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A Journal on Ophthalmology
Minerva Oftalmologica 2013 September;55(3):75-8
Unusual presentation of an orbital lymphoma
Ferrara M., Strianese D., D’alessandro A., Napolitano P., Ruggiero P., Tranfa F., Bonavolontà G.
Dipartimento di Scienze Oftalmologiche Università degli Studi di Napoli “Federico II” Napoli, Italia
The objective of this retrospective case report is to describe a case of a patient with a very unusual presentation of an orbital lymphoma mimicking pleomorphic adenoma of the lacrimal gland. A 58-year-old female patient presented a 15-year history of slowly progressive left proptosis and inferomedial bulbar dislocation, but she was never aware about her left exophthalmos. A Computed Tomography (CT) scan incidentally discovered a left orbital mass involving the lacrimal gland and the presumptive diagnosis of lacrimal gland pleomorphic adenoma was made on the basis of clinical and radiological features. No further remarkable clinical or blood work-up features were found. The patient underwent lateral orbitotomy and lacrimal gland excision. Postoperative histological features were consistent with extranodal marginal-zone B-cell lymphomas of MALT (mucosa-associated lymphoid tissue)-type lymphomas and for this reason the patient then underwent to postoperative radiotherapy. This case report shows as the accepted clinical and radiological criteria used for the diagnosis of lacrimal gland fossa lesions might have a certain false-positive rate, even in recent years. Initial surgical approach with the appropriate choice among fine-needle aspiration biopsy, intraoperative biopsy and lacrimal gland excision might be a challenge, since the pathological diagnosis of epithelial lacrimal gland tumors is a crucial issue in terms of prognosis.