Plasmablastic lymphoma mimicking orbital cellulitis

Abstract

Introduction Orbital cellulitis is an uncommon, potentially devastating condition that, when not promptly and adequately treated, can lead to serious sequelae. The presenting clinical signs are proptosis, swelling, ophthalmoplegia, pain and redness of the peri-orbital tissues. A number of cases have been reported in which these symptoms have been mistakenly interpreted as being secondary to an orbital infection whilst, in fact, other pathology was present. Discussion We add another case in which, on clinical grounds and after radiological assessment and laboratory tests, a working diagnosis of orbital cellulitis of the left eye was made. It was only after histopathological analysis of a soft tissue specimen from the maxillary sinus that a diagnosis of an AIDS-related plasmablastic lymphoma was made. The patient was referred to the department of haematology where chemotherapeutic treatment for the lymphoma and the HIV infection was started. This case report adds another differential diagnosis of orbital cellulitis to the existing literature.

To What Extent Can Orbital Cellulitis Emergency Aspect Influence the Diagnosis of Maxillary Sinus Lymphoma?

“…Indeed, though it is exceptional, maxillary lymphoma may mimic orbital cellulitis. To our knowledge, our observation describes the third case of orbital cellulitis revealing maxillary lymphoma [3,6]. In fact, this tumoral entity is generally insidious with myriad presentations and it is revealed in most cases by sinonasal nonspecific signs [7].…”

A Unique Presentation of Diffuse Large B-Cell Lymphoma Involving the Central Nervous System

“…Additionally, other types of lymphoma such as T-cell, natural killer T-cell, and plasmablastic lymphoma presenting with orbital signs can be found in the literature. [9][10][11] The characteristic signs and symptoms of orbital cellulitis, which included proptosis, chemosis, eyelid swelling and erythema, decreased vision, and pain are very similar to those found with any orbital process. Thus, a high level of suspicion with a broad differential diagnosis is warranted.…”

Orbital plasmablastic lymphoma: a clinico-pathological correlation of a rare disease and review of literature

“…Conjunctival chemosis,9,10 lid swelling,9 ptosis,10 and a loss of sensation along the trigeminal nerve12 are other findings described upon clinical examination. Vision is either reduced or lost in the affected eye.…”

“…Computed tomography revealed a soft tissue mass that is usually associated with bony destruction. Involvement of the paranasal sinuses,9,12,13 intracranial tissues,11,12 nasopharynx,13 and eyelids10 in contiguity may be seen. Involvement of the ethmoid sinus, lid, and temporal fossa was seen in the present series.…”

“…Staining for CD45 and other B-cell markers, CD20 or CD79a, varies from absent to weak immunoreactivity. Reports on CD10, CD56, and Bcl-6 are conflicting 5,10,12,25. The Ki-67 index is usually around the 100% mark, thus explaining the highly aggressive nature of PBL.…”