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First Author: M.Gessa SPAIN
Co Author(s): B. Perez-Morenilla I. Relimpio R. Angeles F. Espejo
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To describe the clinical case of a patient with subconjunctival mass which is diagnosed with No Hodgkin Lymphoma (NHL)
Hospital Universitario Virgen Macarena, Sevilla, Spain. Clinical case and explanatory images of CT, PET and pathology
Male, 70, with conjunctival lession in the right eye. Personal history: hypertension, prostatic hypertrophy and COPD. Physical examination: BCVA: 0.8 RE, 1.0 LE BMC:solitary solid lesion in salmon pink subconjunctival even limbus, near caruncle. No other findings in ocular examination No palpable lymphadenopathy. Orbital CT scan is showing no other injuries. Suspecting conjunctival lymphoma is decide surgical excision with safety margins and cryotherapy. Are sent for pathologic examination the tumor, fat perilimbic caruncle and conjunctiva. The patient"s postoperative course was favorable eye level. Pathology report: Subconjunctival mass: NHL diffuse large cell Caruncle: fibrofatty unaltered Perilimbic conjunctiva: minimal inflammatory changes Immunohistochemistry study: Positive: CD10, CD20, BCL-2 and CD45 Negative: CD3, cyclin D1, CD30, ALK and AME CT of neck, thorax and abdomen: Collar: small lymphadenopathy in the supraclavicular region, posterior cervical chains and submandibular Chest: mediastinal lymphadenopathy in right paratracheal region and cranial. Abdominal: multiple lymphadenopathy and conglomerates in mesentery root, retroperitoneal region, celiac trunk and para-aortic PET: No evidence of pathological accumulation of tracer in orbicular regions. Infradiaphragmatic extensive lymphatic involvement and limited supradiaphragmatic hypermetabolic soft tissue nodule right arm suggestive of malignancy Others: CBC: unaltered Biochemistry unaltered Coagulation: no changes Serology: negative
Clinical Trial: NHL diffuse large B-cell, extranodal, with secondary right conjunctival involvement. He decides to start chemotherapy treatment regimen R-CHOP, six cycles, one every 21 days. The patient at this time is between the fifth and sixth cycles, has good general, analytical stable and no B symptoms of lymphoma.
A solitary orbital tumor does not rule out associated systemic pathology. Draw out a systemic study because, as we have seen, 75% of orbital tumors are secondary. Hence the importance of early diagnosis by the ophthalmologist, since it raises the possibility of establishing a chemotherapy treatment, which involves the elimination of any possible outbreak extraorbital undetected and decreases the rate of distant recurrence.