Diffuse large B cell lymphoma of the eyelid in a patient with AIDS

Abstract

A 49-year-old man was evaluated for rapidly enlarging left lower eyelid and left neck masses. Biopsies of the masses showed diffuse large B-cell lymphoma (DLBCL). He tested positive for Human Immunodeficiency Virus (HIV). The patient was treated with chemotherapy and antiretroviral therapy, and the masses reduced in size. KeywordsAcquired Immunodeficiency Syndrome; Diffuse Large B-Cell Lymphoma; Rituximab; c-Myc Gene; Eyelids; Orbit Case ReportA 49-year-old man was evaluated for left jaw pain and swelling. He had a left neck mass that he noticed a week prior to presentation, which had rapidly enlarged and become painful. The patient also had a two-month history of an enlarging left lower eyelid mass (Figure 1). The patient denied fevers, chills, or weight loss, but admitted to having night sweats. He had no recent history of oral abscesses or dental procedures and denied having any ocular pain, dysphagia, dypsnea, or difficulty breathing. He denied having a history of Human Immunodeficiency Virus (HIV).Computed tomography (CT) of the head and neck revealed a large soft tissue mass in the left lower eyelid, measuring 5×4cm. The mass extended into the superomedial orbit, compressing and displacing the globe laterally. Additionally, the CT revealed a 5×5cm neck mass with central necrosis as well as enlarged submental and bilateral jugular lymph nodes. The findings were suspicious for an abscess, and the patient underwent biopsy with incision and drainage of the neck mass and biopsy of the left lower eyelid mass. Cultures from the neck mass were negative. The patient gave permission for a laboratory testing for HIV, and it showed that he was positive with a CD4 count of 187/mm 3 and a viral load of 131,000 copies/mL. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its licencees, to permit this article (if accepted) to be published in BJO and any other BMJ Group products and to exploit all subsidiary rights, as set out in our licence (http://bjo.bmjjournals.com//ifora/licence.pdf). Microscopic examination of the eyelid specimen was performed (Figure 2A,B). Special stains for fungi and bacteria including acid-fast bacilli were negative. Immunohistochemical stains were positive for CD45, CD68, and Ki-67 in many cells with Ki-67 cell fraction of 50% ( Figure 2D), CD20 in the small round cells ( Figure 2C), and CD3 in scattered cells, but negative for Human Herpes Virus 8 (HHV8), Epstein-Barr Virus (EBV), and CD30, which excluded the possibility of a CD30+ lymphoproliferative lesion. Fluorescence in situ hybridization on formalin-fixed tissue showed no rearrangement involving the c-MYC gene. The histopathologic findings in the neck mass specimen were similar to those in the eyelid mass. (The neck mass was actually an enlarged lymph node in the neck). Taken together, both were classified as diffuse large B-cell lymphoma (DLBCL). ...