Conjunctival lymphomas usually grow very quickly on the surface of the eye and are fleshy, pink masses that are often referred to as salmon patch lesions. Conjunctival lymphoma looks like a salmon patch on the eye. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma 80%. This video demonstrates biopsy of a salmon patch lesion under the inferior medial portion of the conjunctiva. Conjunctival lymphoma conjunctival lymphomas usually grow very quickly on the surface of the eye and are fleshy, pink masses that are often referred to as salmonpatch lesions. They typically have an indolent course presenting with a salmon pink patch in the bulbar conjunctiva. Here we report a case of conjunctival lymphoma in a young woman complicated by pregnancy. Typical conjunctival emzl presents as a fleshy, often mobile, nonlobulated salmonpink patch. This is very important since up to onethird of the patients have either regional lymph node involvement andor systemic involvement at the time of diagnosis without having symptoms.
A second biopsy of the right inferior forniceal conjunctiva showed a focal infiltrate of b and t cells with lymphoepithelial lesions consistent with the working diagnosis. Sometimes they can easily be seen on the white part of the eye but most often they grow under the eyelid and toward the cornea, the clear domelike structure on the front part of the eye. We present a case of a 47yearold hispanic woman who presented with left eye itching and irritation associated with a painless pink mass. Conjunctival lymphoma classically manifests as a pink salmoncolored, smoothsurfaced subconjunctival mass, sometimes with feeder vessels figure 2. The differential diagnosis for an elevated salmon colored conjunctival patch most commonly includes benign lymphoid hyperplasia and conjunctival lymphoma. Case study a case of conjunctival follicular lymphoma. Ocular morbidity after radiotherapy of orbital and conjunctival lymphoma. Seven patients had lymphoma refractory to the prior line of treatment.
On ocular examination, the different types of conjunctival lymphoma frequently present with distinct clinical features. We describe an unusual case of emzl arising from reactive lymphoid hyperplasia rlh of the conjunctiva. A conjunctival cyst is a cyst on the conjunctiva of your eye. Conjunctival lymphoma is a form of cancer but it is usually quite low grade and patients tend to do well with a slow course. Orbital lymphoma is a bcell nonhodgkin lymphoma, and in most cases arises from mucosaassociated lymphoid tissue i. The study concludes that conjunctival malt lymphoma presents in various ways, so biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the. Salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12.
Ocular adnexal lymphomas account for 12% of all nonhodgkins lymphomas. Lymphoma of the conjunctiva new york eye cancer center. They note that bilateral ocular manifestations were more common in patients with follicles compared with patients presenting the salmonpatch appearance. Classification, diagnosis, and management of conjunctival. Conjunctival lymphoma occurs most frequently in middleaged and elderly individuals as a painless patch that is salmon pink.
I was diagnosed with mucosa associated lymphoid tissue malt lymphoma of my left eye today. Typical conjunctival emzl presents as a fleshy, often mobile, nonlobulated salmon pink patch. Distinct clinical clues may be suggestive of a subtype, such as emzl demonstrating a mobile, nonlobulated salmon pink patch or follicular lymphoma demonstrating a multinodular appearance. Conclusion conjunctival malt lymphoma presents in various ways, not only with the salmonpatch appearance. Lymphoma is a cancer of the cells that fight infection b and tcells and can occur anywhere in the body. In cases of follicular lesions responding poorly to topical steroids, a. Most lymphomas are found in the fornix or the bulbar conjunctiva, and 20% have an underlying extraocular lymphoma. Westcott scissors are used to make an incision through the conjunctiva overlying the lesion. Characteristic findings of conjunctival lymphoma identified during slit lamp biomicroscopy include the presence of a fleshy, vascularized, salmon pink patch that is readily movable. Conjunctival malt lymphoma typically presents with the characteristic salmon patch lesion, albeit with varying clinical symptoms reported in the literature. Conjunctival malt lymphoma typically presents with the characteristic salmonpatch lesion, albeit with varying clinical symptoms reported in the literature. Review the diagnosis and treatment of the major malignant tumors of the ocular adnexa, including the eyelid, conjunctiva, and orbit. A 35yearold woman had fleshy salmonpink conjunctival tumors in both. Ocular adnexal lymphoma oal is a rare manifestation of nhl and accounts for 1%2% of all nhl and 5%10% of all extranodal lymphomas.
Jan 08, 2020 physical examination examination can reveal a salmon colored mass or patch, chemosis, ptosis, hyperemia, dryness, and epiphora, among others. An unusual presentation of pediatric conjunctival mucosa. Aug 28, 2014 conjunctival extranodal marginal zone lymphoma is rare but should be considered in the differential diagnosis of a pink salmon patch. Conjunctival lymphoma is the second most common ocular adnexal tumor and generally manifests as a salmon pink patch on the fornix of the eye. If misdiagnosed as chronic conjunctivitis initially, biopsy should be considered if unresponsive to conventional therapies. The conjunctiva is that clear membrane that covers the white part of your eye. They typically have an indolent course presenting with a salmonpink patch in the bulbar conjunctiva. May 15, 2019 one analysis of 117 patients with conjunctival lymphoma found systemic involvement in 31%, most often in those with bilateral multifocal ocular adnexal lymphoma. Ninetyeight percent of conjunctival lymphomas arise from blymphocytes. Marginal zone bcell lymphoma malttype lymphoma is the most frequent subtype identified on biopsy and immunohistochemical studies. On exam, orbital lymphoma may have a classic salmonpatch appearance figures 2 and 3, restriction in extraocular motility, periorbital edema, ptosis, hyperemic conjunctiva, andor a firm palpable mass 4.
On the eye, conjunctival lymphoma appears as a painless pink tumor hidden up under the eyelids. Lymphoma involved the right eye in 6 patients, the left eye in 7 patients, and both eyes in 7 patients. During the exam, look for a mobile, salmon pink, or multinodular mass and make sure to evert the eyelids. Slit lamp image of right eye with salmon patch conjunctival lesion in the superior temporal conjunctiva. Localised primary conjunctival malt lymphomas have a good prognosis. After several months the growth was bigger and curved around my eye a bit and was salmon colored. Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. This is a tumor of the front surface of the eye that usually appears as a salmonpink, fleshy patch. Eye examination revealed a salmoncolored raised lesion involving supranasal bulbar conjunctiva extending to superior fornix of the left eye. Support our mission help make a difference in the lives of everyone affected by eye cancer. It is unclear, however, if malt exists normally in the conjunctiva of the eye, or whether it represents. Conjunctiva is the primary site of involvement in onethird of cases.
Characteristic findings of conjunctival lymphoma identified during slit lamp biomicroscopy include the presence of a fleshy, vascularized, salmonpink patch that is readily movable. This mass is clinically consistent with a lymphoma. Aug 28, 2014 conjunctiva is the primary site of involvement in onethird of cases. Physical examination examination can reveal a salmon colored mass or patch, chemosis, ptosis, hyperemia, dryness, and epiphora, among others. Superior and inferior fornices should be carefully examined to detect occult lesions. The most common subtype of conjunctival lymphoma is extranodal. Conjunctival lymphomas can become large enough to displace the eyeball, and restrict eye movement. Conjunctival lymphomas typically are hidden behind the eyelids and painless. The etiology is not known but is thought related to chronic inflammation from autoimmune conditions or infectious causes.
Benign diagnoses that may be considered include a nonpigmented nevus, dermoid or lipodermoid, pyogenic granuloma, lymphangioma, amyloid deposition, papilloma, fibroma, or as in our case, a. The pathogenesis of conjunctival emzl remains unknown. The clinical impression of the average ophthalmologist is that this type of conjunctival lesion is of a benign character. A conjunctival lymphoma is a tumor that usually appears as a painless, salmonpink, fleshy patch on the eye. Physical examination revealed the presence of a pink salmonpatch involving her left medial conjunctiva. Physical examination revealed the presence of a pink salmonpatch involving her left medial. The biopsy confirmed lymphoma conjunctival lymphoma in the right eye of a patient. Primary episcleral or conjunctival lymphoma falls into this category. A complex choristoma presenting as a salmon patch lesion in. Patients with this disease usually consult first an ophthalmologist. Jun 22, 2018 a conjunctival cyst is a cyst on the conjunctiva of your eye.
Physical examination revealed the presence of a pink salmon patch involving her left medial conjunctiva. While primary conjunctival lymphoid tumours are well described 2, 3 and may even affect both eyes, 4 conjunctival metastasis from systemic spread seems to be rare. The salmon patch of malignant conjunctival lymphoma arrow. All but 3 patients were registered in this trial at first relapse. Extra nodal marginal zone bcell lymphoma emzl of the conjunctiva typically arises in the marginal zone of mucosaassociated lymphoid tissue. They are typically discovered during a routine comprehensive eye exam. Diagnosis and treatment of conjunctival lymphoma american.
Treatment of malt lymphoma of the conjunctiva with. Jul 27, 2017 salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. Malignant lymphoma of the conjunctiva sciencedirect. Lymphoma or cancer of the eyes symptoms and treatment. On exam, orbital lymphoma may have a classic salmon patch appearance figures 2 and 3, restriction in extraocular motility, periorbital edema, ptosis, hyperemic conjunctiva, andor a firm palpable mass 4. Jan 10, 2012 primary vitreoretinal lymphoma pvrl is a variant of primary central nervous system lymphoma pcnsl, which is generally an aggressive, diffuse large bcell malignancy associated with poor prognosis. To the best of our knowledge, this is the first pediatric case of conjunctival malt lymphoma diagnosed in the absence of a salmon patch lesion. Most patients notice the reddish discoloration of the surface of the eyeball conjunctiva. Should a conjunctival lymphoma be diagnosed, a full clinical workup should be performed. Established in 1998, the eye cancer foundation is an educational and supportive resource for eye cancer patients, their families, and physicians. Conjunctival lymphoma arising from reactive lymphoid.
Conjunctival extranodal marginal zone lymphoma is rare but should be considered in the differential diagnosis of a pink salmon patch. Isolated conjunctival lymphoma metastasis from previous low. It started as a swelling in the lower conjunctival area which i attributed to allergy. It is the third most common malignancy involving the conjunctiva, behind squamous cell carcinoma and melanoma 4. Therefore, biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the typical appearance of malt lymphoma. Conjunctival lymphoma is most common in the 5th to 7th decades, with a slight female predominance 1,3. The differential diagnosis for an elevated salmoncolored conjunctival patch most commonly includes benign lymphoid hyperplasia and conjunctival lymphoma. One analysis of 117 patients with conjunctival lymphoma found systemic involvement in 31%, most often in those with bilateral multifocal ocular adnexal lymphoma. Sep 18, 2012 extra nodal marginal zone bcell lymphoma emzl of the conjunctiva typically arises in the marginal zone of mucosaassociated lymphoid tissue. Approximately 515% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. Conjunctival lymphomas are usually hidden behind the eyelids and are painless.
Conjunctival lymphoma can appear clinically identical to reactive lymphoid hyperplasia. Ocular adnexal lymphomas constitute 2% of nonhodgkin lymphoma case and up to onethird of them occur in patients with disseminated lymphoma. Lymphoma of the conjunctiva the eye cancer network. To the best of our knowledge, this is the first pediatric case of conjunctival malt lymphoma diagnosed in the absence of a salmonpatch lesion. Primary vitreoretinal lymphoma pvrl is a variant of primary central nervous system lymphoma pcnsl, which is generally an aggressive, diffuse large bcell malignancy associated with poor prognosis. Sometimes they can easily be seen on the white part of the eye but most often they grow under the eyelid and toward the cornea, the clear domelike structure on. Conjunctival lymphoma classically manifests as a pink salmon colored, smoothsurfaced subconjunctival mass, sometimes with feeder vessels figure 2. May 28, 2016 the salmonpatch of conjunctival lymphoma. Diagnosis and management of malignant tumors of the eye. As the tumor enlarges, patients seek medical attention. Twenty percent of conjunctival lymphomas have bilateral involvement, so make sure to examine both eyes. A 35yearold woman had fleshy salmon pink conjunctival tumors in both eyes, oculus uterque.