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45 year old with boggy pink conjunctiva and glaucoma

Posted by admin@meditred.com - Posted on 08/22/2015 17:34:24 oculoplastics


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45 year old presented with a boggy conjunctiva (fIg 1) and diplopia. H/O intractable glaucoma in this eye x 2 years for which he was treated with AGV. Pt c/o that ever since he had the AGV , his eye has been getting worse even though the glaucoma itself was well controlled. Because of the unusual appearance of the conjunctiva, we took a biopsy (Fig 2).

What is the diagnosis and how do you manage this case?


Diagnosis:  

MALT type (mucosa-associated lymphoid tissue) Conjunctiva 

Lymphoma

Biopsy specimen showing conjunctival epithelium and underlying stroma infiltrated by small lymphoid cells. Haematoxylin & eosin;Immunostaining showed predominantly B cells with small numbers of T cells. This was consistent with a diagnosis of low grade non-Hodgkin's lymphoma of the MALT type (mucosa-associated lymphoid tissue). Blood tests including bone profile, serum immunoglobulins, marrow biopsy and CT scans of head, neck, chest, abdomen and pelvis confirmed that the disease was localised.


 MALT was coined in 1980s  to describe a characteristic arrangement of lymphoid tissue found in certain mucosal surfaces. Conjunctival MALT usually presents with mild symptoms of redness, irritation and photophobia. 

Examination: orange-pink, salmon-pink or pale masses in the upper or lower fornices and are often bilateral. Orbital involvement results in ptosis, diplopia, impaired ocular motility and proptosis 

Not known to recurr or disseminate after treatment 

Treatment: local radiotherapy.


Our patient's lymphoma was found restricted to the eye and  did very well following radiation.




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