Korean J Ophthalmol.  2006 Sep;20(3):192-194. 10.3341/kjo.2006.20.3.192.

T-Cell Lymphoma Presenting as Painful Ophthalmoplegia

• Lee DS
• Woo KI
• Chang HR

• KMID: 754579
• DOI: http://doi.org/10.3341/kjo.2006.20.3.192

Abstract

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.

Keyword

Ophthalmoplegia; Orbital lymphoma; Orbital tumor; T-cell lymphoma

MeSH Terms

Tomography, X-Ray Computed
Pain/diagnosis/*etiology
Orbital Neoplasms/*complications/diagnosis
Ophthalmoplegia/diagnosis/*etiology
Middle Aged
Lymphoma, T-Cell/*complications/diagnosis
Humans
Female
Fatal Outcome
Diagnosis, Differential
Biopsy

Figure

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  Fig. 1 The pictures show mild exophthalmos, erythematous, eyelid swelling, limited extraocular movement of the left side at initial presentation.

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  Fig. 2 (A) Orbital CT at the first examination shows subtle enlargement of the extraocular muscles of the left orbit. (B, C) In the CT of two months later, bulged cavenous sinus (arrow) and enlarged extraocular muscles are noticed.

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  Fig. 3 (A) The atypical lymphoid cells show irregular outlines with small inconspicuous nucleoli (H&E stain; ×400). (B) The cells are strongly positive for UCHL-1.

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