Asadi-Amoli Fahimeh, Nozarian Zohreh, Bonaki Hirbod Nasiri, Mehrtash Vahid, Entezari Samaneh
Department of pathology, Tehran University of Medical Sciences, Tehran, Iran E-mail :
Asian Pac J Cancer Prev. 2016;17(8):3727-31.
The most common type of ocular lymphoma is non-Hodgkin lymphoma (NHL), categorized into two groups: indolent (slow growing) and aggressive (rapid growing). Differentiating benign reactive lymphoid hyperplasia (RLH) from malignant ocular adnexal lymphoma (OAL) is challenging. Histopathology, immunohistochemistry (IHC) and ow cytometry have been used as diagnostic tools in such cases.
In this retrospective case series, from 2002 to 2013 at Farabi Eye Center, 110 patients with ocular lymphoproliferative disease were enrolled. Prevalence, anatomical locations, mean age at diagnosis and the nal diagnosis of the disease with IHC were assessed. Comparison between previous pathologic diagnoses and results of IHC was made. Immunoglobulin light chains and B-cell and T-cell markers and other immuno-phenotyping markers including CD20, CD3, CD5, CD23, CD10, CYCLIND1 and BCL2 were evaluated to determine the most accurate diagnosis. The lymphomas were categorized based on revised European-American lymphoma (REAL) classi cation.
Mean age±SD (years) of the patients was 55.6 ±19.3 and 61% were male. Patients with follicular lymphoma, large B-cell lymphoma or chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) tended to be older. Nine patients with previous diagnoses of low grade B-cell lymphoma were re-evaluated by IHC and the new diagnoses were as follows: extranodal marginal zone lymphoma(EMZL) (n=1), SLL(n=1), mantle cell lymphoma (MCL) (n=3), reactive lymphoid hyperplasia RLH (n=2). Two cases were excluded due to poor blocks. Flow cytometry reports in these seven patients revealed SLL with positive CD5 and CD23, MCL with positive CD5 and CyclinD1 and negative CD23, EMZL with negative CD5,CD23 and CD10. One RLH patient was negative for Kappa/Lambda and positive for CD3 and CD20 and the other was positive for all of the light chains, CD3 and CD20. Orbit (49.1%), conjunctiva (16.1%) and lacrimal glands (16.1%) were the most common sites of involvement.
Accurate pathological classi cation of lesions is crucial to determine proper therapeutic approaches. This can be achieved through precise histologic and IHC analyses by expert pathologists.
眼部淋巴瘤最常见的类型是非霍奇金淋巴瘤（NHL），分为两组：惰性（生长缓慢）和侵袭性（生长迅速）。区分良性反应性淋巴组织增生（RLH）与恶性眼附属器淋巴瘤（OAL）具有挑战性。组织病理学、免疫组织化学（IHC）和流式细胞术已被用作此类病例的诊断工具。
在这个回顾性病例系列中，2002年至2013年期间在法拉比眼科中心纳入了110例眼部淋巴增殖性疾病患者。评估患病率、解剖位置、诊断时的平均年龄以及通过IHC得出的疾病最终诊断。比较先前的病理诊断与IHC结果。评估免疫球蛋白轻链、B细胞和T细胞标志物以及其他免疫表型标志物，包括CD20、CD3、CD5、CD23、CD10、CYCLIND1和BCL2，以确定最准确的诊断。根据修订的欧美淋巴瘤（REAL）分类对淋巴瘤进行分类。
患者的平均年龄±标准差（岁）为55.6±19.3，61%为男性。滤泡性淋巴瘤、大B细胞淋巴瘤或慢性淋巴细胞白血病/小细胞淋巴瘤（CLL/SLL）患者往往年龄较大。对9例先前诊断为低度B细胞淋巴瘤的患者进行了IHC重新评估，新诊断如下：结外边缘区淋巴瘤（EMZL）（n = 1）、SLL（n = 1）、套细胞淋巴瘤（MCL）（n = 3）、反应性淋巴组织增生RLH（n = 2）。由于切片质量差，排除2例。这7例患者的流式细胞术报告显示，SLL的CD5和CD23呈阳性，MCL的CD5和CyclinD1呈阳性，CD23呈阴性，EMZL的CD5、CD23和CD10呈阴性。1例RLH患者的κ/λ呈阴性，CD3和CD20呈阳性，另1例所有轻链、CD3和CD20均呈阳性。眼眶（49.1%）、结膜（16.1%）和泪腺（16.1%）是最常见的受累部位。
病变的准确病理分类对于确定合适的治疗方法至关重要。这可以通过专家病理学家进行精确的组织学和IHC分析来实现。
