Ocular Adnexal Lesions Research Articles

Apocrine Hidrocystoma- A Histological Diagnosis

An Asian female in her 20s, presented with a painless swelling in the left upper eyelid for 2 years. A cystic, non-tender, well defined swelling of 3 by 4 mm with a punctum was seen in the medial aspect of left upper eyelid. Best corrected visual acuity was 20/20 in both eyes, with anterior and posterior segment examination within normal limits in both eyes. Provisional diagnosis of Sebaceous cyst was made, excision of cyst was planned for cosmetic indication. Cyst removal in toto was done and sent for histopathological examination. HPE report was awaited and came the surprise report - APOCRINE HIDROCYSTOMA, a rare, benign, cystic tumor of the apocrine sweat glands. Since surgical excision is the treatment option for apocrine hidrocystoma, patient was informed of the same and reassured. The diagnosis is histological and hence apocrine hidrocystoma must be kept in mind while considering differential diagnosis of cystic lesions in ocular adnexa.

Anterior segment and ocular adnexal lesions in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome at a tertiary hospital in Southwestern Nigeria

Anterior segment and ocular adnexal lesions in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome at a tertiary hospital in Southwestern Nigeria

Current Status of the Spectrum and Therapeutics of Helicobacter pylori-Negative Mucosa-Associated Lymphoid Tissue Lymphoma.

Simple SummaryThe prevalence of Helicobacter pylori (HP)-negative gastric mucosa-associated lymphoid tissue (MALT) lymphoma has increased over the last two decades, whereas that of HP-positive gastric MALT lymphoma has decreased. Although the role of first-line antibiotics in the treatment of HP-negative gastric MALT lymphomas remains ambiguous, several case series have reported that a first-line HP eradication therapy (HPE)-like regimen could result in complete remission in a proportion of patients with localized HP-negative gastric MALT lymphoma. Previous sporadic reports have indicated that certain patients with extragastric MALT lymphoma can respond to first-line antibiotic treatment as well. These findings suggest that, in contrast to antibiotic-unresponsive tumors, antibiotic-responsive tumors may be recognized within the spectrum of HP-negative MALT lymphoma. In addition to conventional chemotherapy and immunochemotherapy, macrolide antibiotics and immunomodulatory drugs have been previously used and demonstrated to be efficacious. This article provides the spectrum and therapeutics for HP-negative MALT lymphoma.Helicobacter pylori (HP)-unrelated mucosa-associated lymphoid tissue (MALT) lymphoma includes the majority of extragastric MALT lymphomas and a small proportion of gastric MALT lymphomas. Although the role of first-line antibiotics in treating HP-negative gastric MALT lymphomas remains controversial, HP eradication therapy (HPE)-like regimens may result in approximately 20–30% complete remission (CR) for patients with localized HP-negative gastric MALT lymphoma. In these patients, H. heilmannii, H. bizzozeronii, and H. suis were detected in sporadic gastric biopsy specimens. Extragastric MALT lymphoma is conventionally treated with radiotherapy for localized disease and systemic chemotherapy for advanced and metastatic diseases. However, a proportion of extragastric MALT lymphomas, such as ocular adnexal lesions and small intestinal lesions, were reported to be controlled by antibiotics for Chlamydophila psittaci and Campylobacter jejuni, respectively. Some extragastric MALT lymphomas may even respond to first-line HPE. These findings suggest that some antibiotic-responsive tumors may exist in the family of HP-negative MALT lymphomas. Two mechanisms underlying the antibiotic responsiveness of HP-negative MALT lymphoma have been proposed. First, an HPE-like regimen may eradicate the antigens of unknown bacteria. Second, clarithromycin (the main component of HPE) may have direct or indirect antineoplastic effects, thus contributing to the CR of these tumors. For antibiotic-unresponsive HP-negative MALT lymphoma, high-dose macrolides and immunomodulatory drugs, such as thalidomide and lenalidomide, have reported sporadic success. Further investigation of new treatment regimens is warranted.

Malignancies in Immunoglobulin G4-Related Ophthalmic Disease

Background: Increased risk of developing cancer in patients with Immunoglobulin G4-related disease (IgG4-RD) have been reported. Association of malignancies and IgG4-related ophthalmic disease (IgG4-ROD), however, remains unclear. Methods: A retrospective review of medical records, orbital images and histopathology reports from 2005 to 2019 in a territory-wide, biopsy-proven cohort, fulfilling the “probable” or “definite” comprehensive diagnostic criteria of IgG4-RD. Findings: All 122 patients had biopsies taken from single or multiple ocular adnexal lesions including lacrimal glands (n=108), discrete orbital masses (n=30), infiltrated orbital fat (n=10), conjunctiva(n=2) or extraocular muscles (n=3). Totally 16 (13%) patients developed cancer over 73±48 months’ follow-up. 9 developed ocular adnexal lymphoma (OAL) and 7 had extra-orbital malignancies. The incidence of OAL was significantly higher (standardized incidence ratios (SIRs) =10.0, 95%CI=4.5-17.6) while that of extra-orbital malignancies was similar (SIRs=0.54, 95%CI=0.2-1.0) to the general population. The risk of OAL was highest within the first year of IgG4-ROD diagnosis (SIRs=46.7, 95%CI=18.5-87.6) as 7 of the 9 OAL were diagnosed concomitantly with IgG4-ROD. Patients who developed OAL or extra-orbital malignancies were older at the time of diagnosis of IgG4-ROD compared to the rest of the cohort (64.9±7.1 years and 68.3±8.5 years versus 55.2±15.0 years, both p<0.05). Radiologically, asymmetric lacrimal gland enlargement (78% versus 13%, p<0.05), lack of frontal (none versus 12%, p<0.05) or infraorbital nerve enlargement (none versus 36%, p<0.05) was associated with OAL. Pre-treatment serum IgG4 level or extraorbital involvement by IgG4-RD was not significantly different between patients with or without cancer. Interpretation: In this IgG4ROD cohort, 7% patients developed OAL, which is 10-fold that of the general population. Patients presenting with asymmetric lacrimal gland enlargement, lack of frontal or infraorbital nerves involvement radiologically were associated with OAL. Incidence of extraorbital malignancy was similar to that of the general population. Funding: None. Declaration of Interests: No conflicting relationship exists for any author. Ethics Approval Statement: Ethical approval was obtained from the Institutional Review Board (IRB) of each participating hospital.

Disseminated histoplasmosis with ocular adnexal involvement in seven cats

To describe the clinical features, diagnosis, and treatment of disseminated histoplasmosis with conjunctival and/or nictitating membrane involvement in cats. Medical records from seven cats with naturally acquired disseminated histoplasmosis and conjunctival and/or nictitating membrane lesions were reviewed for signalment, clinical findings, diagnostic results, treatment, and outcome. Breeds included domestic shorthair (n=5), Maine Coon (n=1), and Siamese mix (n=1) with four spayed females and three castrated males. Conjunctival abnormalities were identified in four cats, and nictitating membrane lesions were identified in four cats; one cat had both a conjunctival and nictitating membrane lesion. Cytologic evaluation of lesions identified Histoplasma capsulatum organisms in two of four cases sampled, and histopathologic evaluation identified Hcapsulatum in both cases in which a sample was submitted. Histoplasmosis antigen testing was positive in three of four submitted samples. Initial treatment for all cats included fluconazole (median dose: 26mg/kg/d). Median duration of follow-up was 11months (range: 1-108months; n=4). Resolution of ocular adnexal lesions was achieved in three cats. Two cats had relapse of disease, one of which was subsequently euthanized. One cat with concurrent feline immunodeficiency virus (FIV) infection died one month after diagnosis of histoplasmosis. Histoplasmosis should be a differential diagnosis for ocular adnexal inflammatory lesions in cats.

CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease: multi-institutional case series.

To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease (IgG4-MALT lymphoma), a rare but clinically important complication of ocular adnexal IgG4-related disease. We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three tertiary and one secondary referral centers, between February 2003 and December 2016. Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified. CT and MR images were analyzed by consensus of two experienced head and neck radiologists. Lacrimal glands were the main site of involvement in all seven patients. The lesions typically showed well-demarcated margins, iso- to hyperattenuation on precontrast CT, T2 hypo- to isointensity, T1 isointensity, and homogenous internal architecture with homogenous enhancement pattern. Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images, respectively. Unlike in typical ocular adnexal IgG4-related disease, T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases. Although the findings may be nonspecific, the possibility of accompanying MALT lymphoma may need to be considered, when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients. However, this is a case series of a very rare complication of ocular adnexal IgG4-related disease, and thus caution is warranted to generalize the conclusion.

Long-term outcomes of ocular adnexal lesions in IgG4-related ophthalmic disease

AimsTo determine the long-term outcomes of ocular adnexal lesions in immunoglobulin G4-related ophthalmic disease (IgG4-ROD).MethodsThis retrospective, non-randomised exploratory study included 82 patients with ocular adnexal lesions. We evaluated the long-term...

A clinicopathological study on IgG4-related ophthalmic disease.

To investigate clinicopathological features of immunoglobulin G4-related ophthalmic disease (IgG4-ROD), and analyze the recurrence rates following systemic corticosteroid administration. We retrospectively searched clinical features, laboratory and histological findings based on the medical records of 21 patients with IgG4-ROD. All the patients examined in this study underwent surgical resection in the ocular adnexal lesions and underwent histological evaluation. This study further investigated clinical and histopathological features of 15 patients who received systemic corticosteroid after the resection. The mean age of the patients consisting of 7 males (33%) and 14 females (67%) was 61y. Fourteen patients were diagnosed as definitive, and 2 and 5 patients were probable and possible IgG4-ROD, respectively. Eyelid swelling was an initial symptom in 11 patients (52%) who did not show systemic involvements at a diagnosis. Fifteen patients received systemic corticosteroid administration, and all showed remission of inflammation. Among them, 10 patients did not recur, whereas 5 patients (33%) recurred during tapering. There were no significant difference between patients with or without recurrence in clinicopathological features. In this study, female patients are more predominant in IgG4-ROD. While inflammation recurs in one-third of patients, this study do not identify factors associated with recurrence after systemic corticosteroid administration.

Conjunctival reactive lymphoid hyperplasia – a rare case report

Ocular adnexal lymphoproliferative lesions can appear in the conjunctiva, orbit, eyelid and lacrimal gland. They can be both primary or secondary and range from benign lymphoid hyperplasia (BLH) to malignant lymphoma. Nodular lesions in conjunctiva are not very common in childhood. So a high index of suspicion of these lesions should be in mind while evaluating them. We present this case to create awareness about this lesion and the need for follow up in such children. Keywords: Benign lymphoid hyperplasia, Conjunctival nodular lesions, Lymphoma

Ocular Manifestations among HIV Infected Children in Ouagadougou, Burkina Faso

Ocular manifestations among HIV infected children are diverse and global incidence varies from 7% to 75%. At this age, eye lesions are often unnoticed because of the incapacity to express eye discomfort. The purpose of this study is to describe ocular manifestations among HIV-infected children and hence associated factors in the Department of Paediatrics at the Yalgado Ouédraogo Teaching Hospital. This was a cross-sectional descriptive and analytical study conducted between July 2014 and December 2014. A complete ophthalmic examination was systematically done to all HIV-positive children attending the clinic, as part of their routine medical visit. The most recent socio-demographic, clinical, biological and treatment data were registered. Seventy-nine children had an ocular examination and among them 92.4% were on ARV treatment. The incidence of ocular manifestations was 46.7%. Median age was 8 years old (interquartile 6 - 12 years old). Sex ratio was 1.3. The risk of ocular manifestations involvement among boys was twice than that of girls. More than half (59.5%) of children who had ocular problems had not expressed ocular discomfort. Ocular adnexal lesions were more common (35.4%) compared to eye segments (8.9%) lesions. Anterior segment and posterior segment lesions were statistically associated with immune system depression (p = 0.003 and 0.001). However, this relationship was not statistically significant (p = 0.15). Five out of seven children who had eye fundus lesions had CD4 count 3. Ocular manifestations were very common among HIV infected children in our context. Ophthalmic examination should be systematic at admission and regularly repeated during follow-up.

Role of Fine Needle Aspiration Cytology as a Diagnostic Tool in Orbital and Adnexal Lesions.

Purpose:To evaluate the role of fine needle aspiration (FNAC) as a diagnostic tool in cases of orbital and ocular adnexal masses. Cytological findings were correlated with histopathological diagnosis wherever possible.Methods:FNAC was performed in 29 patients of different age groups presenting with orbital and ocular adnexal masses. Patients were evaluated clinically and investigated by non-invasive techniques before fine needle aspiration of the masses. Smears were analyzed by a cytologist in all cases. Further, results of cytology were compared with the histopathological diagnosis.Results:The age of patients ranged from 1 to 68 years (mean: 29.79±19.29). There were 14 males and 15 females with a male to female ratio of 0.93:1. Out of 29 cases, 26 aspirates were cellular. Cellularity was insufficient in three (10.34%) aspirates. Out of 26 cellular aspirates, 11 were non-neoplastic while 15 were neoplastic on cytology. Subsequent histopathologic examination was done in 21/26 cases. Concordance rate of FNAC in orbital and ocular adnexal mass lesions with respect to the precise histologic diagnosis was 90%.Conclusion:When properly used in well-indicated patients (in cases where a diagnosis cannot be made by clinical and imaging findings alone), FNAC of orbital and periorbital lesions is an invaluable and suitable adjunct diagnostic technique that necessitates close cooperation between the ophthalmologist and cytologist. However, nondiagnostic aspirates may sometimes be obtained, and an inconclusive FNAC should not always be ignored.

Ocular adnexal IgG4-related disease: CT and MRI findings

Background/aimsTo evaluate CT and MRI findings of histopathologically proven ocular adnexa IgG4-related disease.MethodsStudy subjects included 18 patients with histopathologically proven ocular adnexal IgG4-related disease. CT (n=16) and MR (n=3) images...

Spectrum of orbital and ocular adnexal lesions: An analysis of 389 cases diagnosed by fine needle aspiration cytology

The aim of the present study was to evaluate the scope and the limitations of fine needle aspiration cytology (FNAC) in orbital and ocular adnexal lesions. This study was a retrospective audit of 389 cases of orbital and ocular adnexal lesions subjected to FNAC over a period of 12 years (1998-2009). The cyto-smears were reviewed and the lesions were categorized under different diagnostic categories in adult and pediatric population. Three hundred and one adult patients (age ≥15 years) and 88 pediatric patients (age ≤14 years) constituted the study group. In the adult population, there were 23.3% cases of infectious and lymphoproliferative lesions and 12.6% of benign cysts. In the pediatric population, 18.2% cases had infectious and lymphoproliferative lesions and 8% had benign cysts. Various benign tumors (9.6% in adults) included pleomorphic adenoma, meningioma, and schwannoma. Benign vascular tumors predominated in the pediatric population. A majority of malignant tumors in adults were lymphoreticular malignancies (12.6%); non-Hodgkin's lymphoma being the most common followed by malignant epithelial tumors (10.3%). Nearly 3.6% cases of soft tissue/bone sarcomas and 6.3% of metastatic tumors were seen in adult population. However, most of the orbital tumors in the pediatric population were malignant small blue round cell tumors (33%). FNAC is a cost-effective technique with good diagnostic value in the assessment of ophthalmic lesions, especially when sampling and interpretation are performed by experienced personnel in the light of clinico-radiological information.

Clonal Analysis of Bilateral, Recurrent, or Systemically Multifocal Ocular Adnexal Lymphoma

The purpose of this study is to determine the same or different clonality between bilateral or recurrent lesions, or between or among ocular adnexal lesions and systemically multifocal lesions in 10 consecutive patients with ocular adnexal lymphoma : 8 had extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) and 2 had mantle cell lymphoma, observed from 1995 to 2008 at Okayama University Hospital. A discrete DNA fragment was generated by polymerase chain reaction amplification of the immunoglobulin heavy chain gene from all samples except for two samples of bilateral orbital mantle cell lymphoma lesions and one sample of the scalp skin MALT lymphoma lesion. The size of DNA fragments were the same between bilateral orbital or conjunctival lesions of 5 patients, between original and recurrent conjunctival lesions of one patient, between the orbital lesion and the oral cavity lesion in one patient, and among bilateral orbital lesions, buccal, rectum, and stomach lesions of one patient. Sequencing of the DNA fragments showed the same sequence between bilateral or recurrent or multifocal lesions in 8 patients except for one : the bilateral orbital lesions, rectum, and stomach lesions shared the same sequence while the buccal lesion had one nucleotide difference compared to the sequence shared by the other 4 lesions. In conclusion, bilateral, recurrent, or systemically multifocal lesions of ocular adnexal lymphoma shared the clonality between or among the lesions.

Relationship between primary ocular adnexal mucosa-associated lymphoid tissue lymphoma and eye infection

To study the role of pathogenic microorganisms commonly associated with chronic eye disease, including Chlamydia psittaci, Chlamydia trachomatis, Chlamydia pneumoniae, herpes simplex virus (HSV) type 1 and type 2, and adenovirus type 8 and type 19, in the development of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma in Chinese patients. Sixty-eight archival cases of primary ocular adnexal lymphoproliferative lesions, including 38 cases of MALT lymphoma, 3 cases of non-MALT lymphoma and 27 cases of chronic inflammation, were enrolled into the study. DNA was extracted from the paraffin-embedded tissue samples. The presence of DNA of C. psittaci, C. trachomatis, C. pneumoniae, HSV type 1, HSV type 2, adenovirus type 8 and adenovirus type 19 were analyzed by multiplex touchdown enzyme time-release polymerase chain reaction (TETR-PCR). All of the specimens yielded PCR products of over 100 base pairs and were thus suitable for TETR-PCR screening of infectious agents. The prevalence of DNA of C. psittaci, C. trachomatis and adenovirus type 19 were 0 in MALT lymphoma, non-MALT lymphoma and chronic inflammation. There were 2 cases positive for C. pneumoniae DNA, amongst the 38 cases of MALT lymphoma studied (5.3%, 2/38). HSV type 1, HSV type 2 and adenovirus type 8 DNA was found in each of the 3 patients with chronic inflammation. The study indicates that C. psittaci, C. trachomatis, C. pneumoniae, HSV type 1, HSV type 2, adenovirus type 8 and adenovirus type 19 probably play little role in the pathogenesis of ocular adnexal MALT lymphoma in Chinese patients.

Primary ocular adnexal lymphoproliferative lesions: clinicopathologic features and genetic alterations

To investigate clinicopathological and genetic characteristics of primary ocular adnexal lymphoproliferative lesions. Clinical, morphological and immunohistochemical features of 37 archival cases of primary ocular adnexal lymphoproliferative lesions were studied including 5 cases of reactive lymphoid hyperplasia and 32 lymphomas retrospectively. Classification of the lymphomas were made according to the WHO classification of tumors of haematopoietic and lymphoid tissues. All cases were studied by interphase fluorescence in situ hybridization (FISH) using dual color break apart probes of IgH, MALT1, bcl-6, c-Myc, bcl-2, CCND1, bcl-10, and FOXP1 for detection of chromosomal aberrations involving IgH, MALT1, bcl-6, c-Myc, bcl-2, cyclinD1, bcl-10 and FOXP1 genes, respectively. FISH with IgH / bcl-2 dual color dual fusion probe was used for detection of t(14;18)(q32;q21)/IgH-bcl-2. CEP18 spectrum orange probe was used for detection of aneuploidy of the chromosome 18. Among 32 cases of lymphomas, 28 cases (87.5%) were extranodal marginal zone B-cell lymphomas of mucosa associated lymphoid tissue (MALT lymphoma), 2 cases were follicular lymphoma (FL) and 2 cases diffuse large B cell lymphoma (DLBCL). Among the 28 cases of MALT lymphoma, chromosomal aberrations were found in 60.7% (17/28) by interphase FISH analysis. One case showed positive IgH break-apart signal with unknown partner. 16 cases showed three copies of different genes, of which, three copies of MALT1, bcl-6, and c-Myc were identified in 7 cases (25%), 12 cases (43%), and 2 cases (8%) of MALT lymphomas, respectively. In addition, 5 cases showed two genes including three copies of bcl-6 and MALT1 in 4 cases, and three copies of bcl-6 together with c-Myc in one case. Furthermore, all cases with three copies of MALT1 had trisomy 18. t(14;18)(q32;q21) was detected in both follicular lymphomas. Of the 2 DLBCL cases, one showed three copies of bcl-6 together with trisomy 18 and the other one showed three copies of bcl-6 together with IgH and c-Myc rearrangements. Chromosomal aberration was not found in all 5 cases of reactive lymphoid hyperplasia. The most common entity of primary ocular adnexal lymphomas is MALT lymphoma and FISH is helpful for their differential diagnosis and classification. Trisomy 18 and three copies of bcl-6 are common chromosomal aberrations in primary ocular adnexal MALT lymphomas.

Prognosis for Patients in a Korean Population with Ocular Adnexal Lymphoproliferative Lesions

To analyze the clinical features, treatment outcomes, and prognostic factors associated with lymphoproliferative lesions of the ocular adnexa in a Korean population. Data from 69 patients treated for adnexal lymphoproliferative disease in the 12-year period from 1991 to 2002 were retrospectively evaluated. The 69 patients had a median age of 46 years (range, 15-73 years); 60 of these patients were diagnosed with extranodal marginal zone B cell lymphomas (MALT lymphomas) and had 10 year cause specific survival and relapse free survival rates of 95.6% and 82.6%, respectively. Of 6 patients (8.7%) with concurrent systemic lymphoma, including 4 diagnosed with stage IV disease, 3 died from lymphoma. Only one patient with a primary ocular adnexal MALT lymphoma developed systemic lymphoma, which was treated with surgical resection. Local recurrence either at the primary site or in the fellow eye occurred in 11.6% of patients at a median follow-up time of 102 months (range, 79-132 months), and was controlled using repeat irradiation in all cases. Statistical analysis showed the presence of concurrent systemic lymphoma, bilateral disease, and an advanced stage at diagnosis, were linked to lymphoma-related death (Log-rank test, p < 0.05) and systemic progression (Fisher's exact test, p < 0.05), and that the tumor location was not a prognostic factor for lymphoma-related death or relapse at any site. Ocular adnexal lymphoproliferative disease in Koreans occurred at a relatively young age, and was mostly orbitally located and of the MALT subtype, which is highly localized and rarely associated with extraorbital relapse. Primary or secondary status, stage at presentation, and bilaterality were found to be prognostic factors.

Clinical and pathological features of 112 cases with ocular adnexal lymphoproliferative lesions

To investigate the histopathological classification and clinical features of ocular adnexal lymphoproliferative lesions. The clinical, histomorphological and immuno-histochemical features of 112 cases of ocular adnexal lymphoproliferative lesions (116 paraffin specimens) were studied retrospectively. The lesions were classified according to the World Health Organization classification of tumors of haematopoietic and lymphoid tissues (2001). This group of patients' ages averaged at 49. The mean duration between the onset of the symptoms and the time of presentation was 22 months. Sixteen patients (14.3%) had bilateral lesions. Proptosis or local orbital mass was presented in 69 cases (61.6%). Reactive lymphoid hyperplasia was diagnosed in 11 cases (9.8%) and atypical lymphoid hyperplasia in 10 cases (8.9%). The rest 91 cases (81.3%) were diagnosed as lymphoma, among which 74 cases (81.3%) were extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-EMZL). MALT-EMZL is the most frequent type of ocular lymphoproliferative lesions in ocular adnexa. The ocular adnexal lymphoproliferative lesions show an indolent course clinically, tending to affect the old. Bilateral case is not uncommon.

B-Cells in Ocular Adnexal Lymphoproliferative Lesions Express B-cell attracting Chemokine 1 (CXCL13)

The homeostatic chemokine, B cell attracting chemokine 1 (CXCL13), has been implicated in the pathogenesis of lymphocyte-mediated diseases. We investigated the cellular expression of this chemokine in the spectrum of ocular adnexal lymphoproliferative lesions. Laboratory investigation. CXCL13 expression in paraffin-embedded adnexal biopsy specimens was determined by indirect immunohistochemistry with antigen retrieval. In 15 of 16 biopsy specimens, including reactive lymphoid hyperplasia (n = 7), atypical lymphoid hyperplasia (n = 3), and B cell lymphoma (n = 6), CXCL13 was detected. CD20-positive B-cells, as well as dendritic cells and endothelial cells, expressed the chemokine. B-cells in ocular adnexal lymphoproliferative lesions demonstrate expression of CXCL13, a chemokine that may participate in tumor pathogenesis and is a potential target for novel therapies.

Conjunctival lymphoid hyperplasia presenting with bilateral panuveitis

To report on a case of bilateral conjunctival lymphoid hyperplasia presenting with bilateral panuveitis in a female patient. Observational case report. In this case excisional biopsy indicated lymphoid tissue. Immunohistochemistry showed a follicular architecture with appropriate zoning of B and T lymphocytes. Causes of panuveitis were considered and excluded based on a detailed history, physical examination, and laboratory investigations. The bilateral panuveitis resolved on topical corticosteroids and visual acuity returned to normal. Ocular adnexal lymphoproliferative lesions consist of a spectrum of disease entities, including reactive lymphoid hyperplasia, atypical lymphoid hyperplasia, and lymphoma. There are no established clinical criteria to differentiate between these lesions. This case highlights the importance of a thorough ophthalmic examination in these patients, as an intra-ocular inflammatory process may accompany the conjunctival findings. Furthermore, we advocate periodic follow-up examinations because of the small potential risk of developing ocular or systemic lymphoma in these patients.