Benign reactive lymphoid hyperplasia of the conjunctiva in childhood

Abstract

There were 24 patients with lymphoid lesions classified as conjunctival BRLH during the 12-year period evaluated in this study. The mean age at diagnosis was 11.6 years. Twenty-three patients were males (96%). Systemic medical history included three patients with bronchial asthma, one patient with Down's syndrome, one patient with generalised skeletal malformation and one patient with gastritis. The initial uncorrected visual acuity was 20/30 or better in 93.5% of the eyes. At presentation, the tumour was unilateral in 12 cases (50%). The conjunctival mass was located on the bulbar conjunctiva in all cases. The mass was present nasally in 96% of lesions. No cases (that were tested) had an infectious aetiology. PCR demonstrated monoclonality suggestive of lymphoma in two cases; however, this did not alter the final diagnosis as BRLH per histopathological criteria and clinical course, CONCLUSIONS: All investigated cases of paediatric conjunctival BRLH had a benign clinical course with no local or systemic dissemination and a male predominance. Recurrence was rare, and in our cohort, it was not associated with malignant transformation.

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

“…In terms of lesion location, more than half of the lesions involved the nasal bulbar conjunctiva, one third of them involved the caruncle and plica semilunaris, while the rest of them were located in the fornix and tarsal conjunctiva. Eight patients had enlarged painless pre- or post-auricular lymph nodes at presentation and two presented with enlarged painless submental lymph nodes [5, 6, 11]. Moreover, six patients had concurrent ( n = 4) or recent ( n = 2) infectious mononucleosis with generalized lymphadenopathy, fever, tonsillitis and positive Epstein-Barr virus (EBV) serology [22, 34–38].…”

“…The exact etiology and pathogenesis of benign reactive lymphoid hyperplasia (BRLH) remains unknown. However, BRLH is thought to result from a chronic inflammatory response of lymphoid cells to antigenic stimulation [5, 6]. The disorder displays a predilection for the male gender and the most common site of involvement is the nasal conjunctiva [1, 6–11].…”

“…However, BRLH is thought to result from a chronic inflammatory response of lymphoid cells to antigenic stimulation [5, 6]. The disorder displays a predilection for the male gender and the most common site of involvement is the nasal conjunctiva [1, 6–11]. Due to the clinical resemblance of BRLH to conjunctival lymphoma and the potential risk of malignant transformation, thorough examination and assessment of such lesions is warranted [1–4, 8, 9, 12, 13].…”

Conjunctival reactive lymphoid hyperplasia – a rare case report

“…(8) We understand the importance of the phenotyping but our patient had classical signs of allergic lymphoid hyperplasia in histopathology and was not financially willing to undergo IHC. The characteristic feature in benign lymphoid hyperplasia is reactive follicles with numerous macrophages in the centre.…”

“…The characteristic feature in benign lymphoid hyperplasia is reactive follicles with numerous macrophages in the centre. (8) There is no definitive recommended treatment for conjunctival BLH. Current treatments include cryotherapy, radiotherapy or surgical excision with steroids.…”