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Case Study: February 2016
History
A 55 year old female with a history of Non-Hodgkin’s lymphoma presents with a salmon patch lesion over the right medial bulbar conjunctiva.
It is biopsied and the slaient features are demonstrated in the plates.
Questions
1. What do Figs 1 and 2 show?
2. What types of lymphoid cells are seen in Fig 3?
3. Can you predict the immunohistichemical stains used in Figs 4,5 and 6?
4. What is the most likliest diagnosis?
5. Is this a conjunctival primary lesion?
1. Nodular collections of lymphocytes.
2 Centrocytes (the smaller darker irregular ones) and centroblasts (the lighter, larger ones with nucleoli).
3. Fig 4-CD20; Fig 5-CD10; Fig 6-bcl-6
4. Lymphoma involving the conjunctiva. This is follicular lymphoma-follicular pattern grade 1/2 (WHO classifcation).
5. No. It is a recurrence of this patient’s systemic follicular lymphoma.
References
Rasmussen PK, Coupland SE, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, McKelvie P, Mulay K, Prause JU, Ralfkiaer E, Sjö LD, Heegaard S.Ocular adnexal follicular lymphoma: a multicenter international study. JAMA Ophthalmol. 2014 Jul;132(7):851-8
