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Unusual lymphoma of lacrimal gland

Gupta, Pankaj; Gupta, Kirti; Gupta, Vivek

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Indian Journal of Ophthalmology: September 2014 - Volume 62 - Issue 9 - p 974-975
doi: 10.4103/0301-4738.143971
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Dear Sir,

Orbit is involved in upto 10% of all extranodal lymphomas. Lacrimal gland is the commonest orbital structure involved in orbital lymphomas.[1] We present a case of patient who presented with unusual features of lymphoma involving lacrimal gland. A 50-year-old female presented with painless gradually progressive mass in superotemporal orbit for last 6 months [Fig. 1a]. There were no visual or systemic complaints. CT scan revealed well-localized homogenous hyperdense superotemporal orbital mass with bony fossa formation [Fig. 1b] and globe indentation. Differential diagnoses of benign orbital mass including lacrimal gland pleomorphic adenoma, fibrous histiocytoma, schwannoma and neurofibroma were considered. The patient underwent orbitotomy with mass excision. The orbital mass measured 25 × 20 × 19 mm [Fig. 1c] and had smooth outer surface. The histopathology of mass revealed diffuse sheets of atypical lymphoid cells present discretely, with small round to oval hyperchromatic nuclei and inconspicuous nucleoli [Fig. 2a and b]. Occasional mitotic figures were seen. These cells were infiltrating the lacrimal gland substance [Fig. 2c]. The cells were positive with CD20 and negative with CD3 [Fig. 2d and e]. The final diagnosis of low grade B cell lymphoma involving lacrimal gland was made. The patient thereafter received systemic chemotherapy and orbital radiotherapy. Lymphoma of lacrimal gland usually presents radiologically with characteristic soft tissue deposits that are diffuse and tend to mould to the lacrimal gland and surrounding structures.[2] There are no bony changes or globe indentation.[2] The present patient presented with radiological features of solid orbital mass that have not been described in context of lacrimal gland lymphoma previously.

Figure 1
Figure 1:
(a) Clinical photograph of the patient showing swelling in left upper eyelid region. (b) CT scan orbits showing superotemporal homogenous orbital mass with globe indentation and bony fossa formation. (c) Excised orbital mass
Figure 2
Figure 2:
(a) Diffused sheets of atypical lymphoid cells present discretely (H and E, ×100). (b) Small, round to oval cells with hyperchromatic nuclei and inconspicuous nucleoli (H and E, ×400). (c) Lymphomatous deposit infiltrating and destroying the lacrimal gland (H and E, ×40) (d) Tumor cells immunopositive with CD20 (anti-CD20, ×100). (e) Tumor cells negative with CD3 (anti-CD3, ×100)
1. Rey-Porca C, Pérez-Encinas M, González F. Arch Soc Esp Oftalmol 2008;83:95–103
2. Mafee MFSom PM, Curtin HD. Eye and orbit Head and Neck Imaging. 19963rd ed St Louis Mosby-Yearbook:1009
© 2014 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow