Conjunctival lymphoma a case report

Abstract

Purpose Orbital lymphomas are not frequent within orbital pathologies; they are commonly found associated to systemic diseases. Lymphomas affecting only the conjunctiva are even less frequent and their bilateral manifestation are uncommon. The characteristic lesion of conjunctival lymphomas is an orange‐pink mass at the bottom of the bag, without adhesion to deep planes. Patients are often asymptomatic but they may also complain of irritation of the eye. Painful proptosis or ptosis may appear if the affectation extends to the orbit. The average age of presentation is 60–70 years and it is more common in women. The diagnosis is confirmed by biopsy of the lesion. Methods We report the case of a 55‐year‐old woman with a conjunctival bilateral mucosa associated lymphoid tissue (MALT) lymphoma, not associated to systemic disease. The patient came to the service complaining of one month of epifora and itching in both eyes, with a salmon patch conjunctival mass in the temporal tarsal conjunctiva of the left eye, without any inflammatory signs or decreased visual acuity. Results A partial exeresis and biopsy of the left eye subconjunctival mass was performed. An extranodal lymphoma of the lymphoid tissue associated with mucosa was diagnosed (MALT lymphoma), CD20: positive, BCL2: positive and Ki67: 5%. Ocular ECO and MRI demonstrated infiltration of the external rectus muscle, being in contact with the superior rectus muscle, and PET CT confirmed a normal metabolic pattern. The patient was followed up for several months in the departments of Ophthalmology and Oncology, treatment was initiated with radical radiotherapy 30 Gy, fractionation cGy 200 in the left conjunctiva, which started on January 30 2017 and ended on February 18 2017. Conclusion Biopsy offers an early diagnosis for conjunctival lymphoma, being its prognosis very good. Because of this, ophthalmologists should be aware of this pathology, its characteristics and diagnosis.