Conjunctival extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in the fornix: do not overlook conjunctival lymphomas

Abstract

BackgroundHere we report three cases of conjunctival lymphoma that were initially unnotified or misdiagnosed as other ocular diseases because of the small tumor size, peripheral tumor location (the tumor was hidden in the fornix), and nonspecific symptoms.MethodsThree patients diagnosed with conjunctivitis or nasolacrimal duct obstruction were referred to our clinic because they were unresponsive to standard medical treatments. Routine anterior segment examination did not reveal any lesions, but further careful examination with a strong eyelid draw revealed minimally elevated tumors in the peripheral fornix under the lid. Excisional biopsies were performed.ResultsHistopathologic and immunohistologic examinations indicated the presence of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). All patients underwent additional radiation therapy. There was no evidence of recurrence in any patient during the follow-up period.ConclusionDetection of conjunctival lymphoma can be challenging. If no apparent lesion is present and the patient has nonspecific symptoms, the inner surface of the eyelid should be carefully examined. Elaborate eyelid eversion, with eyeball movement, should be performed to avoid misdiagnosing or overlooking peripheral conjunctival lymphomas.

A case of palpebral conjunctival MALT lymphoma misdiagnosed as giant papillary conjunctivitis

“…However, several reports have documented the misdiagnosis of this disease. For example, it has been repeatedly misdiagnosed as chronic conjunctivitis [5][6][7]. In general, conjunctival MALT lymphoma occurs in elderly people ranging in age from 50-70 years.…”

“…In general, conjunctival MALT lymphoma presents as characteristic salmon-pink nodular patches; thus, its diagnosis is straightforward. However, there have been reports of its misdiagnosis as allergic conjunctivitis [4], chronic conjunctivitis [5][6][7], and Sjögren's syndrome [8].…”

Salmon‐coloured lesions mimicking conjunctival papillae: an unusual presentation of unilateral conjunctival lymphoma in a young man

“…The rarity of this condition in this age group together with the non‐specific clinical presentation poses a challenge to make an initial correct diagnosis. Indeed, the tumours masquerading as a ‘red eye’ mimicking allergic or chronic conjunctivitis, nasolacrimal duct obstruction or dry eye irritation have been reported …”

“…Indeed, the tumours masquerading as a 'red eye' mimicking allergic or chronic conjunctivitis, nasolacrimal duct obstruction or dry eye irritation have been reported. 9,[26][27][28][29] Optimal management of this patient, including other ocular adnexal lymphomas, is an integrated multidisciplinary approach that involves the patient's general practitioner, optometrist, ophthalmologist and oncologist. Optometrists should be vigilant and consider lymphomas as a differential when faced with the classic appearance of salmon-coloured lesions and especially when they are unresponsive to initial conventional therapies.…”