Indian Journal of Ophthalmology

ARTICLES
Year
: 1972  |  Volume : 20  |  Issue : 4  |  Page : 189--190

Proptosis-a manifestation of malignant lymphoma


SP Gupta, VB Pratap, RL Kaul 
 Department of Ophthalmology, King George's Medical College, Lucknow, India

Correspondence Address:
S P Gupta
Department of Ophthalmology, King George«SQ»s Medical College, Lucknow
India




How to cite this article:
Gupta S P, Pratap V B, Kaul R L. Proptosis-a manifestation of malignant lymphoma.Indian J Ophthalmol 1972;20:189-190


How to cite this URL:
Gupta S P, Pratap V B, Kaul R L. Proptosis-a manifestation of malignant lymphoma. Indian J Ophthalmol [serial online] 1972 [cited 2021 Apr 16 ];20:189-190
Available from: https://www.ijo.in/text.asp?1972/20/4/189/34634


Full Text

Ocular presentations of malignant lymphoma are quite rare, though in itself it is not a rare entity. This may be attributed to comparative lack of lymphoid tissue in the orbit and other ocular tissues. ANDERSON (1966) has described presence of lymphoid tissue normally in conjunctiva, more so in the palpebral portion near the fornix. He found it more abundant in children than in old peoples, where it may be present as a remnant. COPENHAVER (1964) mentioned that normally the lymphoid tissue is present in the substance of lacrimal gland of adults only. WOLF (1964) has described that orbit is completely devoid of lymphnodes, only lymphatics are pre­sent, as in other parts of the eye and no true lymphatics are present in re­tina.

Cases of ocular presentations of this lymphoreticular disease have been re­ported in literature sporadically. MUKHERJEE AND DESHPANDE (1962) reported a case of bilateral proptosis due to lymphosarcoma. CONSUL AND KULSHRESHTHA (1963) reported a case of bilateral exophthalmos with Hodgkin's disease. REDDY AND Row (1966) reported unilateral proptosis due to malignant lymphoma.

The interest of reporting this case of malignant lymphoma with bilateral proptosis, lies in the rare ocular mani­festations of the disease.

 Case Report



G. D. Saxena; a middle aged man of 40 years was admitted in this de­partment, with complaints of painless progressive bulging of both the eyes and swelling of the lids for last 8 years. This swelling started from... the right upper lid and gradually extended to whole of the orbit and lids. After some­time. the other eye was involved in. the same manner. Within two years his eyes became quite prominent with hard swellings of. the lids. On the basis of biopsy report-6 years back in another hospital-he was diagnosed as benign lymphoma and was given some medi­cal treatment which gave him no re­lief. As his symptoms progressed he now got admitted here. In the mean time he suffered from pulmonary tu­berculosis, for which he took treatment and got relieved.

On Examination

There was marked firm nodular un­reducible swelling of both the lids in both eyes, with axial proptosis . both eyes (Plate 1). There was mild oedema over the lids, which was prob­ably due to the venous stasis. There was no other anomaly in the eyes balls. Movements of eyeballs were normal. Pupillary reactions and fundi were normal. Vision was 6/9 in each eye and J 1 for near.

Hertel's exophthalmometer showed proptosis of 22 mm. in the right eye and 20 mm. in the left eye.

Intra-ocular pressure and visual fields were normal.

There was discrete enlargement of lymphnodes all over the body, which were firm and nontender. Rest of the systemic examination was normal.

Blood examination was normal ex­cept that it was slightly hypochromic.

X-ray: Orbit and skull showed soft tissue shadow building over the eyeball regions but no deformity of orbits.

Optic foramena-enlargement of left optic foramen with ill defined bone margin superiorly.

Biopsy of the growth of left lower lid was taken for histopathological studies. Microscopically the tumour consisted of diffuse masses of cells, showing a monocellular picture. Cells were rot coded in shape with deeply stained r ucleus and thin rim of bluish stained cytoplasm. Occasionally in between the cells a few fibroblasts were seen. These features suggest the tumour to be malignant lymphocytic lymphoma (Plate 2).

Treatment

A course of Endoxan (200 mg.) intravenously was given but there was no improvement. Radiotherapy was not advisable due to good vision in both eyes.

 Summary



A case of malignant lymphoma with bilateral proptosis, and no other ocular and visual complaints is being reported.

 Acknowledgement



We extend our thanks to Dr. R. K. Gupta, M. D., department of Patho­logy for the help in histopathological study[6].

References

1Anderson, W. A. D.: Pathology. P. 782. C. V. Mosby Co., Marezen Co. Ltd (1966).
2Copen-haver W. M.: Bailey's Text Book of Histopathology. p. 623, William and Wilkins, Co. Baltimore (1964).
3Consul, B. N., Kulshreshtha O. P.: Hodgkin's Disease and Bilateral Ex­ophthalmos, Am. J. Ophth. 56, 462 (1963).
4Mukherjee K. C. and Deshpande D. H.: Journal Post-graduate Medicine. 8, 120 (1962)).
5Reddy P. S. and Row M. V. J.: A case of Malignant Lymphoma of the Orbit. Orient Arch. Ophth. 4, 175 (1966).
6Wolf, E.: Anatomy of the Eye and the Orbit. H. K. Lewis & Co. Ltd. London. p. 418 (1966).