptosis; therefore, DHAP chemotherapy was started. Unfortunately, after 1 cycle of the second salvage chemotherapy, he died due to severe fungal infection of the hard palate. Despite the fact that involvement of any extranodal site is possible, concurrent involvement of many systems in NKTL patients is unusual. Nasal-type NKTL has a poor prognosis, despite local radiotherapy and systemic chemotherapy. Physicians should be aware of this rare disorder than can only be diagnosed after extensive immunohistochemical studies. Conflict of interest:None declared.
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Affiliation(s)
- Burcu Türker
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Burak Uz
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Metin Işık
- Hacettepe University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey
| | - Ozlen Bektaş
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Nilgün Sayınalp
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Aysegül Uner
- Hacettepe University, Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Osman İlhami Ozcebe
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Ely A, Evans J, Sundstrom JM, Malysz J, Specht CS, Wilkinson M. Orbital involvement in extranodal natural killer T cell lymphoma: an atypical case presentation and review of the literature. Orbit 2012; 31:267-269. [PMID: 22681504 DOI: 10.3109/01676830.2011.605506] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 06/01/2023]
Abstract
PURPOSE To report a rare case of extranodal NK/T cell lymphoma (NKTL) and to compare its features with those cases previously reported. DESIGN Case report, observational and literature review. METHODS Complete ophthalmologic examinations followed by excisional biopsy, histopathologic examination and therapy with radiation and chemotherapy. MAIN OUTCOME MEASURES Evaluation of clinical presenting features and histopathologic diagnosis along with patient outcome. RESULTS A 22 year old female presented as a referral with right orbital swelling, decreased vision and eye pain for 5 weeks. Subsequent orbital CT and multiple biopsies resulted in a diagnosis of extranodal natural killer (NK)/T cell lymphoma (NKTL). Despite continued chemotherapy and orbital radiation the patient expired within 3 months of diagnosis. To our knowledge, only 8 cases of orbital involvement without nasal mucosal involvement are reported in the literature, the majority in patients of male gender around the fifth decade. CONCLUSIONS Here we present an atypical and aggressive case of extranodal NK/T cell lymphoma presenting in a 22 year old Caucasian female as orbital swelling without evidence of nasal mucosal involvement. It is important to distinguish NKTL from the more common benign lymphoproliferative lesions of the orbital adnexa as prognosis of these two clinical entities varies and timely diagnosis is key. The present case demonstrates that extranodal NKTL can occur in the orbit without evidence of the more common nasal mucosal presentations and should be included in the differential diagnosis of ocular adnexal lesions suspicious for a lymphoproliferative disorder and/or an inflammatory process.
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Affiliation(s)
- A Ely
- Penn State Hershey Milton S. Hershey Medical Center, Department of Ophthalmology, Hershey, PA, USA.
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Li DM, Lun LD. Mucor irregularis infection and lethal midline granuloma: a case report and review of published literature. Mycopathologia 2012; 174:429-39. [PMID: 22744721 DOI: 10.1007/s11046-012-9559-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/28/2012] [Indexed: 12/16/2022]
Abstract
Mucor irregularis (Rhizomucor variabilis) infection and lethal midline granuloma (LMG) are characterized by progressive swelling, ulceration, and destruction of the central face that is usually fatal. Pathological features are inflammation, necrosis, and granulation. LMG has been called by various names, and in recent years, it has been known as NK/T cell lymphoma. However, diagnosis still relies on the progressive necrosis course rather than malignancy in histology. The disease has long challenged physicians, particularly when it worsens with radiotherapy or chemotherapy but sometimes achieves total remission without anti-malignancy therapies. We describe a 35-year-old man who had typical clinical-pathological symptoms of LMG, which turned out to be primary M. irregularis infection; that was diagnosed by positive tissue culture and fungal elements in histology. The patient was successfully treated with antifungal therapy (liposomal amphotericin B, total 4,600 mg and amphotericin B total 277 mg, over a duration of 70 days). We hereby review current knowledge about the epidemiology, clinical manifestations, radiographic characteristics, and pathologic features of LMG with those of M. irregularis infection and their associations. We conclude that primary M. irregulars infection can mimic the clinico-pathological symptoms of LMG and the condition responds favorably to aggressive antifungal therapy.
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Affiliation(s)
- Dong Ming Li
- Department of Dermatology, Research Center for Medical Mycology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
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Yoo JH, Kim SY, Jung KB, Lee JJ, Lee SJ. Intraocular involvement of a nasal natural killer T-cell lymphoma: a case report. Korean J Ophthalmol 2012; 26:54-7. [PMID: 22323887 PMCID: PMC3268170 DOI: 10.3341/kjo.2012.26.1.54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 02/02/2011] [Indexed: 11/23/2022] Open
Abstract
Herein, we report a case of nasal natural killer T-cell lymphoma (NKTL) with intraocular involvement. A 57-year-old woman was referred due to a three-day history of photophobia and diplopia in the left eye. One-month previously, she was diagnosed with nasal NKTL of the right nasal cavity. Ophthalmic examination revealed conjunctival injection and ptosis. The left pupil was fully dilated and non-reactive to light. Ocular motion was restricted on left-upper gaze. Five days later, anterior uveitis developed and persisted despite topical steroid treatment. An orbital magnetic resonance imaging was without specific findings, however, ophthalmoplegia, vitreous opacity, and an iris mass were observed. A diagnostic anterior chamber aspiration was performed. Aqueous humor aspiration revealed 35% morphologically atypical lymphocytes. After an intravitreal triamcinolone injection, radiotherapy and chemotherapy were administered; this resolved the uveitis and iris mass. When refractory uveitis or orbital pseudotumor occurs in patients with nasal NKTL, ocular and orbital involvement of the NKTL should be considered.
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Affiliation(s)
- Jae Ho Yoo
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
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Poli M, Sève P, Merrot O, Grange JD, Kodjikian L. Diagnosis of a multicentric extranodal nasal-type natural killer T-cell lymphoma made with an anterior chamber tap. Retin Cases Brief Rep 2012; 6:46-9. [PMID: 25390710 DOI: 10.1097/ICB.0b013e3182051e0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the case of an unusual multicentric Epstein-Barr virus (EBV)-associated extranodal nasal-type natural killer T-cell lymphoma masquerading as unilateral panuveitis, diagnosed with an anterior chamber tap. METHODS The clinical history and the morphological, immunohistochemical, and molecular features of a 51-year-old white man with left severe panuveitis were retrospectively evaluated. RESULTS The patient initially presented with a 3-month history of recalcitrant sinusitis and new onset of unilateral loss of vision. Clinical examination revealed right peripheral facial nerve palsy, severe panuveitis of the left eye, and nasopharyngeal obstruction. Anterior chamber aspirates were examined. The combination of the presence of small- to intermediate-size lymphocyte proliferation, moderate elevation of the interleukin-10 level on cytokine profiling, and slightly positive polymerase chain reaction for EBV in the aqueous humor indicated an EBV-induced nasal-type natural killer T-cell lymphoma. Transnasal biopsy revealed the presence of numerous irregular lymphoma cells with positive staining for CD3, CD56, EBV-encoded RNA in situ hybridization, and negative staining for CD4, CD8, and CD1a. Lumbar puncture, cerebral magnetic resonance imaging, thoracoabdominal computed tomography, and upper digestive tract endoscopy revealed meningeal, renal, adrenal, and digestive involvement. Massive hemorrhage of the upper digestive tract caused rapid death. CONCLUSION Extranodal nasal-type natural killer T-cell lymphoma is a very uncommon disease that may present acutely, sometimes as pseudouveitis. Simple investigations such as anterior chamber aspirates for cytological examination, reinforced by cytokine profiling and viral polymerase chain reaction looking for EBV, may provide a rapid diagnosis, necessary given the poor prognosis of the disease. To our knowledge, and after extensive review of the literature, we did not find another case report diagnosing this entity by anterior chamber paracentesis.
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Wu LL, Yuen HKL, Chan CKM, Lai TYY, Chan JKC, Cheuk W. Panuveitis as an initial presentation of extranodal NK/T-cell lymphoma. Leuk Lymphoma 2009; 50:648-50. [DOI: 10.1080/10428190802713539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
We describe eight cases of acute proptosis due to mantle cell lymphoma (MCL), among 26 consecutive MCL cases. The median time of onset was 29 months (range 0-102) from diagnosis. Two cases presented initially with orbital masses while five as sudden disease progression after multiple courses of chemotherapy. In each case, there was dramatic loss of vision and severe proptosis, which uniformly responded to radiotherapy and/or further chemotherapy. Unilateral blindness only occurred in two cases, with recurrent orbital relapse and repeated retinal irradiation and retro-orbital optic nerve involvement, respectively. The high incidence, as well as bilateral and recurrent nature, of orbital involvement suggested a homing mechanism of MCL to this site. Despite the absence of central nervous system involvement, most cases died of refractory disease. Apart from lymphomatous polyposis of the gut, MCL cells also show predilection to ocular presentation, and must be considered as a differential diagnosis to maltoma in the two anatomical sites.
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Affiliation(s)
- Charmaine Hon
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong.
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Charton J, Witherspoon SR, Itani K, Jones FR, Marple B, Morse B. Natural killer/T-cell lymphoma masquerading as orbital cellulitis. Ophthalmic Plast Reconstr Surg 2008; 24:143-5. [PMID: 18356722 DOI: 10.1097/IOP.0b013e3181659867] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe 3 cases of natural killer/T-cell lymphoma that presented by masquerading as orbital cellulitis. All of the patients were examined for pain, fever, proptosis, and motility restriction. Computed tomography of the orbits and sinuses revealed orbital soft-tissue swelling without focal abscess in all 3 cases. Bacterial and fungal cultures were negative in each case and all of the patients had initial improvement on systemic antibiotics, only to relapse several days later. Diagnosis of natural killer/T-cell lymphoma was then made based on biopsy of the orbit or sinus. Natural killer/T-cell lymphoma should be considered in cases of orbital cellulitis or sinusitis that fail to respond to traditional management. Biopsy of the affected region should be performed expeditiously to diagnose this condition. Repeat biopsy may be needed.
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Cimino L, Chan CC, Shen D, Masini L, Ilariucci F, Masetti M, Asioli S, Sartori A, Cappuccini L. Ocular involvement in nasal natural killer T-cell lymphoma. Int Ophthalmol 2008; 29:275-9. [PMID: 18438613 DOI: 10.1007/s10792-008-9220-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 02/25/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical, morphologic, and immunohistochemical features of a case of paranasal natural killer/T-cell lymphoma (NKTL) with ocular involvement. CASE REPORT In March 2005 the patient presented with a maxillary sinusitis and upper nasal obstruction. In July she underwent a nasal computed tomography (CT) scan and multiple biopsies of the granulomatous tissue in the nasal fossae. The diagnosis was NK/T non-Hodgkin's lymphoma nasal type, stage IV A. Afterwards she presented anterior uveitis. In September after the diagnosis of lymphoma the patient underwent a bone marrow biopsy and thoracic and abdominal CT scan. An ophthalmic examination including visual acuity assessment and fundoscopic examination was made. In October she started chemotherapy cycles. Maxillary CT scan and ophthalmic examinations were performed during the cycles. In January 2006 after severe recurrences of panuveitis a diagnostic vitrectomy was performed. RESULTS A diagnosis of T-lymphoma cells in the vitreous was made; the tumor was most likely originating from her paranasal NKTL. The condition of the patient deteriorated rapidly and she expired on February 2006. CONCLUSIONS Nasal and paranasal sinus lymphomas are rare, but aggressive diseases with a tendency to invade tissues and spread to CNS, including the eye. Ocular manifestations prior to systemic ones may be useful to monitor the response to therapy.
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Affiliation(s)
- Luca Cimino
- Department of Ophthalmology, Arcispedale S.M. Nuova, Viale Risorgimento 80, Reggio Emilia, Italy.
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Chen CS, Miller NR, Lane A, Eberhart C. Third Cranial Nerve Palsy Caused by Intracranial Extension of a Sino-Orbital Natural Killer T-Cell Lymphoma. J Neuroophthalmol 2008; 28:31-5. [DOI: 10.1097/wno.0b013e3181674228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sandner A, Kösling S, Helmbold P, Winkler M, Bloching MB, Holzhausen HJ. [Primary nasal natural killer/T-cell lymphomas: classification and clinicopathological features]. HNO 2007; 55:93-9. [PMID: 17103008 DOI: 10.1007/s00106-006-1470-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/23/2022]
Abstract
BACKGROUND Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more. MATERIAL AND METHODS Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report. RESULTS Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor. CONCLUSIONS Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.
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Affiliation(s)
- A Sandner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle/Saale.
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Velankar MM, Kini AR. Ocular involvement by T-cell post-transplant lymphoproliferative disorder of cutaneous origin. Pathology 2007; 39:369-71. [PMID: 17558871 DOI: 10.1080/00313020701329831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Primary nasal natural killer (NK)/T-cell lymphoma is the most common cellular subtype seen in nasal lymphomas. It is rare in the Western population but occurs more frequently in Asia, South America, and Mexico. The purpose of this study was to describe the computed tomography (CT) and magnetic resonance (MR) imaging findings of primary nasal NK/T-cell lymphoma. METHODS During the period between January 1990 and June 2006, the CT (n=24) and MR (n=6) images of 24 patients with biopsy-proved nasal NK/T-cell lymphoma were reviewed retrospectively. Both CT and MR images were evaluated for site and extent of disease and for pattern of involvement of adjacent areas. RESULTS The most common symptoms at presentation were nasal obstruction, nasal discharge, and epistaxis. There was involvement of the unilateral nasal cavity in 16, bilateral nasal cavity including nasal septum in 5 and nasal choana in 3. Sites of extension outside the nasal cavity included tumor extension into paranasal sinuses (n=15), nasopharynx (n=5), nasal labial fold (n=3), oropharynx (n=2), infratemporal fossa (n=2), other subcutaneous soft tissue of the face (n=2) and anterior cranial fossa base (n=1). Bony destruction was demonstrated in 18 cases, involving the sinus bony wall (n=15), nasal turbinate (n=10), lamina papyracea (n=6), orbital floor (n=3), and hard palate (n=2). Regional lymphadenopathy was also detected in 3 patients with nasal NK/T-cell lymphoma. CONCLUSION The CT and MR appearances of nasal NK/T-cell lymphoma are nonspecific, and the diagnosis requires histologic confirmation. However, the differential diagnosis of nasal NK/T-cell lymphoma should be included if the images present soft tissue of the nasal cavity with bony erosion or destruction; involvement of the orbital cavity, nasopharynx and infratemporal fossa; and subcutaneous or nasolabial fold soft tissue infiltration, especially in Asian populations.
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Affiliation(s)
- Chang-Hsien Ou
- Department of Radiology, Buddhist Tzu-Chi General Hospital, Taichung Branch, and Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
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Affiliation(s)
- Yuka Shimonagano
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kumiko Nakao
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kimiharu Uozumi
- Division of Host Response, Center for Chronic Viral Disease, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Koichi Haraguchi
- Division of Host Response, Center for Chronic Viral Disease, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKTCL), previously known as lethal midline granuloma is a distinct clinico-pathological entity associated with Epstein-Barr virus that typically causes destruction of the midface, palatal and orbital walls. In addition, ENKTCL can involve the skin, soft tissue, testes, gastrointestinal and upper respiratory tract. ENKTCL neoplastic cells express some T-cell associated antigens, most commonly CD2 and cytoplasmic CD3epsilon and, in favour of an NK-cell origin, CD56. Early stage disease may respond to radiotherapy alone, however late stage disease does not respond well to any available therapies. Overall, patients with ENKTCL have a cumulative probability of survival at 5 years ranging from 37.9% to 45.3%.
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Affiliation(s)
- Dalal Abdullah Al-Hakeem
- Oral Medicine Unit, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, UCL Eastman Dental Institute for Oral Health Care Sciences, 256 Gray's Inn Road, London WC1X 8LD, UK
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Kase S, Namba K, Kitaichi N, Ohno S. Epstein-Barr virus infected cells in the aqueous humour originated from nasal NK/T cell lymphoma. Br J Ophthalmol 2006; 90:244-5. [PMID: 16424544 PMCID: PMC1860178 DOI: 10.1136/bjo.2005.081885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Luther N, Greenfield JP, Chadburn A, Schwartz TH. Intracranial Nasal Natural Killer/T-cell Lymphoma: Immunopathologically-Confirmed Case and Review of Literature. J Neurooncol 2005; 75:185-8. [PMID: 16283442 DOI: 10.1007/s11060-005-1862-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 11/25/2022]
Abstract
Advances in immunophenotypic profiling now permit characterization of natural killer/T-cell (NK/T-cell) lymphoma as distinct from other extranodal T- and B-cell Non-Hodgkin's lymphomas. NK/T-cell lymphoma presents most commonly in the nasal cavity. Disease progression to the central nervous system (CNS) is a rare phenomenon. We present here, to our knowledge, the first immunophenotypically-confirmed case of direct extension of nasal NK/T-cell lymphoma to the brain. In addition, we review the literature with respect to NK/T-cell lymphoma metastasis to the CNS. The overall prevalence of NK/T-cell lymphoma CNS metastasis is less than 3%. Although rare, CNS invasion portends a poor prognosis, emphasizing the importance of early and accurate immunophenotype profiling and the need for novel, aggressive therapy.
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Affiliation(s)
- Neal Luther
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Abstract
PURPOSE To report the development of a macular hole as a complication of cat scratch disease. DESIGN Case report. METHODS A 10-year-old girl was seen with unilateral neuroretinitis from serologically confirmed cat scratch disease. Twelve days later, she developed a macular hole in the involved eye. Fundus photography and optical coherence tomography (OCT) were obtained at presentation and after the development of a macular hole. RESULTS Fundus photography and OCT on presentation revealed a nasal neurosensory detachment and multiple inflammatory foci throughout the macula, including a subfoveal lesion. Fundus photography and OCT 12 days later revealed the development of a partial posterior vitreous detachment and a full thickness macular hole. CONCLUSIONS Macular hole should be included among posterior segment complications of cat scratch disease. In this case, the macular hole was associated with partial vitreous detachment and a preexisting subfoveal lesion, likely representing an inflammatory focus.
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Affiliation(s)
- Thomas A Albini
- Baylor College of Medicine, Department of Ophthalmology, Houston, TX 77030, USA
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Cruz AAV, Leite LVDO, Chahud F, Neder L, Tone LG, Valera ET, Elias J. T-Cell Sinonasal Lymphoma Presenting as Acute Orbit With Extraocular Muscle Infiltration. Ophthalmic Plast Reconstr Surg 2004; 20:473-6. [PMID: 15599254 DOI: 10.1097/01.iop.0000144935.03795.0f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
We describe a rare case of sinonasal T-cell lymphoma in an 11-year-old boy who presented with a right acute orbit characterized by proptosis, eyelid edema and erythema, limitation of eye movements, and excruciating pain on the right side of his face. Orbital computed tomography showed progressive right extraocular muscle enlargement. One biopsy specimen showed extensive tissue necrosis and an infiltrate of atypical cells with pleomorphic nuclei within the walls of blood vessels. Immunohistochemical studies demonstrated that these cells were positive for leucocyte common antigen (CD45), CD3 cytoplasmic, CD45RO, and terminal deoxynucleotidyl transferase and negative for CD20, CD57, CD56, CD99 and Epstein-Barr virus. Chemotherapy for T-cell non-Hodgkin lymphoma was initiated, but the patient's status deteriorated and the child died of respiratory insufficiency, sepsis, and central nervous system infection.
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Affiliation(s)
- Antonio Augusto V Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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Hon C, Kwok AKH, Shek TWH, Au WY. Unusual locations of involvement by malignancies: Case 4. Bilateral hypopyon heralding CNS relapse of cutaneous natural killer cell lymphoma. J Clin Oncol 2003; 21:3373-4. [PMID: 12947077 DOI: 10.1200/jco.2003.01.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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