Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. Lymphoma is a cancer of the cells that fight infection b and tcells and can occur anywhere in the body. Physical examination examination can reveal a salmon colored mass or patch, chemosis, ptosis, hyperemia, dryness, and epiphora, among others. Conjunctival lymphomas are usually hidden behind the eyelids and are painless. Bulbar involvement is more common, usually more easily recognized, and is associated with a better prognosis than malt lymphoma of. They typically have an indolent course presenting with a salmonpink patch in. Treatment of malt lymphoma of the conjunctiva with. Lymphoma of the conjunctiva lymphoma of the conjunctiva the salmon patch of malignant conjunctival lymphoma arrow. In 25% of patients the conjunctiva is involved, in which case patients demonstrate a salmon red patch of swollen conjunctiva 1. Conjunctival lymphoma arising from reactive lymphoid. Help make a difference in the lives of everyone affected by eye cancer. Multiple myeloma manifesting as a salmon patch conjunctival mass.
The study concludes that conjunctival malt lymphoma presents in various ways, so biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the. Objective to report clinical, histopathological and molecular features of salmon patchlike conjunctival lesions in paediatric and adolescent patients, and discuss management of these patients and outcome. A diagnosis of follicular lymphoma grade 1 of the conjunctiva wasmade. A conjunctival cyst is a cyst on your conjunctiva, which is a clear membrane covering your outer eye. He was found to have an infected left eye with an enlarged left caruncle and a fleshy salmonpink swelling that extended into the inferior forniceal conjunctiva figure 1. Isolated conjunctival lymphoma metastasis from previous low. The remainder of the ocular examination revealed a left cataract but no other abnormalities. A conjunctival lymphoma is a tumor that usually appears as a painless, salmonpink, fleshy patch on the eye. This video demonstrates biopsy of a salmon patch lesion under the inferior medial portion of the conjunctiva. Feeder vessels and rapid growth are not typically seen in lymphoma. Case study a case of conjunctival follicular lymphoma. When a salmon patch occurs on the face, it is often called an angel kiss, and when it occurs on the back of the neck, it is known as a stork bite.
Lymphoma or cancer of the eyes symptoms and treatment. Lymphoma is found on the conjunctiva about 40% of the time. Another presentation is that of a chronic follicular conjunctivitis fig. While less common than conjunctival squamous neoplasia or melanoma, conjunctival lymphoma accounts for a significant portion of ocular adnexal lymphomas oals 25% 3, 4. This cyst often looks like a clear bubble on the surface of the eye. Here we report a case of conjunctival lymphoma in a young woman complicated by pregnancy. Tcell lymphoma is rare in the orbit and usually of. Typical conjunctival emzl presents as a fleshy, often mobile, nonlobulated salmonpink patch. Lymphoma of the conjunctiva new york eye cancer center.
Approximately 515% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. The birthmarks are caused by expansions dilations in tiny blood vessels called capillaries. Red colored tumors on the eye can be a presenting sign of systemic lymphoma. Typical conjunctival emzl presents as a fleshy, often mobile, nonlobulated salmon pink patch. On examination, right visual acuity was 69 and left was 618. Such involvement as a complicating factor in patients with leukemia is not infrequent, as is well known 6. Conjunctival lymphomas can become large enough to displace the eyeball, and restrict eye movement. The tumour was surgically resected and the patient remains disease free four years later.
Malignant lymphoma of the conjunctiva sciencedirect. Ninetyeight percent of conjunctival lymphomas arise from blymphocytes. Jun 22, 2018 a conjunctival cyst is a cyst on your conjunctiva, which is a clear membrane covering your outer eye. The salmon patch of malignant conjunctival lymphoma arrow. Distinct clinical clues may be suggestive of a subtype, such as emzl demonstrating a mobile, nonlobulated salmon pink patch or follicular lymphoma demonstrating a multinodular appearance. A case of conjunctival follicular lymphoma mimicking mucosaassociated lymphoid tissue lymphoma lamia abdalkader,1,5 yasuharu sato,1. We present a case of a 47yearold hispanic woman who presented with left eye itching and irritation associated with a painless pink mass. Comparing benign reactive lymphoid hyperplasia vs malignant lymphoma revealed lymphoma with greater base and more likely located as a diffuse mass or in a nonnasal bulbar site. On ocular examination, the different types of conjunctival lymphoma frequently present with distinct clinical features.
After the diagnosis of lymphoma, long term follow up is advised as. Rlh affects males and females equally, and tends to occur in young patients. This report describes the unusual occurrence of a biopsy confirmed low grade lymphoma recurring in the conjunctiva, three years after initial diagnosis of systemic disease. May 15, 2019 this tumor is most often located in the conjunctival fornix 44% or midbulbar 42% region and, rarely, in the caruncle 7% or limbus 7%. Conjunctival lymphoma looks like a salmon patch on the eye. The eye cancer foundation depends on the generosity of individuals, businesses, churches, foundations and organizations. It is important for ophthalmologists to recognize the characteristics of ocular surface tumors and to have an understanding of their management. Diagnosis and treatment of conjunctival lymphoma american. On the other hand, it can also be considered secondary lymphoma, or a condition that is coming from systemic lymphoma from elsewhere in the body. Conjuctival lymphoma presents as a diffuse, slightly elevated pink mass located in the stroma or deep to tenons fascia. It usually presents as a salmonpink nodular patch involving the bulbar conjunctiva.
Rlh affects males and females equally, and tends to occur in. Conjunctival malt lymphoma characteristically manifests as a painless fleshycoloured salmonpatch lesion arising from the fornix. Physical examination revealed the presence of a pink salmon patch involving her left medial conjunctiva. Reactive lymphoid hyperplasia rlh is a result of antigen stimulation of the conjunctival malt system. Salmon patch is the name given to a very common group of birthmarks seen in babies. Paediatric and adolescent elevated conjunctival lesions in. Ocular surface tumors are rare but potentially deadly diseases of the conjunctiva andor cornea. Westcott scissors are used to make an incision through the conjunctiva overlying the lesion. As the tumor enlarges, patients seek medical attention. Lymphoma of the conjunctiva lymphoma of the conjunctiva noted in the superonasal fornix arrow. Aug 28, 2014 clinical features are often nonspecific. Characteristic findings of conjunctival lymphoma identified during slit lamp biomicroscopy include the presence of a fleshy, vascularized, salmon pink patch that is readily movable. These lesions are fleshy and often originate the fornix or adjacent to the limbus. Jan 08, 2020 physical examination examination can reveal a salmon colored mass or patch, chemosis, ptosis, hyperemia, dryness, and epiphora, among others.
The other types including mantle cell lymphoma, diffuse large bcell lymphoma and lymphoplasmacytic lymphoma are occasionally seen in the orbit. It is the third most common malignancy involving the conjunctiva, behind squamous cell carcinoma and melanoma 4. Approximately 515% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25%. A definitive diagnosis of the lymphoma is based on a combination of. This is a tumor of the front surface of the eye that usually appears as a salmonpink, fleshy patch. Ocular adnexal lymphoma oal is a rare manifestation of nhl and accounts for 1%2% of all nhl and 5%10% of all extranodal lymphomas.
Eye examination revealed a salmoncolored raised lesion involving supranasal bulbar conjunctiva extending. This mass is clinically consistent with a lymphoma. An unusual presentation of pediatric conjunctival mucosa. Features such as rapid growth, invasion of surrounding tissues, ulceration and presence of feeder vessels support a diagnosis of lymphoma. Clinically, reactive lymphoid hyperplasia can also appear nearly identical to conjunctival lymphoma, so it is crucial to establish the correct diagnosis via. Ocular adnexal lymphomas constitute 2% of nonhodgkin lymphoma case and up to onethird of them occur in patients with disseminated lymphoma. They typically have an indolent course presenting with a salmon pink patch in the bulbar conjunctiva. It usually presents as a salmon pink nodular patch involving the bulbar conjunctiva. Aug 28, 2014 conjunctiva is the primary site of involvement in onethird of cases. Conjunctival lymphoma shows a female predominance and occurs most frequently in the fifth to seventh decade of life as a salmonpink nodular patch in the bulbar conjunctiva. Conjunctival lymphoma can be considered primary lymphoma, which means the lymphoma is localized on the eye and found nowhere else in the body.
The other important conjunctiva malignancy in children was lymphoma. The etiology is not known but is thought related to chronic inflammation from autoimmune conditions or infectious causes. Extra nodal marginal zone bcell lymphoma emzl of the conjunctiva typically arises in the marginal zone of mucosaassociated lymphoid tissue. Conjunctival lymphoma can appear clinically identical to reactive lymphoid hyperplasia. Conjunctival lymphoma occurs most frequently in middleaged and elderly individuals as a painless patch that is salmon pink. They are typically discovered during a routine comprehensive eye exam. On the eye, conjunctival lymphoma appears as a painless pink tumor hidden up under the eyelids. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma 80%. Bulbar involvement is more common, usually more easily recognized, and is associated with a better prognosis than malt lymphoma of the palpebral conjunctiva. Differentiating benign vs malignant conjunctival tumors in. Conjunctival lymphomas typically are hidden behind the eyelids and painless.
Support our mission help make a difference in the lives of everyone affected by eye cancer. The average delay between clinical onset and diagnosis is 68 months secondary to lack of significant symptoms 1,3. The lesion often has a color similar to salmon, hence the term salmon patch. Patients who do not have conjunctival involvement 75% of cases present with an orbital mass, usually in the superior lateral quadrant, in proximity to the lacrimal gland 1,6. Alternatively, they may present as smaller, solitary lesions of the bulbar conjunctiva. Sugarbaker and craver 27 found that 1 per cent of extranodal primary lymphomas were in the ocular adnexa and that 1. In summary, a salmon patch conjunctival mass is a manifestation of multiple myeloma. Jul 27, 2017 salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. We describe an unusual case of emzl arising from reactive lymphoid hyperplasia rlh of the conjunctiva. Ocular involvement of systemic nonhodgkins lymphoma is rare. Most patients notice the reddish discoloration of the surface of the eyeball conjunctiva. Conjunctival lymphoma is most common in the 5th to 7th decades, with a slight female predominance 1,3. Patients often have minimal symptoms, leading to an average delay of eight months between clinical onset and diagnosis.
Ocular adnexal lymphoma oal represents 5% to 15% of all extranodal nonhodgkin lymphomas and 55% of all orbital malignancies. Characteristic findings of conjunctival lymphoma identified during slit lamp biomicroscopy include the presence of a fleshy, vascularized, salmonpink patch that is readily movable. They typically have an indolent course presenting with a salmonpink patch in the bulbar conjunctiva. Eye examination revealed a salmoncolored raised lesion involving supranasal bulbar conjunctiva extending to superior fornix of the left eye figure 1. Lymphoma of the conjunctiva the eye cancer network. Please note salmoncolored raised lesion involving nasal bulbar conjunctiva extending to superior fornix. Lymphangioma of the conjunctiva lymphangioma of the conjunctiva note the variably sized subconjunctival lymphangiectasias. Conjunctival lymphoma is a form of cancer but it is usually quite low grade and patients tend to do well with a slow course. Physical examination revealed the presence of a pink salmonpatch involving her left medial conjunctiva. Classification, diagnosis, and management of conjunctival. Salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. In this report, the salmon patch conjunctival mass was an initial manifestation of multiple myeloma, but based on the results of bone marrow biopsy, and hematologic and image tests, the patient had an advanced multiple myeloma and poor prognosis. Distinct clinical clues may be suggestive of a subtype, such as emzl demonstrating a mobile, nonlobulated salmonpink patch or follicular lymphoma demonstrating a multinodular appearance.