Clinical presentation of reactive lymphoid hyperplasia (RLH) on the ocular surface – report of 6 cases

Abstract

Abstract Purpose Reactive lymphoid hyperplasia (RLH), also called inflammatory pseudotumor, benign lymphoma or pseudolymphoma, is a benign and reversible enlargement of lymphoid tissue probably as a reaction to antigen hyperstimulation. RLH consists of dense sheets of small mature lymphocytes with the formation of primary and secondary follicles reminiscent of normal lymph node architecture. In this study we wanted to evaluate the clinical presentation of RLH on the ocular surface. Methods We reviewed 6 patients (3 males, 3 females) with RLH of the ocular surface. The mean age at the time of diagnosis was 28 yrs (range: 8 to 77 yrs). Paraffin sections were stained with H&E and PAS and further evaluated using immunohistochemistry. Results In 2 patients, RLH was confined to the caruncle. One patient presented with a large cyst‐like lesion, another one with a conjunctival nodule near the medial canthus, and in the oldest patient the RLH manifested itself as a pemphigoid‐like conjunctival lesion in the lower fornix. A 26‐years old female patient with a Non‐Hodgkin‐Lymphoma of the left conjunctiva developed conjunctival RLH one month later in the lower fornix of the fellow eye. Follow‐up (1‐11 yrs) was uneventful in all patients. Conclusion In our case series, RLH presented as a singular lesion with varying clinical morphology. Obviously, it has to be carefully distinguished from lymphoma and should be considered in the differential diagnosis even of cyst‐like lesions and at unusual sites such as the caruncle.