Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo 060-8638, Japan.
World J Surg Oncol. 2012 Sep 18;10:194. doi: 10.1186/1477-7819-10-194.
Extra nodal marginal zone B-cell lymphoma (EMZL) of the conjunctiva typically arises in the marginal zone of mucosa-associated lymphoid tissue. The pathogenesis of conjunctival EMZL remains unknown. We describe an unusual case of EMZL arising from reactive lymphoid hyperplasia (RLH) of the conjunctiva. A 35-year-old woman had fleshy salmon-pink conjunctival tumors in both eyes, oculus uterque (OU). Specimens from conjunctival tumors in the right eye, oculus dexter (OD), revealed a collection of small lymphoid cells in the stroma. Immunohistochemically, immunoglobulin (Ig) light chain restriction was not detected. In contrast, diffuse atypical lymphoid cell infiltration was noted in the left eye, oculus sinister (OS), and positive for CD20, a marker for B cells OS. The tumors were histologically diagnosed as RLH OD, and EMZL OS. PCR analysis detected IgH gene rearrangement in the joining region (JH) region OU. After 11 months, a re-biopsy specimen demonstrated EMZL based on compatible pathological and genetic findings OD, arising from RLH. This case suggests that even if the diagnosis of the conjunctival lymphoproliferative lesions is histologically benign, confirmation of the B-cell clonality by checking IgH gene rearrangement should be useful to predict the incidence of malignancy.
结膜黏膜相关淋巴组织边缘区 B 细胞淋巴瘤（EMZL）通常发生在黏膜相关淋巴组织的边缘区。结膜 EMZL 的发病机制尚不清楚。我们描述了一例源自结膜反应性淋巴组织增生（RLH）的 EMZL 的不常见病例。一名 35 岁女性双眼（OU）均出现肉质鲑鱼粉红色结膜肿瘤。右眼（OD）结膜肿瘤标本显示基质中有一小群淋巴细胞。免疫组化检查未发现免疫球蛋白（Ig）轻链受限。相比之下，左眼（OS）弥漫性非典型淋巴样细胞浸润，CD20 阳性，B 细胞标志物阳性 OS。肿瘤组织学诊断为 OD 的 RLH 和 OS 的 EMZL。PCR 分析在 OU 的连接区（JH）区域检测到 IgH 基因重排。11 个月后，再活检标本显示 OD 基于相容的病理和遗传发现的 EMZL，源于 RLH。该病例提示，即使结膜淋巴增生性病变的诊断在组织学上为良性，通过检查 IgH 基因重排确认 B 细胞克隆性也有助于预测恶性肿瘤的发生。
