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|Year : 1964 | Volume
| Issue : 4 | Page : 176-178
Primary lymphosarcoma of the lids
Willingdon Hospital, New Delhi, India
B S Jain
Willingdon Hospital, New Delhi
|How to cite this article:|
Jain B S. Primary lymphosarcoma of the lids. Indian J Ophthalmol 1964;12:176-8
The intensely malignant but highly radio-sensitive tumours of lymphoid tissue (Lymphosarcoma) arise rarely in the lids. Sugar. Baker and Graver (1940) found only one such case out of 196 and Gall Mallary (1942) one in 618. When it does occur in the lid, the disease is less malignant than in other situations as it tends to remain localised to this area for months or even years. The leukaemic blood picture if present is incidental, according to whether the cells enter the blood stream or not in considerable numbers. A male with this condition, who survived for over 2 years and the disease remained localised to the tipper lid is described.
| Case Report|| |
A farmer aged 52, from a village reported in 1958 with a large swelling in the inner part of right upper lid, which started 8 months ago and rapidly increased in size. To start with, it gave no trouble to the patient, but by one month he could not open his right eye (mechanical ptosis). Three months later his right eye ball under the swelling protruded forwards and was pushed down followed by pain, redness and watering. The pain increased and the vision got greatly diminished. But he could carry on with the other eye and so ignored it.
A month before coming here, he notice a swelling in the left upper lid starting in the manner it did in the right upper lid. There was no history of injury and nothing relevant could he discovered in his past, present or family history.
Examination:--The patient looked well nourished. A large swelling of the size of a cricket ball occupied the region of the right upper lid, the eyebrow and the lower half of the forehead. It looked nodular. The skin was intact though stretched over the swelling and was bluish in colour with dilated veins visible over it. Palpation showed the mass to be nodular and generally firm with comparatively softer areas. It was non-reducible and nonpulsatile and no bruit could be heard over it on auscultation. The skin could still be pinched up from all over the tumour, but the tumour mass was firmly fixed to the underlying tissue. Because of the great vascularity, the region of the tumour was warmer than the opposite side, but there was no fluctuation. The regional lymph glands presented no abnormality. The right eye was lying proptosed with edematous, steamy, ulcerated cornea, displaced downwards, partly covered by the swelling and lay outside the orbit, on the everted lower lid.
The left upper lid showed a small swelling occupying its inner part and tailing off laterally about its middle. The swelling was firm in consistency, non-reducible and non-pulsatile. No bruit could be heard. The skin was mobile and normal, but the swelling was only slightly mobile over the underlying structures. Regional glands on this side were also normal. Except for the swelling on the lid, the left eye was normal in position, movements and functions.
General Examination:-The glands all over the body including the spleen were found normal. Ear, nose and throat examination including the nasopharynx revealed no abnormality. Routine laboratory examination including total and differential leucocytic count, urine and stool examinations were normal.
Radiological studies of chest, skull and orbit and accessory nasal sinuses did not reveal anything unusual. It was considered to be a malignant growth and a biopsy was planned.
A piece of tissue was removed from the highly vascular, fleshy, sarcomatous mass and sent for histopathological examination. The report was as follows:
Microscopic:- "All the sections obtained from different parts of the tissue were examined. Three of them include small lymph nodes. The primary disease process appears to be in lymph nodes, in which the normal follicular structure is completely destroyed and inundated with sheets of cells, which show little variation in size and shape. The cytoplasm outlines are indistinct and the nuclei are generally big and vesicular, some containing one to two nucleoli. Chromatin shows condensation in few places and nuclear forms are generally those described as lymphoblasts. Occasionally scattered are larger nuclei, but no giant cell forms are encountered. There is little evidence of polymorphism" (Plates I & 2)-[Figure - 1],[Figure - 2]. The diagnosis is compatible with malignant lympho-blastic type of sarcoma.
Treatment : - The case was referred for Radiotherapy to the Safdarjang Hospital. The patient reported back after one month with the swelling on the left eye completely gone while the one on the right eye considerably shrunken, causing loose wrinkles of the skin. The eye on the right side had cone into Pthisis Bulbi.
Result:--At his next visit, after another month, the swelling of the right eye had also disappeared leaving some thickening. The patient looked anaemic and complained of muscular weakness. There was no evidence of general lymph gland involvement and the blood count except for microcytic hypochromic anaemia (irradiation) showed no abnormality.
Follow Up: The patient did not come to our hospital after that. Six months later I had a chance of going to his village. He was back to normal with no local or general complaint.
There was no evidence of general lymph gland involvement. Even the neck and parotid lymph nodes were normal. He was requested to report to the hospital for a check up, but he never came. On a chance visit to his village in 1961, I was told that he had died of fever lasting about 3 weeks.
Discussion & Conclusion : -- The tumour, evidently started in the inner part of the right upper lid and invaded the palpebral fascia, entered the orbit, displaced and damaged the eye ball. Later, it started in the left upper lid by a separate focus. Lymphoid tissue is present in abundance around the eye widely scattered in the ocular adnexa. Hyperplasia of this tissue in the lids is of common occurrence due to a large number of known and unknown irritants. Most of these lymphoid hyperplasias are benign in nature. The fact that malignant lympho-sarcoma under such conditions is rare (comparing with the common occurrence of carcinoma in breast and uterus) and its strange behaviour of remaining localised to the lids, (which in the case described were involved in turn) for a long time resulting in comparatively better prognosis, is a medical curiosity.
| Summary|| |
A case of lymphoblastic sarcoma of both the upper eyelids is described. The right eyeball got proptosed and later became atrophiced.
Radiotherapy led to complete disappearance of the growths. The comparatively benign nature when this condition occurs in the lids is emphasised.
| References|| |
|1.||Duke Elder (1952) Textbook of Ophthalmology, Vol. V. Henry Kimpton, London, pp. 5085, 5086. |
|2.||Gall & Malory (1942) Amer. 1. of Path. 18. 381. |
|3.||Stransbury. (1948), Arch. of Ophthal. 40, 518. |
|4.||Sugarbaker & Craver (1940) J. Amer. Med. Assn. 115, 17. |
[Figure - 1], [Figure - 2]