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Year : 1987  |  Volume : 35  |  Issue : 1  |  Page : 32-8

Ocular malignant lymphoma. A clinical pathological study

Dr.Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S, New Delhi, India

Correspondence Address:
A Panda
Dr.Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S, New Delhi
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Source of Support: None, Conflict of Interest: None

PMID: 3330053

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Eleven histologically proved cases of ocular malignant lymphoma diagnosed and managed during the year 1974-81 are reported. The follow-up period ranges from 2-7 years. The difficulties in diagnosis, treatment and prognosis are discussed.

How to cite this article:
Panda A, Rath G, Dayal Y. Ocular malignant lymphoma. A clinical pathological study. Indian J Ophthalmol 1987;35:32

How to cite this URL:
Panda A, Rath G, Dayal Y. Ocular malignant lymphoma. A clinical pathological study. Indian J Ophthalmol [serial online] 1987 [cited 2022 Dec 7];35:32. Available from: https://www.ijo.in/text.asp?1987/35/1/32/26335

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  Introduction Top

Malignant lymphoma is a disease of the reticulo endothelial system. The incidence of lymphoma among all tumours of the ocular adnexa is stated to vary from 3% to 14%. Among lymphomas in general ocular involvement is very infrequent ranging from 1-4% [1]. The purpose of this paper is to review the clinicopathological features of 11 primary lymphomas of orbit.

  Materials Top

Eleven patients of different age and sex who attended the ophthalmic plastic surgery unit of Dr.R.P.Centre for Ophthalmic Sciences and diagnosed both clinically as well as histopathologically as malignant lymphoma of the orbit from 1974-81 were included. After getting the proven diagnosis by histopathological study the cases were referred for radiotherapy.

Radiotherapy was administered to these cases by a Cobalt-60 teletherapy machine. The position of the portals varied with the site of the diseases. In the patients where one eye was involved, one anterior and a lateral field was used. However, many patients where one eye was involved, one anterior and lateral field was used. However, in patients with bilateral retro-orbital disease a pair of parallel opposed portals were employed. The tumour dose ranged from 40-45 Gys. in 16 to 18 treatment sessions over 3 to 32 1 weeks.

  Results Top

The pertinent findings for the eleven patients who had primary orbital lymphoma are summarised in [Table - 4]. [Table - 2] highlighted the clinical localisation of lesions. Mode of presentation of the cases were shown in [Table - 3] & [Figure - 1]. Duration of symptoms before presentation are given in [Table - 4].

  Histopathology Top

The histological categories of the cases are summarised in [Table - 5].

Well differentiated type (small cell type).

This was characterised by a diffuse monomorphic infiltrates of small, uniformly round cells with dark nuclei, dense chromatin and scanty cytoplasm. No mitosis was seen [Figure - 2].

Poorly differentiated type (Medium cell type)

This was characterised by predominance of lymphocytic cells with a scattering of reticulum cells.

Hodgkins type: This type was almost similar to well differentiated type, except that it had presence of Reed-Sternberg cells.

Radiotherapy: The post radiotherapy response of the cases was satisfactory. All the patients tolerated the treatment well. No untoward effect was observed in any case.

  Discussion Top

Ocular malignant lymphomas are uncommon [2]. Involvement of the orbit as a presenting sign is rare and few such cases are seen in the literature [2],[3],[4],[5]. The classification of malignant lymphomas can be used solely on its histological appearance. It is much easier to give prognosis for histologically malignant lymphomatous process than for those which show less histologic evidence of malignant growth (6). Lymphomas of the head and neck tend to follow a less malignant course than those arising elsewhere in the body (7). The ocular lymphomas produce the signs and symptoms to seek early medical advice and are cured by virtue of early treatment. Another factor is the relative paucity of lymphoid tissue in the region of the eye. This accounts for the small percentage of primary tumours rather than for the lowered tendency for them to become generalised and do not always spread to neighbouring lymph nodes with the orderly progression as one sees in carcinoma [8].

The age group of the patients as seen in literatures varied from 4th - 7th decades except in Burkits type [9]. Regarding the sex variation, opinion varied. Henderson [2] is of opinion that the male to female ratio is 2:1. Predominance of the male are also seen in other series [4],[10]. Morgen was of opinion that there was no sex difference [5]. This series is also similar to others as regards to age and sex [4],[9]sub .

The most frequent site for lymphoid lesion in the orbit is the area around the lacrimal gland as lymphatics are found only in the lacrimal gland.

The pre-auricular gland is involved less often in cases of primary tumour of the region of the eye than in cases of generalised disease with secondary involvement. Our series is also in agreement with the previous authors [4],[9].

The clinical localisation of the mass is usually in the superior quadrant, which is true in our series also. The usual modes, of presentation are swelling of the lids, proptosis and presence of a mass [4],[5]. The same is also true in our series though there is more than one presenting feature. The duration of symptoms before presentation is longer in our series. This may be accounted by the fact that our centre being a referral one, patients come after attending other hospitals. It could also be due to ignorance and low socio-economic status of our patients.

When lymphoma involves the orbit, it usually does so as a localised tumour [11] and is amenable to cure. It could also be involved as a site - of spread in a patient with known lymphoma. Less commonly orbital lymphoma occurs as a presentation of systemic disease which is either revealed during evaluation or becomes manifest later in the course of the disease.

Malignant lymphoma of the orbit may be mimicked by many other entities if not scanned carefully. The complete management of such case must include ultrasonography, C.T. Scan, surgical removal, microscopic examination of the specimen and further treatment with radiotherapy.

The radiation therapy is the mainstay of treatment since surgery has a very limited role to play. In localised disease radiotherapy alone gives high cure rate. Baisbane et al (8) have reported 5 year cure rate of 54%. In a series from Christie Hospital and Holt Radium Institute in Manchester, Franklin has reported 70% five year survival in patients, where disease was initially confined to the orbit [12]. Way back in 1956, Lederman (13) had achieved 78.6% three years survival in 14 patients of orbital lymphoma.

The lymphoma of the small cell type seen in orbit and ocular adnexa are considered to be of low malignancy from their prognostic point and that of the medium, type cell show poor prognosis. In our series there is no recurrence in a single case during a period of follow up of 7 years. However two of the patients of medium cell type were lost from follow-up.[13]

  References Top

Brishbane, J.U., Simmaons, L.Harvey, E.F. and Richard, N.S. malignanat Lymphoma presenting in orbit Cancer. 1981.  Back to cited text no. 1
Heath P: Ocular lymphomas. Amer.J.Ophthalmol. 32: 1213, 1943.  Back to cited text no. 2
Schulz, 1.D. and Heath P. Lymphoma of conjunctiva. Radiology 50: 500, 1948.  Back to cited text no. 3
Arthur, G.K., Arthur R.U. and Stephen, T.K. Malignant Lymphoma. Am.J.C1.Path 68:377, 1977.  Back to cited text no. 4
Jorgen K.: malignant lymphoma. Acta Ophthalmol. 55:549,1971.  Back to cited text no. 5
H.Willicom J.W. and Ether B.H.: Follicular lymphoma. Cancer 9: 792,1956.  Back to cited text no. 6
Sugar Baker E.D. and Craver L.F. Lymphosarcoma JAMA 115:17, 1950. 38  Back to cited text no. 7
Ingalls R.G.: Tumors of the orbit allied pseudo-tumors Charles Thomas Springfield, 1953.  Back to cited text no. 8
Henderson J.W. Orbital Tumors W.B. Saunders Company Philadelphia, 1973.  Back to cited text no. 9
Nara Y. (1982) : Lymphoid tumors of the orbit & ocular adnexa.  Back to cited text no. 10
A.B.Reese. Tumors of the eye. Harper & Row, Hagerstown, Mary Land, London, 3rd Edition, 1976.  Back to cited text no. 11
Franklin, C.I.U.: Primary lymphoreticular tumours in the orbit. Clin. Radial 26: 137, 1975.  Back to cited text no. 12
Lederman treatment of orbital Tumors. Proc. Royal Soc. Med. 49: 754, 1956.  Back to cited text no. 13


  [Figure - 1], [Figure - 2]

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]


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