Orbital lymphoid lesions: short series with cytohistological correlation
Keywords:
Orbital lymphoid hyperplasia, Pseudolymphoma, lymphoma.Abstract
Orbit and ocular adnexae are common sites (10-15%) for developing lymphoid lesions but have diagnostic and staging difficulties similar to other extranodal sites. Out of 15 fine needle aspirates from orbital lesions received in last 5 years three female patients of age 56, 46 and 72 years  presented to FNAC clinic with upper eyelid swellings of 2 years, 3 years and 3 months  duration. Systemic examination was unremarkable. Hematological and Serum protein electrophoresis was normal. On MRI case 1 was suggestive of infective/neoplastic lesion. On CECT case 2 was suggestive of pseudotumor/lymphoma while case 3 was suggestive of pseudotumor. FNAC of case 1 showed polymorphous population of lymphoid cells, without any significant mitosis. FNAC of  case 2  showed a monotonous population of lymphoid cells and Case 3 showed a relatively monotonous population in a background of lymphoglandular bodies. Case 1: Responded to steroids. Case 2: was advised a biopsy for confirmation,  Case 3: Excision done in view of the recurrent nature with no response to steroids. Histopathology in Case 2 showed a non encapsulated mass with proliferation  of lymphoid cells forming nodules, IHC showed a monoclonal pattern while Case 3 showed a nonencapsulated mass with nodular proliferation of  lymphoid cells involving the surrounding adipose tissue with formation of primary and secondary follicles and Immunohistochemistry (IHC) showed a polyclonal population. Three cases are being discussed to highlight the diagnostic dilemmas in orbital lymphoid lesions and relevance of IHC in such cases.
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