Lymphoproliferative Disease of the Ocular Adnexa: A Clinical and Pathologic Study With Statistical Analysis of 69 Patients

Sullivan, Tim; Whitehead, Kevin J.; Williamson, Richard; Grimes, David A.; Schlect, David; Brown, Ian; Dickie, Graeme

doi:10.1097/01.iop.0000159173.42243.ad

Cited by 97 publications

(64 citation statements)

References 65 publications

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“…[9][10][11] Clinical manifestations of the orbital lymphomas include swelling and prolapses of the eyelid, painless but palpable masses, and exophthalmia and oculomotor defects. 12 These clinical findings are neither specific nor early signs of the development of primary orbital lymphomas. Early diagnosis can only be made with a needle biopsy.…”

Section: -8mentioning

confidence: 98%

CT and MRI features of Primary Orbital Lymphoma: review of 14 cases

et al. 2011

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Objective: To assess the computed tomography (CT) imaging and magnetic resonance imaging (MRI) features of primary orbital lymphoma and to establish a differential diagnosis. Material & Methods:Fourteen patients (9 male and 5 female) suffering from primary orbital lymphoma underwent CT scanning with and without contrast. Pre-and post-contrast MRI scans were performed in 10 patients. Their ages ranged from 1.5 to 65 years (average age: 36 years). The course of diseases varied from 2 months to 16 years. Results:The diagnosis was confirmed pathologically in all cases. Lesions were bilateral in 4 cases and unilateral in 10 cases. Periorbital preseptal tissues were involved mainly in the upper lateral quadrant of the orbit. Focal masses were observed in 5 patients. Lesions that infiltrated the lacrimal gland, adjacent extraocular muscles and intraorbital tissues, along with the extraocular muscles, were found in other patients. The tumors that had advanced into intraorbital tissues and had involved extraocular muscles, displayed either a "casting sign" or a "ring sign". Isodense soft-tissue masses with clear demarcation were found on plain CT film and lesions displayed low to intermediate signal intensity on T1-weighted MRI and relatively low or high signal intensity on T2-weighted MRI. The lesions demonstrated homogeneously marked enhancement on CT and MRI with contrast medium. Conclusion:CT imaging and MRI -particularly MRI -can demonstrate the location, configuration, inner structure and characteristic manifestations of the orbital lymphomas. This may assist the pre-operative diagnosis of these lesions.

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Section: -8mentioning

confidence: 98%

CT and MRI features of Primary Orbital Lymphoma: review of 14 cases

et al. 2011

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“…As a result of the known incidence of late local and systemic recurrence and mortality, we believe that these patients should be followed for life, in conjunction with the treating oncologist and the family practitioner. 11,39 When CT-PET becomes more widely available, this may become the preferred technique, considering this combines functional and anatomical information simultaneously.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Anatomical site was divided into orbital, conjunctival, lacrimal sac, and eyelid lesions, based on clinical, imaging, and intra-operative findings, as previously defined. 11 The CT scanning of the ocular adnexae was performed using axial and direct coronal 2-mm contiguous slice imaging, with administration of intravenous contrast. The images were evaluated by a single observer (TJS) for location, circumscription, density, enhancement with contrast media, moulding to adjacent structures, calcification, tissue invasion, and bone destruction.…”

Section: Methodsmentioning

confidence: 99%

Imaging features of ocular adnexal lymphoproliferative disease

Sullivan

Valenzuela²

2006

Eye

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Purpose To evaluate the imaging characteristics of a cohort of patients with ocular adnexal lymphoproliferative disease (OALD). Methods A noncomparative retrospective review between 1992 and 1995 and prospective study from 1995 to 2005 of the clinical, imaging and treatment of 105 patients presenting to tertiary orbital referral centre presenting with OALD. Results One hundred and five patients (mean age 61 years, range 11-90 years) with equal gender distribution were included. Fifty-three were primary and 52 were secondary. Computed tomography (CT) usually showed a well-circumscribed lesion of greater than brain density, moulding to adjacent tissues with moderate enhancement. Aggressive histology was associated with bone destruction, while moulding was associated with indolent histology (Po0.005). MRI in OALD showed intermediate signal intensity on T1-and T2-weighted images and moderate enhancement with gadolinium. Gallium scanning sensitivity to detect ocular adnexal disease was 25 and 57% for systemic involvement. Positron emission tomography (PET) upstaged (71%) of patients with systemic lymphoproliferative involvement, having a higher sensitivity than CT in detecting distant disease (86 vs 72%). Conclusions CT and/or MRI are essential in the evaluation of OALD and can be used to establish that an orbital lesion may be lymphoprolifetaive in nature. Further, these imaging modalities may predict the behaviour of the lymphoma in certain cases. Gallium scanning provides no additional information to CT and does not influence patient treatment. PET represents an important addition to the assessment of OALD with real impact on patient management.

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“…Lymphoma is the most common orbital malignancy, has a predilection for the elderly, and classically presents as painless proptosis or adenexal swelling over a duration of 5-7 months. 7,9 Non-Hodgkin's lymphoma is reported 11 to have an orbital presentation in 2.4% of all non-Hodgkin's lymphoma cases, while its prevalence is about 5% in systemic NHL. 9 According to Liang et al, 12 the incidence of secondary central nervous system lymphoma in a patient with orbital non-Hodgkin's lymphoma is 5.9%, and the most common form of central nervous system involvement in lymphoma is leptomeningeal metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…The second most common type is either follicular, 12% to 23%, or DLBCL, 7% to 21%, depending on the study. [4][5][6][7][8][9] The frequency of ocular adnexal lymphoma with localization to the orbit has been cited as 54%. 5 It has been suggested that it may be more appropriate to analyze ocular 10 found that for secondary ocular adnexal lymphoma, follicular type is most common (33%-66%) followed by (in approximate decreasing frequency) multiple myeloma/plasmacytoma, lymphoplasmocytic lymphoma/immunocytoma, mantle cell lymphoma, DLBCL, Burkitt lymphoma, MALT lymphoma and chronic lymphocytic leukemia.…”

Section: Discussionmentioning

confidence: 99%

Systemic non-Hodgkin’s lymphoma involving the orbit and leptomeninges

Ts¹,

Anis²,

Doych³

et al. 2010

Digit J Ophthalmol

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SummaryWe report a case of diffuse large B-cell lymphoma in a 46-year-old female presenting in an unusual manner with stage IVB disease including concurrent orbital and leptomeningeal involvement. The cytologic features and cytogenetics of the malignancy are noted, and the management and progression of the disease, with attention to orbital involvement, is recorded for a period of over 2.5 years, until the patient's death. Case ReportA 46-year-old woman presented to our clinic with a complaint of intermittent proptosis, diplopia, and ptosis in her right eye for 4 months. During this period, she also noted a loss of balance, gait difficulties, and lower extremity weakness, numbness, and tingling. For the 6 months prior to presentation, she had also experienced weight loss and fatigue.Ophthalmologic examination revealed visual acuities of 20/20 in both eyes. External examination demonstrated proptosis, soft tissue swelling in the upper and lower lids, and scleral "show" with mild conjunctival injection and chemosis in the right eye (Figure 1). Enlarged, matted, and non-tender cervical lymphadenopathy was also found. There was marked restriction of the right eye on adduction. The rest of the anterior and posterior segment examinations were unremarkable in both eyes. Neurological examination was pertinent for bilateral distal lower extremity motor and sensory deficits, diminished reflexes in the knees, and absent reflexes in the ankles. A Romberg test was positive.Computed tomography of the head showed an enhancing soft tissue mass in the medial aspect of the right orbital fossa. MRI demonstrated an enhancing right orbital mass with intraconal and extraconal involvement, which communicated with the right ethmoid sinus. An MRI of the spine showed diffuse enlargement and enhancement of the lumbar and sacral nerve roots.Biopsy of the left cervical lymph node (Figure 2) demonstrated diffuse large B-cell lymphoma (DLBCL). Diagnosis was confirmed with immunohistochemical stains that showed positive staining for B-cell markers CD19, CD20 (Figure 3) and lambda light chain restriction. Staining for CD3 and CD5 was negative, ruling out a T-cell lymphoma, small lymphocytic lymphoma/ chronic lymphocytic leukemia, and mantle cell lymphoma; negative staining for CD10 ruled out a follicular lymphoma. 1 Furthermore, the BCL-1 stain showed heavy background staining, and definitive positivity was not ascertained, while fluorescence in situ hybridization of 100 cells did not show a [t(11;14)] rearrangement-a typical hallmark of mantle-cell lymphoma. 2 The Ki-67 proliferation index was 20% to 30%. Cytogenetic stud-

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Lymphoproliferative Disease of the Ocular Adnexa: A Clinical and Pathologic Study With Statistical Analysis of 69 Patients

Cited by 97 publications

References 65 publications

CT and MRI features of Primary Orbital Lymphoma: review of 14 cases

CT and MRI features of Primary Orbital Lymphoma: review of 14 cases

Imaging features of ocular adnexal lymphoproliferative disease

Systemic non-Hodgkin’s lymphoma involving the orbit and leptomeninges

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