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Conjunctival follicular lymphoma after treatment for invasive squamous cell carcinoma.

da Cunha LP, Barros JN, Motono M, Costa FD, da Cunha MC, Chojniak MM - Case Rep Ophthalmol (2014)

Bottom Line: The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue.After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III.Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.

View Article: PubMed Central - PubMed

Affiliation: Clínica de Olhos Dr. Moacir Cunha, Brazil.

ABSTRACT

Backgrounds/aims: The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue.

Methods: Conjunctival impression cytology was performed for a rapid initial diagnosis of lymphoma, and subsequent histopathological and immunohistochemical studies were carried out for its confirmation and to identify the best therapeutic regimen.

Results: After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III.

Conclusion: Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.

No MeSH data available.


Related in: MedlinePlus

A slit-lamp biomicroscopy appearance of the lesion showing a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of the right eye.
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Figure 1: A slit-lamp biomicroscopy appearance of the lesion showing a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of the right eye.

Mentions: The authors describe the case of a 79-year-old female patient, Caucasian, smoker, from Sao Paulo (SP, Brazil). In July 2013, she was evaluated by one of the authors (M.M.) due to the complaint of an abnormality and swelling of the inferior conjunctiva and the medial canthus of her right eye for a period between 4 and 6 months. She had a history of previous cataract surgery and corneal transplantation for the treatment of Fuchs endothelial dystrophy in 2008, and also an excisional biopsy for an ocular surface squamous neoplasia that was histologically graded as invasive squamous cell carcinoma in the inferior conjunctiva of the same eye in 2011. On examination, the visual acuity of both eyes was 20/25 on the Snellen chart. She had a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of her right eye (fig. 1). There was no pain and no history of trauma. The patient's intraocular pressure was measured at 12 mm Hg in both eyes. The rest of the exam was unremarkable. A previous hysterectomy with salpingo-oophorectomy due to her bilateral benign ovarian cysts and her treatment for an in situ carcinoma of the breast with conservative surgery, followed by radiotherapy, were recorded as her past medical history. Her family history was positive for breast cancer. Based on a slit-lamp examination and also to rule out an eventual recurrence of her previous ocular surface squamous neoplasia, impression cytology (IC) was performed to aid in the initial diagnosis. Following the administration of topical anesthesia with 0,5% proxymetacaine hydrochloride (Anestalcon® 0.5%, Alcon, Sao Paulo, Brazil), a membrane filter (Millipore HAWG01300, Bedford, Mass., USA) was placed onto the lesion surface, gently pressed for 5 s, and then peeled off. The sampling was performed 3 consecutive times in order to increase the sensitivity of the IC and to access the deeper layers. The filters were immediately fixed in a solution containing glacial acetic acid, formaldehyde 37%, and ethyl alcohol in a 1:1:20 volume ratio. All strips were processed for the periodic acid-Schiff and Gill's hematoxylin stain. Glass slides were mounted with Entellan (Merck, Darmstadt, Germany) and cells were analyzed under light microscopy by an experienced professional (J.N.B.).


Conjunctival follicular lymphoma after treatment for invasive squamous cell carcinoma.

da Cunha LP, Barros JN, Motono M, Costa FD, da Cunha MC, Chojniak MM - Case Rep Ophthalmol (2014)

A slit-lamp biomicroscopy appearance of the lesion showing a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of the right eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296246&req=5

Figure 1: A slit-lamp biomicroscopy appearance of the lesion showing a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of the right eye.
Mentions: The authors describe the case of a 79-year-old female patient, Caucasian, smoker, from Sao Paulo (SP, Brazil). In July 2013, she was evaluated by one of the authors (M.M.) due to the complaint of an abnormality and swelling of the inferior conjunctiva and the medial canthus of her right eye for a period between 4 and 6 months. She had a history of previous cataract surgery and corneal transplantation for the treatment of Fuchs endothelial dystrophy in 2008, and also an excisional biopsy for an ocular surface squamous neoplasia that was histologically graded as invasive squamous cell carcinoma in the inferior conjunctiva of the same eye in 2011. On examination, the visual acuity of both eyes was 20/25 on the Snellen chart. She had a salmon patch swelling extending from the nasal fornix to the inferior fornix and involving the bulbar conjunctiva in the medial canthus of her right eye (fig. 1). There was no pain and no history of trauma. The patient's intraocular pressure was measured at 12 mm Hg in both eyes. The rest of the exam was unremarkable. A previous hysterectomy with salpingo-oophorectomy due to her bilateral benign ovarian cysts and her treatment for an in situ carcinoma of the breast with conservative surgery, followed by radiotherapy, were recorded as her past medical history. Her family history was positive for breast cancer. Based on a slit-lamp examination and also to rule out an eventual recurrence of her previous ocular surface squamous neoplasia, impression cytology (IC) was performed to aid in the initial diagnosis. Following the administration of topical anesthesia with 0,5% proxymetacaine hydrochloride (Anestalcon® 0.5%, Alcon, Sao Paulo, Brazil), a membrane filter (Millipore HAWG01300, Bedford, Mass., USA) was placed onto the lesion surface, gently pressed for 5 s, and then peeled off. The sampling was performed 3 consecutive times in order to increase the sensitivity of the IC and to access the deeper layers. The filters were immediately fixed in a solution containing glacial acetic acid, formaldehyde 37%, and ethyl alcohol in a 1:1:20 volume ratio. All strips were processed for the periodic acid-Schiff and Gill's hematoxylin stain. Glass slides were mounted with Entellan (Merck, Darmstadt, Germany) and cells were analyzed under light microscopy by an experienced professional (J.N.B.).

Bottom Line: The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue.After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III.Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.

View Article: PubMed Central - PubMed

Affiliation: Clínica de Olhos Dr. Moacir Cunha, Brazil.

ABSTRACT

Backgrounds/aims: The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue.

Methods: Conjunctival impression cytology was performed for a rapid initial diagnosis of lymphoma, and subsequent histopathological and immunohistochemical studies were carried out for its confirmation and to identify the best therapeutic regimen.

Results: After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III.

Conclusion: Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.

No MeSH data available.


Related in: MedlinePlus