Benign Reactive Lymphoid Hyperplasia of the Caruncle and Plica: Report of 5 Cases

Bagheri, Abbas; Babsharif, Babak; Yazdani, Shahin; Kanavi, Mozhgan R.

doi:10.1097/iop.0b013e3181596b68

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…Two subjects only 14 years of age and the oldest was 30 years. Three of the subjects were males in accordance with previous reports that suggested higher incidence among males 20. We found very few cases of benign lymphoid hyperplasia affecting children documented in the literature 21.…”

Section: Discussionsupporting

confidence: 91%

A clinicopathologic study of excised conjunctival lesions

Elshazly

2011

Middle East Afr J Ophthalmol

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Purpose:This study was aimed at to determine the frequency of excised conjunctival lesions in a patient population treated over a 10-year period.Materials and Methods:The data of all excised conjunctival lesions with tissue diagnoses from 1998 to 2008 in the pathology department were analyzed.Results:The patient group comprised 192 conjunctival specimens; 106 (55.2%) obtained from male patients and 86 (44.8 %) from female patients. The age range was 75 years with a mean age of 27.07 ± 17 years. The most frequent excised lesions were pyogenic granulomas, which represented 30.7% (59 cases). Pigmented epithelial tumors were the second most common benign conjunctival lesions (44 cases, 22.9%). Out of these cases, compound nevus represented 86.4% (38 cases) and junctional nevus represented 6.8% (3 cases). Primary acquired melanosis and subepithelial nevus were reported in two cases (4.5%) and one case (2.3%), respectively. Cystic lesions represented 12% (23 cases). These were mostly ductal retention cysts in 16 cases (70%), occupying the fornix in eight cases. Ocular surface squamous neoplasia (OSSN) was detected in 21 cases (10.9%) significantly affecting an older age group as compared to other lesions (mean age 45.9 ± 16.7). Other less frequent lesions included papilloma (10 cases, 2.5%), dermolipoma (8 cases, 4.2%), solid dermoid (3 cases, 1.6%), hemangioma (15 cases, 7.8%), and benign reactive lymphoid hyperplasia (four cases, 2.1%).Conclusion:Benign lesions were the most frequent histologically diagnosed conjunctival lesions. The true malignant lesions were lower than what has been described in many reports. The significant proportion of precancerous OSSN can be attributed to sun exposure and ultraviolet light in Egypt.

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Section: Discussionsupporting

confidence: 91%

A clinicopathologic study of excised conjunctival lesions

Elshazly

2011

Middle East Afr J Ophthalmol

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“…Small mature lymphocytes usually populate the interfollicular zones [4, 6]. These follicles usually present distinct borders, variable size and irregular shape and are divided by wide interfollicular areas with prominent mantle zones [4, 7]. In contrast, neoplastic follicles are more closely packed together, do not vary in size and shape, and their mantle zones may not be evident [4, 7].…”

Section: Discussionmentioning

confidence: 99%

“…These follicles usually present distinct borders, variable size and irregular shape and are divided by wide interfollicular areas with prominent mantle zones [4, 7]. In contrast, neoplastic follicles are more closely packed together, do not vary in size and shape, and their mantle zones may not be evident [4, 7]. Moreover, in the majority of cases, RLH lesions are characterized by polyclonality, as well as the absence of Dutcher bodies and cytologic atypia, nonetheless, these features only favor the diagnosis of the disease and are not pathognomonic [2, 7, 26].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, neoplastic follicles are more closely packed together, do not vary in size and shape, and their mantle zones may not be evident [4, 7]. Moreover, in the majority of cases, RLH lesions are characterized by polyclonality, as well as the absence of Dutcher bodies and cytologic atypia, nonetheless, these features only favor the diagnosis of the disease and are not pathognomonic [2, 7, 26]. Finally, as far as immunohistochemistry is concerned, the Bcl-2 marker plays a crucial role in differentiating BRLH from follicular lymphoma, as it is usually elevated in follicular lymphoma and negative in BRLH [4, 6].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

et al. 2019

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Background To report a case of bilateral benign reactive lymphoid hyperplasia (BRLH) of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation, treatment and risk of transformation to lymphoma. Case presentation A case report is described and review of the literature from January 1975 to January 2019 was performed. A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions. Incisional biopsy revealed BRLH. Oral doxycycline was initiated (100 mg two times a day) for a total of 2 months. Both lesions decreased in size significantly at the patient’s two-month follow up visit. The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years. The lesion in the left eye has remained stable in size after cessation of the oral doxycycline. A total of 235 cases of conjunctival BRLH were identified in our literature search. The mean age at diagnosis was 35.2 years (range, 5 to 91 years). BRLH lesions were unilateral in 75% of patients and bilateral in 25% of them. Seven patients (2.9%) had a concurrent Epstein-Barr virus (EBV) infection at the time of lesion appearance. The most common treatments were surgical excision (155/235 or 65.9%) and corticosteroids (30/235 or 12.7%), while 14% (33/235) of the patients were observed and 4.6% (11/235) received external beam radiotherapy alone. Recurrence occurred in ten patients (10/235 or 4.2%), of whom five had undergone surgical excision alone, two excision followed by external beam radiotherapy, one excision and oral corticosteroids, one radiotherapy alone and one had been treated with topical corticosteroids. Overall, only 2 of the 235 reported cases (0.8%) developed malignancy, one localized to the conjunctiva and one systemic. Conclusions Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa. Extensive literature review shows that most cases are treated with surgery, steroids or observation. Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions. BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.

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“…2 An oedematous enlargement of the latter may result from chronic ocular surface inflammation. 3 A previous study has reported that nasal pterygia are associated with plica semilunaris ectopia, causing 'withthe-rule' corneal astigmatism because of the exertion of tractional forces and thus supported the idea that the ectopia of the plica semilunaris in pterygium is an epiphenomenon rather than a causative association. 4 Motivated by this finding, we examined the size and location of the plica semilunaris in candidates for primary (non-recurrent) nasal pterygium excision (Pterygium Group, PG) and an age-and gender-matched group of cataract surgery candidates (Control Group, CG) with a view to further evaluate the potential role of the plica semilunaris in the clinical profile of ophthalmic pterygium.…”

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confidence: 85%