While benign, complex choristomas are grossly indistinguishable from malignant. Aug 28, 2014 on followup after 2 months, the patient did not report any itching or irritation of her left eye. Sometimes we will offer injections into the lesion to help it shrink. The cmgs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. An excisional biopsy was performed utilizing a notouch technique, given the possibility of a malignant lesion, with removal of the conjunctival tumor and placement of an amniotic membrane graft.
While primary conjunctival lymphoid tumours are well described 2, 3 and may even affect both eyes, 4 conjunctival metastasis from systemic spread seems to be rare. These lesions are usually primary extranodal bcell neoplasms, although 10 to 30. Accurate diagnosis by an ophthalmologist is based on history and clinical examination. Conjunctival lymphomas can become large enough to displace the eyeball, and restrict eye movement.
He associated the lesion with the onset of a red eye and episodic foreign body. Objective to report clinical, histopathological and molecular features of salmon patchlike conjunctival lesions in paediatric and adolescent patients, and discuss management of these patients and outcome. This is a tumor of the front surface of the eye that usually appears as a salmonpink, fleshy patch. The differential diagnosis for an elevated salmoncolored conjunctival patch most commonly includes benign lymphoid hyperplasia and conjunctival lymphoma.
Clinical features can go a long way in differentiating these conditions. A complex choristoma presenting as a salmon patch lesion. Conjunctival lymphoma is a cancer but is considered low grade and treatable. The patient continues to followup without any visual. Conjunctival pigmented lesions college of optometrists. Lymphoma of the conjunctiva new york eye cancer center. They note that bilateral ocular manifestations were more common in patients with follicles compared with patients presenting the salmonpatch appearance. Conjunctival melanoma conjunctival melanoma in a african american.
A complex choristoma presenting as a salmon patch lesion in the. In cases of follicular lesions responding poorly to topical steroids, a conjunctival malt. Salmon patch is the name given to a very common group of birthmarks seen in babies. Diagnosis and management of malignant tumors of the eye. Paediatric and adolescent elevated conjunctival lesions in. What is the differential diagnosis of this condition. He reported mild itching and intermittent foreign body sensation. The lesion often has a color similar to salmon, hence the term salmon patch. New salmonpatch hemorrhages were observed superonasally in the right eye, and inferiorly in the left eye see figure 5. Salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. When in doubt, any suspicious lesion should undergo biopsy. While less common than conjunctival squamous neoplasia or melanoma, conjunctival lymphoma accounts for a significant portion of ocular adnexal lymphomas oals 25% 3, 4. Most patients notice the reddish discoloration of the surface of the eyeball conjunctiva. Differentiating benign vs malignant conjunctival tumors in.
The conjunctiva is a translucent, vascularized mucous membrane that can be divided into three regions. Common conjunctival lesions olivier continuing medical. Isolated conjunctival lymphoma metastasis from previous low. As the tumor enlarges, patients seek medical attention. Conjunctival lymphoma can appear clinically identical to reactive lymphoid hyperplasia. Conjunctiva is the primary site of involvement in onethird of cases. Conjunctival malt lymphoma typically presents with the characteristic salmonpatch lesion, albeit with varying clinical symptoms reported in the literature.
Purpose we describe a rare case of a complex choristoma appearing as a salmonpatch lesion in the nasal conjunctiva. The etiology is unknown but is thought to be due to chronic inflammation. Eye examination revealed a salmoncolored raised lesion involving supranasal bulbar conjunctiva extending to superior fornix of the left eye. Primary episcleral or conjunctival lymphoma falls into this category. Ninetyeight percent of conjunctival lymphomas arise from blymphocytes. Patients with this disease usually consult first an ophthalmologist. Investigation of refractory follicular conjunctival lesions.
The most important predisposing factor for conjunctival melanoma is the presence of longstanding conjunctival nevus or pam. Jun 22, 2018 a conjunctival cyst is a cyst on the conjunctiva of your eye. Symptoms, treatment for eye lesions by david laber eyeworld staff writer at the ascrs winter update earlier this year, attendees received thorough coverage of benign and malignant conjunctival tumors including appearances, treatment options and potential pitfalls. This mass is clinically consistent with a lymphoma. Slitlamp examination revealed complete resolution of the salmonpatch seen previously. Salmonpatch hemorrhages after central retinal artery occlusion in sickle cell disease. This opinion may be due to the great rarity of the lesion, to the lack of repeated biopsy studies, or to the fact that there is insufficient time to observe such cases. Conjunctival lymphoma is the second most common ocular adnexal tumor and generally manifests as a salmon pink patch on the fornix of the eye. The conjunctiva is an important site of extranodal lymphoma development, which comprises 2530% of all lymphomatous disease 1, 2. A case of conjunctival follicular lymphoma mimicking mucosaassociated lymphoid tissue lymphoma lamia abdalkader,1,5. Patients who do not have conjunctival involvement 75% of cases present with an orbital mass, usually in the superior lateral quadrant, in. In 25% of patients the conjunctiva is involved, in which case patients demonstrate a salmon red patch of swollen conjunctiva 1.
A complex choristoma presenting as a salmon patch lesion in. A and b left eye examination reveals a pink salmon patch over the. Investigation of refractory follicular conjunctival. It is the third most common malignancy involving the conjunctiva, behind squamous cell carcinoma and melanoma 4. The role of sentinel lymph node biopsy in the management of malignant conjunctival and eyelid tumors is highlighted. Dec 01, 2005 external examination of the right eye revealed a large conjunctival mass involving the superior conjunctiva and extending 5 mm onto the superior cornea figures 1ad. How to recognize and treat 3 types of malignant lesions. Slit lamp image of right eye with salmon patch conjunctival lesion in the superior temporal conjunctiva. An unusual presentation of pediatric conjunctival mucosa.
Physical examination revealed the presence of a pink salmonpatch involving her left medial conjunctiva. The patient population usually includes young to middle aged adults and the presenting sign is usually chronic redness 3. Conjunctival lymphoma is the second most common ocular adnexal tumor and generally manifests as a salmonpink patch on the fornix of the eye. Conjunctival lymphoma is most common in the 5th to 7th decades, with a slight female predominance 1,3. Top a salmon patch conjunctival mass was noted in the temporal bulbar conjunctiva of left eye. Conjunctival melanoma conjunctival melanoma an episcleral nodule of conjunctival melanoma arrow. Conjunctival malt lymphoma presents in various ways, not only with the salmonpatch appearance. Multiple myeloma manifesting as a salmon patch conjunctival mass. Shields supported by the eye tumor research foundation, inc. On followup after 2 months, the patient did not report any itching or irritation of her left eye. To the best of our knowledge, this is the first pediatric case of conjunctival malt lymphoma diagnosed in the absence of a salmonpatch lesion. Conjunctival argyrosis conjunctival argyrosis conjunctival pigmentation due to drops containing a silver solution. The size of conjunctival lesion was approximately 10 mm. It can be difficult to differentiate between the types of lesions, but according to zaina almohtaseb, md, assistant professor and assistant residency program director, cullen eye institute, baylor college of medicine, houston, there are 3 types of.
External examination of the right eye revealed a large conjunctival mass involving the superior conjunctiva and extending 5 mm onto the superior cornea figures 1ad. The photograph shows a pink raised conjunctival lesion with an appearance that is. It may be diffuse or focal and may be limited to the area of the limbus perilimbal injection traditionally ascribed to uveitis. Feeder vessels and rapid growth are not typically seen in lymphoma. The birthmarks are caused by expansions dilations in tiny blood vessels called capillaries. We present a case of a 47yearold hispanic woman who presented with left eye itching and irritation associated with a painless pink mass. Macroscopic findings revealed a right conjunctival lesion of a tan irregular. A glistening salmon patch lesion in the bulbar conjunctiva. Eye movement restriction can cause diplopia doublevision. Biopsy of subconjunctival lymphoma university of iowa. Surgery with freezing treatment can control the disease.
On exam, conjunctival lesions are classically described as salmon patch fleshy lesions. Case study a case of conjunctival follicular lymphoma. General considerations tumors of the conjunctiva and cornea occupy a large spectrum of conditions ranging from benign inflammatory lesions such as pingueculitis or episcleritis to aggressive, lifethreatening malignancies such. A repeat ct of the orbits demonstrated complete resolution of the left conjunctival lesion figure 4.
If the tumor extends behind the eyeball, it can be pushed forward proptosis. Marginal zone bcell lymphoma malttype lymphoma is the most frequent subtype identified on biopsy and immunohistochemical studies. Conjunctival lymphoma is an ocular surface tumor that usually appears as a. Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. The clinical impression of the average ophthalmologist is that this type of conjunctival lesion is of a benign character. Benign diagnoses that may be considered include a nonpigmented nevus, dermoid or lipodermoid, pyogenic granuloma, lymphangioma, amyloid deposition, papilloma, fibroma, or as in our case, a complex choristoma. Isolated conjunctival lymphoma metastasis from previous.
The study concludes that conjunctival malt lymphoma presents in various ways, so biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the. It ranges from mild the eye is pink, such as in a mild allergic reaction, to severe, such as in a serious infection. Classification, diagnosis, and management of conjunctival. The conjunctiva is that clear membrane that covers the white part of your eye. On examination, his visual acuity was 65 in each eye. In the clinic, patients can present with a variety of conjunctival lesions. Oct 15, 2014 conjunctival reaction this refers to the redness of the eye. Distinct clinical clues may be suggestive of a subtype, such as emzl demonstrating a mobile, nonlobulated salmonpink patch or follicular lymphoma demonstrating a multinodular appearance. The lesions of diffuse large b cell lymphoma may have a grayish coloration. When a salmon patch occurs on the face, it is often called an angel kiss, and when it occurs on the back of the neck, it is known as a stork bite. A conjunctival cyst is a cyst on the conjunctiva of your eye. Red colored tumors on the eye can be a presenting sign of systemic lymphoma. Conclusion conjunctival malt lymphoma presents in various ways, not only with the salmonpatch appearance.
Pyogenic granuloma is an inflammatory lesion of the conjunctiva, usually following surgery or even minor trauma to the conjunctiva. These lesions are fleshy and often originate the fornix or adjacent to the limbus. The patient came to the service complaining of one month of epifora and itching in both eyes, with a salmon patch conjunctival mass in the temporal tarsal conjunctiva of the left eye, without any inflammatory signs or decreased visual acuity. Westcott scissors are used to make an incision through the conjunctiva overlying the lesion. Approximately 515% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma 80%. A partial exeresis and biopsy of the left eye subconjunctival mass was performed. The patient population usually includes young to middle aged adults and the presenting sign is usually chronic redness. A conjunctival bleb is formed when there is a direct connection of the aqueous in the anterior chamber to the subconjunctival space. Conjunctival lymphomas typically are hidden behind the eyelids and painless. May 15, 2019 the most important predisposing factor for conjunctival melanoma is the presence of longstanding conjunctival nevus or pam.
Apr 05, 2016 eyelid lesions are more often than not benign. It can be difficult to differentiate between the types of lesions, but according to zaina almohtaseb, md, assistant professor and assistant residency program director, cullen eye institute, baylor college of medicine, houston, there are 3 types of malignant. Bottom heavy myeloma cells with eccentric nuclei and basophilic cytoplasm infiltrated in the underlying conjunctival stroma arrow. Jul 27, 2017 salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. Another presentation is that of a chronic follicular conjunctivitis fig. Anterior segment biomicroscopy revealed multiple, irregular elevated salmon. Conjunctival lymphoma conjunctival lymphoma salmon patch.
Photograph of the left eye showing a fleshy, salmonpink lesion arising from the caruncle orbital computed tomography ct scans showed a soft tissue swelling anterior to the left globe. Here we report a case of conjunctival lymphoma in a young woman complicated by pregnancy. Therefore, biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the typical appearance of malt lymphoma. Jampol lm, condon p, dizonmoore r, serjeant g, schulman ja. This video demonstrates biopsy of a salmon patch lesion under the inferior medial portion of the conjunctiva. Conjunctival biopsy revealed a lymphoid infiltrate of the connective tissue and epithelium figure 2. On followup one week later, the patient reported improvement in her vision in both eyes. Visual acuities were 2025 in the right eye and 2050 in the left eye. Conjunctival reaction this refers to the redness of the eye.
Diagnosis and treatment of conjunctival lymphoma american. He denied ocular irritation or changes in his vision from the conjunctival lesion. Visual acuity, eye movements and intraocular pressure were normal in both eyes. Overall, the great majority of conjunctival tumors in children are benign, but keep in mind the two important malignant tumors, melanoma and lymphoma. In our case, a salmonpatch conjunctival tumor was biopsied and confirmed to. Conjunctival lymphoma a case report boned 2019 acta. A 68yearold woman presented with nasal conjunctival hyperemia of the left eye.
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