Matsuo Toshihiko, Ichimura Kouichi, Kubonishi Shiro
Departments of Ophthalmology, Okayama University Hospital and Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences.
J Clin Exp Hematop. 2014;54(2):143-7. doi: 10.3960/jslrt.54.143.
Conjunctival lesions are rarely seen in mantle cell lymphoma. Here, we report a patient who developed bilateral conjunctival lesions in the course of chronic lymphocytic leukemia as an initial diagnosis, resulting in the final diagnosis of mantle cell lymphoma by conjunctival biopsy. A 66-year-old man developed conjunctival salmon-pink lesions on both sides in the 1.5-year course of chronic lymphocytic leukemia. He also had irregularly shaped masses with low tissue density in the orbital apex on both sides. Bilateral conjunctival biopsy showed subepithelial infiltration with lymphoid cells, positive for CD20, CD5, and cyclin D1, but negative for CD3, CD10, and CD23. Immunohistochemical restaining of the previous bone marrow biopsy specimen demonstrated lymphoid cells positive for cyclin D1, confirming the diagnosis of mantle cell lymphoma with leukemic presentation. As the case presenting stage IV lymphoma with systemic lymphadenopathy, he underwent 3 courses of combination chemotherapy with fludarabine and cyclophosphamide, and then 6 courses of bendamustine with rituximab, leading to complete remission for the following 3 years. In conclusion, mantle cell lymphoma should be included in the differential diagnosis of conjunctival salmon-pink lesions.
结膜病变在套细胞淋巴瘤中很少见。在此，我们报告一名患者，其在慢性淋巴细胞白血病病程中最初诊断为双侧结膜病变，经结膜活检最终诊断为套细胞淋巴瘤。一名66岁男性在慢性淋巴细胞白血病病程的1.5年中双侧出现结膜鲑鱼粉红色病变。他双侧眶尖还存在形状不规则、组织密度低的肿块。双侧结膜活检显示上皮下有淋巴细胞浸润，CD20、CD5和细胞周期蛋白D1呈阳性，但CD3、CD10和CD23呈阴性。对先前骨髓活检标本进行免疫组化复染显示淋巴细胞细胞周期蛋白D1呈阳性，证实为白血病表现的套细胞淋巴瘤。由于该病例表现为伴有全身淋巴结病的IV期淋巴瘤，他接受了3个疗程的氟达拉滨和环磷酰胺联合化疗，然后接受了6个疗程的苯达莫司汀联合利妥昔单抗化疗，随后3年完全缓解。总之，结膜鲑鱼粉红色病变的鉴别诊断应包括套细胞淋巴瘤。
