Paediatric and adolescent elevated conjunctival lesions in the plical area: lymphoma or reactive lymphoid hyperplasia?

Abstract

It is clinically difficult to differentiate between conjunctival RLH and MALT lymphoma in the paediatric and adolescent population. Both lesions are rare in this age group, particularly MALT lymphoma. Molecular analysis of excised lesions does not always correlate with histopathology. A short treatment course with antiallergic drops may sometimes assist diagnosis without compromising the patients due to the indolent nature of lymphoma in that area.

Immunoglobulin Heavy Chain Gene Rearrangement Studies in the Diagnosis of a Paediatric Conjunctival Lesion

“…Normally one of either kappa or lambda light chains are found in lymphoma, whilst both light chains are present in BRLH, as seen in the left conjunctival biopsy [1, 5]. Testing negative for both light chains from the initial right conjunctival biopsy is unusual and has not been previously documented from our literature review.…”

“…BRLH is characterised by highly concentrated lymphoid tissue with well-defined follicles and germinal centres [2-5]. Although uncommon in children, it is usually situated in the nasal fornix; such as this case [4].…”

“…The use of steroid eye drops could have potentially masked the characteristics of the lesion, hence further confounding diagnosis. [3] Contamination or incorrect processing of the biopsy during initial histopathology and flow cytometry can produce inaccurate findings [5]. Since the proper methodology was conducted correctly for this case, this is unlikely.…”

“…Testing negative for both light chains from the initial right conjunctival biopsy is unusual and has not been previously documented from our literature review. Thus, the use of IgH rearrangement studies was critically important for differentiating between a polyclonal lymphoid population consistent with BRLH compared to monoclonality associated with lymphoma [1, 2, 5]. …”

Can conjunctival lymphoma be a clinical diagnosis?

“…Beykin et al present a series of 11 young patients with the common complaint of a ‘salmon patch’ swelling of the conjunctiva 16. Their aim was to compare the clinical diagnosis with the histopathological diagnosis, which also included extensive immunohistochemical and molecular pathology ‘work-up’ using IgH-PCR.…”