Nasal dissemination of a single-clone IgH-rearranged conjunctival MALT lymphoma through the nasolacrimal duct: A case report

Abstract

Abstract. The aim of the present study was to report a rare case of single-clone, immunoglobulin heavy chain (IgH)-rearranged mucosa-associated lymphoid tissue (MALT) lymphoma in the conjunctiva, with nasal cavity dissemination through the nasolacrimal duct. A 24-year-old female was diagnosed with MALT lymphoma of the nasal cavity at the Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University (Tapei, Taiwan) in October 2008. A biopsy of the relapsing conjunctival lesion revealed a MALT lymphoma by pathological staining, while a single-clone, IgH-rearranged tumor lesion in the nasal cavity and conjunctiva was confirmed using continuous sinus computed tomography scans and polymerase chain reaction. Tumor lesions were negative for Helicobacter pylori and Chlamydia infection, but exhibited bilateral neck lymph node dissemination. A combination of radiation therapy (a total dosage of 46.8 Gray, in two phases covering the left lacrimal sac, nasal cavity and bilateral neck region) and topical ciprofloxacin plus steroid (0.3% ciprofloxacin 4 times a day and betamethasone eye ointment before sleep for 1 month) was provided as an effective therapeutic strategy, and no recurrence was found in the next 3 years. The nasolacrimal duct serves as a channel for conjunctival tumor spreading and is easily neglected. IgH-involved translocation in MALT lymphoma is a factor in the progression of the disease, and aggressive combination therapy is essential for a high-risk, disseminated IgH-rearranged MALT lymphoma.

B-Cell Lymphoma Arising From a Nasal Implant: A Brief Clinical Study

“…Metallic implant-associated lymphoma is EBV-positive and commonly occurs without a tumorous mass. Furthermore, few cases of conjunctival lymphoma that spread to the nasal cavity through the nasolacrimal duct have been reported 4,6 . Yet, extranodal marginal zone B-cell lymphoma of MALT caused by a nasal implant has never been reported before.…”

“…[3][4][5] Gillies temporal approach has been widely used to reduce zygoma fractures. [6][7][8][9] Traditionally, it is the preferred method to reduce the isolated zygomatic arch fracture. It can be combined with other approaches, such as subciliary and intraoral incisions for more complex zygomatic fractures, so-called tripod fractures.…”

Conjunctival Lymphoma

“…There have been 2 reports of conjunctival EMZL spreading down the nasal cavity to the lacrimal sac [ 61 , 62 ]. This is an important consideration and indication for imaging, particularly in patients who report nasal congestion, difficulty breathing or epiphora.…”