Clinical features and prognosis of conjunctival lymphoid hyperplasia
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Abstract:
Background
Primary conjunctival lymphoid hyperplasia exhibit atypical clinical symptoms and easy to cause misdiagnosis and mistreatment.Understanding the clinical characteristics of primary conjunctival lymphoid hyperplasia is of an important clinical significance.
Objective
This study was to analyze the clinical characteristics and therapeutic outcome of patients with primary conjunctival lymphoid hyperplasia.
Methods
The medical records of 20 patients with primary conjunctival lymphoid hyperplasia who was treated in Beijing Tongren Hospital from January 2012 to December 2014 were retrospectively analyed.The age, symptoms, therapy, prognosis, histopathological features and immonochemistry results were reviewed, and the treating approach targeting to different types of conjunctival lymphoid hyperplasia was evaluated.The fellow-up duration was 1-2 years.
Results
Age of the patients ranged from 27 to 83 years old.The lesions were classified as benign lymphocytic hyperplasia, atypical lymphoid hyperplasia and lymphoma.Majority of lesions located in fornix conjunctiva tissue (90%). Follicle-like appearance was seen in the benign lymphocytic hyperplasia, and pink elavation was exhibited at the bulbar conjunctiva in the atypical lymphoid hyperplasia.A diffuse salmon fish like appearance in conjunctiva was the primary feature of conjunctival lymphoma.Histopathological examination showed that conjunctival benign lymphocytic hyperplasia had follicle-like tissue in lesions, atypical lymphoid hyperplasia exhibited diffuse lymphocyte filtration, and conjunctival lymphoma appeared monocyte filtration.The 3 tpyes of lesions also could be differentiated by immunochemistry.The medicine was applied in the eyes with benign lymphocytic hyperplasia, and the combination of resection of lesions with conjunctival tissue or amniotic membrane transplantation was used for the atypical lymphoid hyperplasia or lymphoma eyes.No recurrence of the lesions was found during fellow-up duration.
Conclusions
The clinical manifestations of conjunctival lymphoid hyperplasia lesions are varied, and it is easy to be confused with chronic ocular surface diseases.Pathology and immunochemistry are helpful for the differential diagnosis.The treating regimen is dependent on the lesion type.Most patients have a favorable prognosis with treatment.
Key words:
Conjunctival diseases/pathology; Conjunctival neoplasms/diagnosis & therapy; Hyperplasia; Lymphoid tissue/pathology; Lymphoma/pathology; Retrospective studies; HumansKeywords:
Lymphoid hyperplasia
Follicular hyperplasia
Pseudolymphoma
Atypical Hyperplasia
Mucosa-associated lymphoid tissue
Right Main Bronchus
Mucosa-associated lymphoid tissue
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Lymphoid hyperplasia
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Malignant lymphoma
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Chronic lymphatic leukemia
Chronic leukemia
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Introduction: The clinical-pathological characteristics of 12 patients with intestinal nodular lymphoid hyperplasia (NLH) are described with the aim to try and delineate between hyperplasia and pathological aggregate of lymphoid tissue in the intestine and its association with other diseases from Indian subcontinent. Materials and Method: 12 diagnosed cases of NLH were retrieved out of 2256 intestinal punch biopsy done at our centre and were evaluated as per histological criteria laid down by various authors including their clinical and pathological features. Results: Most frequent symptom includes diarrhoea and weight loss and the severity of these symptoms were directly proportional to the number and location of the lymphoid nodules. Prominent lymphoid nodules in mucosa and/or submucosa were documented histologically in all cases. One patient had associated common variable immunodeficiency which on follow up developed intestinal lymphoid malignancy of NHL type (DLBCL) and the other was having hypogammaglobulinemia. All cases showed absence of plasma cells, except one with predominant symptoms of Gastro-esophageal reflux disease (GERD) rather than diarrhea. Conclusion: NLH runs as a benign course, but these cases should be followed up with histology as well as thorough clinical and biochemical evaluation to detect early lymphoma that can be managed efficiently.
Lymphoid hyperplasia
Submucosa
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Abstract Canine lymphoma represents a heterogeneous group of lymphoid neoplasms, with multicentric nodal lymphoma being the most common presentation. Musculoskeletal involvement is uncommon, and primary muscular lymphoma is a very rare presentation. Only a few cases have been described in dogs, which were of variable classification and immunophenotype. Here, we report the case of a 5‐year‐old female neutered Beagle that presented with an intramuscular mass on the right shoulder and associated lameness and lethargy. One month after initial presentation, multiple cutaneous nodules appeared on the head, and staging with advanced imaging revealed additional masses affecting other muscles. Cytology, histopathology, immunohistochemistry, and PCR for antigen receptor rearrangements of one of the muscle masses and skin lesions supported a diagnosis of peripheral T‐cell lymphoma with large granular lymphocytes at both sites. The dog was euthanized after diagnosis due to the poor prognosis. This is the first report of primary muscular peripheral T‐cell lymphoma with large granular lymphocytes and cutaneous involvement in the dog. Despite being a rare presentation, lymphoma must be considered a differential in dogs presenting with a discrete, intramuscular, soft tissue mass.
Immunophenotyping
Histopathology
Lethargy
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Atelectasis
Chest radiograph
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To the Editor: It was shown by our retrospective study of 56 cases that cutaneous lymphoid hyperplasia (CLH) located on the nipple-areola complex displays atypical microscopic features that are often seen in authentic lymphomas.1 These include absence of germinal center polarization, reduction of mantle zones, coalescence of lymphoid follicles resulting in sheets of centroblasts reminiscent of diffuse large B-cell lymphoma, arrangement of cells in single files between collagen bundles reminiscent of cutaneous leukemia infiltrates, marked B-cell predominance, smooth muscle infiltration, angiocentric arrangement of the infiltrate and monoclonality.1 In our practice we encountered several cases of CLH of the scrotum, which, akin to its counterpart on the nipple, manifested similar atypical histopathological features. Although several articles dealing with CLH on the scrotum are available,2,3 none specifically emphasized this problem. Therefore, we present a series of 9 cases of scrotal CLH to demonstrate that the pseudolymphoma in this anatomic site is often associated with worrisome histology. All patients were male, their age at diagnosis ranging from 6 to 69 years (mean 20.9 years, median 10 years). Seven of the 9 patients presented with a solitary erythematous plaque or nodule on the scrotal skin ranging in size from 0.3 to 2 cm; 2 patients each had 2 nodules. The clinical diagnoses included atheroma (n = 2), nevus (n = 1), fibroma (n = 2), granuloma annulare (n = 1), pseudolymphoma (n = 1), lymphoma (n = 1), or a mere description as “a tumor” (n = 1). Two patients reported a tick bite 1 year and 3 years before the occurrence of the scrotal lesions. One of these 2 patients had also had cervical lymphadenopathy and fever after the bite; he had a positive serology test for Lyme borreliosis and was treated by antibiotic therapy, as was another patient who had had a history of erythema chronicum migrans 7 years before the admission due to the lesion on the scrotum. In all 9 cases treatment consisted of surgical removal of the scrotal lesions. Follow-up, ranging from 1.5 to 13 years (mean 6.3 years, median 7.5 years), was available for all patients, of whom 7 showed neither signs of recurrences nor extracutaneous disease. The remaining 2 patients experienced a local recurrence that occurred at 4 and 5 months after surgery and were treated with antibiotics or surgical removal, resulting in complete remission. Table 1 summarizes the features of CLH of the scrotum that may cause diagnostic difficulties. These are basically the same as reported for CLH on the nipple.1 Histologically, in all cases a dense diffuse or multinodular infiltrate with lymphoid follicles formation occupied the whole dermis with a Grenz zone preserved in 4 cases (Figs. 1A, B). Local and subtle epidermotropism was noted in 3 cases. A majority of the lymphoid follicles varied in sizes and shapes and showed reduced or absent mantle zone and absence of germinal center polarization in all cases (Figs. 1A, C). Lymphoid follicles often coalesced (n = 6) (Fig. 1B) and demonstrated areas of large blasts resembling diffuse large B-cell lymphoma (n = 4). In 5 and 4 cases there was muscle (Fig. 1D) and perineural infiltration, respectively. Foci with cells arranged in a single file between collagen were found in 7 cases (Fig. 1E), and “smudging” of the cells was observed in 8 specimens (Fig. 1B). Prominent angiocentric arrangement of the infiltrate with infiltration of the vessel walls was noted in 3 cases (Fig. 1F). Immunohistochemically, most of the lesions were B-cell predominant (n = 7). In 6 cases there was a prominent admixture of plasma cells of the periphery of the infiltrate, similar to plasma cell clusters seen in marginal zone lymphoma, but these were invariably polyclonal. The meshwork of follicular dendritic cells highlighted by CD21 or CD35 was irregular at least in several follicles in 6 cases. Of the 6 patients analyzed for IgH and TCR gene rearrangements and Borrelia burgdorferi, 3 had a monoclonal IgH rearrangement (these patients had no evidence of the disease at 1.5, 4.5, and 10 years). Borrelia burgdorferi DNA was detected only in 1 case.FIGURE 1: A, A dense infiltrate with numerous lymphoid follicles of various sizes and shapes occupied the dermis. B, Lymphoid follicles are closely located and may coalesce. Note the smudged lymphocytes within the infiltrate; this feature is often seen in leukemic infiltrates in the skin. C, A residual lymphoid follicle with the absence of the mantle zone. D, Smooth muscle infiltration of the lymphoid cells. E, Lymphoid cells spread between collagen bundles reminiscent of the pattern of specific skin involvement in leukemia cutis. F, Angiocentric arrangement with infiltration of the vessel wall.TABLE 1: Features of C L H of the Scrotum That May Cause Diagnostic DifficultiesWe conclude that CLH of the scrotum, similar to its analog on the nipple-areola complex, often manifests atypical histopathological features. This is probably in part due to the anatomical constitution of these sites with an abundance of smooth muscles and nerve fibers. Awareness of this fact is important to avoid a misinterpretation as a lymphoma in both sites. Irena E Belousova, MD, PhD *Department of Dermatology Medical Military Academy St Petersburg Russia Jana Nemcova, MSc Denisa Kacerovska, MD, PhD Michal Michal, MD Dmitry V. Kazakov, MD, PhD †Sikl's Department of Pathology Charles University Medical Faculty Hospital Pilsen 304 60 Czech Republic
Pseudolymphoma
Lymphoid hyperplasia
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