Clinicopathologic Assessment of Ocular Adnexal Lymphoproliferative Lesions at a Tertiary Eye Hospital in Iran

Background The most common type of ocular lymphoma is nonHodgkin lymphoma (NHL) categorized into two groups indolent (slow growing) and aggressive (rapid growing) Differentiating benign reactive lymphoid hyperplasia (RLH) from malignant ocular adnexal lymphoma (OAL) is challenging Histopathology immunohistochemistry (IHC) and ow cytometry have been used as diagnostic tools in such cases Materials and Methods In this retrospective case series from 2002 to 2013 at Farabi Eye Center 110 patients with ocular lymphoproliferative disease were enrolled Prevalence anatomical locations mean age at diagnosis and the nal diagnosis of the disease with IHC were assessed. Comparison between previous pathologic diagnoses and results of IHC was made Immunoglobulin light chains and Bcell and Tcell markers and other immunophenotyping markers including CD20 CD3 CD5 CD23 CD10 CYCLIND1 and BCL2 were evaluated to determine the most accurate diagnosis The lymphomas were categorized based on revised EuropeanAmerican lymphoma (REAL) classi cation Results Mean ageSD (years) of the patients was 556 193 and 61 were male Patients with follicular lymphoma large Bcell lymphoma or chronic lymphocytic leukemiasmall cell lymphoma (CLLSLL) tended to be older Nine patients with previous diagnoses of low grade Bcell lymphoma were reevaluated by IHC and the new diagnoses were as follows extranodal marginal zone lymphoma(EMZL) (n1) SLL(n1) mantle cell lymphoma (MCL) (n3) reactive lymphoid hyperplasia RLH (n2) Two cases were excluded due to poor block Flowcytometry reports in these sevenpatients revealedSLL with positive CD5 and CD23 MCLwith positive CD5 and CyclinD1 and negative CD23 EMZL with negative CD5CD23 and CD10. One RLH patient wasnegative for KappaLambda and positive for CD3 and CD20 and the other was positive for all of the light chains CD3 and CD20 Orbit (491) conjunctiva (161) and lacrimal glands (161) were the most common sites of involvement Conclusions Accurate pathological classi cation of lesions is crucial to determine proper therapeutic approaches This can be achieved through precise histologic and IHC analyses by expert pathologists