|Year : 1975 | Volume
| Issue : 3 | Page : 26-27
Primary sub-conjunctival lymphosarcoma
RD Sharma1, BK Goel2, Asha Goel1, R Parmar1
1 H.P. Medical College, Simla, India
2 Ophthalmology Department, Ripon Hospital, Simla, India
B K Goel
Ophthalmic Surgeon Ripon Hospital, Simla (H.P.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma R D, Goel B K, Goel A, Parmar R. Primary sub-conjunctival lymphosarcoma. Indian J Ophthalmol 1975;23:26-7
|How to cite this URL:|
Sharma R D, Goel B K, Goel A, Parmar R. Primary sub-conjunctival lymphosarcoma. Indian J Ophthalmol [serial online] 1975 [cited 2020 Feb 20];23:26-7. Available from: http://www.ijo.in/text.asp?1975/23/3/26/31304
Lymphosarcoma, a neoplasm composed of lymphocytes and lymphoblasts usually presents with enlargement of lymph nodes and the main metastatic sites other than lymphoid structures themselves are the liver, lungs, heart, kidney, bone marrow and skin.  Cases in which there is little or no lymph node enlargement present the most difficult problems in diagnosis. 
Extranodal lymphomas do occur but subconjunetival lymphosarcoma is very rare. Because of the rarity and special importance with regard to its behaviour a case of conjunctival lymphosarcoma case is being presented below.
| Clinical History|| |
L.D. a 15 year old male patient came to the eye department of Ripon Hospital, Simla with complaint of gradually increasing swelling and redness of the left eye of three months duration. There was no associated pain. The other eye was normal. Acuity of vision and fundii in both eyes were normal. There was no history of previous trauma or operation. On local examination multiple finger like growths in the lower fornix below the tarsal conjunctiva and in the areas of plica semilunaris were seen in the left eye [Figure - 1]. The consistency varied from soft to firm. The conjunctiva in between the processes was congested. The size of the processes varied from 3-4 mm. General physical examination was insignificant. Laboratory investigations were noncontributory. Multiple biopsy bits were taken and sent for histo-pathological examination. The patient has been followed for the last 6 months without any change in clinical picture.
Histo-path a logical Examination : Gross appearance showed multiple, firm, light pink and greyish nodules with shiny smooth surface. Microscopic examination revealed sheet of uniform looking small lymphocytes under a thinned conjunctival epithelial lining of stratified squamous epithelium. The histo-pathological picture was same in all the sections and diagram of lymphocytic lymphosarcoma was made [Figure - 2].
| Discussion|| |
Lymphosarcoma is a disease predominantly of Middle and Old Age  . The more undifferentiated. lesions tend to occur in an earlier age group and males are affected twice as commonly as females  . The sub-conjunctival tumours may be a localised manifestations of a generalised lymph osarcomatous process affecting the lymph nodes widely throughout the body.  The secondary involvement of the eye and orbit is said to occur in 2 to 4 percent of such cases. Duke Elder  has quoted Schultz and Heath reporting 1671 cases of lymphomata out of which 14(0.9%) involved the conjunctiva.
As a rule, sub-conjunctival lymphomata are small hard and red fleshy tumours, quite painless and are of slow growth. They occur at any situation on the palpebral and bulbar conjunctiva, on the plice and also at the limbus and may extend into the cornea. They may be multiple and the overlying conjunctiva is smooth.
Our case presented a very typical picture on gross and microscopic examination. T he absence of any evidence of neoplasm in the blood, bone marrow and regional lymph nodes or lymph nodes elsewhere, makes it an interesting and extemely rare case of primary sub-conjunctival lymphoma falling in the group of extra nodal lymphomas. The extranodal lymphomas assume a special importance because of their biological behaviour being different from nodal lymphomas  . The prognosis is better than other malignant tumours seen in the particular region.
| Summary|| |
A rare case of sub-conjunctival lymphosarcoma is described in a 15 year old boy.
| References|| |
Duggen, 1962, Arch. (Chicago) Ophthar., 68,
Duke Elder, S., 1965, System of Ophthalmology
VIII, Part II, 1193, Henery Kimpton, London.
Evens, R. Winston, 1956, Histological Appearances of Tumours, p. 173, E. & S. Livingston Ltd. Edingburg and London.
Harrison, 1966, Principle of Internal Medicine,
Ed. V, 687 Mc.Grew-Hill Book Company, New York.
Saltzstein, S.L., 1969, Extranodal malignant Lymphomas and Pseudolymphoma, Pathology Annual,
Willis, R.A., 1967, Pathology of Tumours,
Ed. IV, 782, Butterworth, & Co. Ltd. London.
[Figure - 1], [Figure - 2]