J Korean Ophthalmol Soc.  2014 Sep;55(9):1298-1306. 10.3341/jkos.2014.55.9.1298.

Clinical Analysis of Primary Conjunctival Malignant Lymphoma

• Yang JM
• Lee JJ
• Yoon KC

• KMID: 2217112
• DOI: http://doi.org/10.3341/jkos.2014.55.9.1298

Abstract

PURPOSE
To investigate clinical outcomes, response to treatment, and the related factors of recurrence and complication, following treatment of primary conjunctival malignant lymphoma.
METHODS
The medical records of 39 patients diagnosed with primary conjunctival malignant lymphoma between January 2005 and June 2013 were retrospectively reviewed.
RESULTS
The mean age of patients was 51.1 years old. The most common presenting symptom was hyperemia (33.3%). The most common anatomical location of the mass was the fornix (38.5%) and 25.6% patients had bilateral involvement. Histopathologically, mucosa-associated lymphoid tissue (MALT) lymphoma (92.3%) was the most common subtype. Every patient underwent radiotherapy (92.3%) or chemotherapy (7.7%) after surgical excision and had 100% complete remission. Local or systemic recurrence was observed in 15.4% of patients after treatment (mean 8.0 +/- 3.3 months), but was completely remitted after additional radiation or chemotherapy. International prognostic index and location of tumor were significantly related factors for predicting tumor recurrence (p < 0.01, p = 0.02, respectively). Dry eye disease (DED) was the most common ocular complication (44.4%) after radiotherapy. Total radiation dosage and location of tumor were significantly associated factors for developing DED after radiotherapy (both p = 0.04).
CONCLUSIONS
Most conjunctival malignant lymphomas were low grade malignant MALT lymphomas that responded well to treatment but recurrence of tumor and development of DED after radiotherapy were common, therefore predicting and preparing these lymphomas is important.

Keyword

Conjunctival lymphoma; Dry eye disease; Malignant lymphoma; Radiotherapy; Recurrence

MeSH Terms

Drug Therapy
Eye Diseases
Humans
Hyperemia
Lymphoid Tissue
Lymphoma*
Lymphoma, B-Cell, Marginal Zone
Medical Records
Radiation Dosage
Radiotherapy
Recurrence
Retrospective Studies

Figure

• 

  Figure 1. The representive case of the eye with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). (A) Slit-lamp exmanination reveals a ‘salmon-colored’ conjunctival mass in caruncle. (B) Histological examination demonstrates the diffuse proliferation of lymphoid cells in the conjunctiva (Hematoxylin-eosin stain, ×100). Immunohistochemical staining shows positivity of the tumor cells for (C) CD20 (×400) which is a marker for B-cells and (D) CD21 (×100) which reflects follicular dendritic cell meshwork (×100).

• 

  Figure 2. The representive case of the eye with follicular lymphoma. (A) Clinical photograph of the follicular lymphoma presenting classical ‘salmon-colored’ conjunctival mass located in the fornix. Immunohistochemical stain of (B) CD10 and (C) Bcl-6 which are markers of follicular center B-cell differentiation (× 200). (D) Bcl-2 expression by the tumor cells (× 100).

Reference

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