Clinical Analysis of Primary Conjunctival Malignant Lymphoma

PURPOSE: To investigate clinical outcomes, response to treatment, and the related factors of recurrence and complication, following treatment of primary conjunctival malignant lymphoma. METHODS: The medical records of 39 patients diagnosed with primary conjunctival malignant lymphoma between January 2005 and June 2013 were retrospectively reviewed. RESULTS: The mean age of patients was 51.1 years old. The most common presenting symptom was hyperemia (33.3%). The most common anatomical location of the mass was the fornix (38.5%) and 25.6% patients had bilateral involvement. Histopathologically, mucosa-associated lymphoid tissue (MALT) lymphoma (92.3%) was the most common subtype. Every patient underwent radiotherapy (92.3%) or chemotherapy (7.7%) after surgical excision and had 100% complete remission. Local or systemic recurrence was observed in 15.4% of patients after treatment (mean 8.0 +/- 3.3 months), but was completely remitted after additional radiation or chemotherapy. International prognostic index and location of tumor were significantly related factors for predicting tumor recurrence (p < 0.01, p = 0.02, respectively). Dry eye disease (DED) was the most common ocular complication (44.4%) after radiotherapy. Total radiation dosage and location of tumor were significantly associated factors for developing DED after radiotherapy (both p = 0.04). CONCLUSIONS: Most conjunctival malignant lymphomas were low grade malignant MALT lymphomas that responded well to treatment but recurrence of tumor and development of DED after radiotherapy were common, therefore predicting and preparing these lymphomas is important.

Conjunctival Lymphoma: Retrospective Analysis of the Treatment Result and Complications with Radiation Therapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In order to evaluate the response to radiation therapy and to analyze the patterns of failure, survival and complications, we performed a retrospective analysis of patients with conjunctival lymphoma. MATERIALS AND METHODS: From November 1991 to March 1999, 11 patients were diagnosed as conjunctival lymphoma at Asan Medical Center. Five patients had bilateral involvements, and a total of 16 eyes received radiation therapy. Using 6 to 9 MeV electrons or 4 MV photon beams, all patients were treated with a single anterior field to total doses ranging from 30 Gy to 45 Gy delivered in 10 to 25 fractions. The median follow up period was 57 Months. RESULTS: All patients achieved a complete response with radiation therapy. Two of 16 eyes that were treated (12.5%) developed local recurrence after radiation therapy, however they were salvaged with 30 Gy of reirradiation. The five-year local control was 88.9%. One out of 11 patients (9.9%) developed lung metastasis and received chest irradiation. At the last follow up, one had died of pneumonia and 10 patients were alive without disease evidence. The five-year overall survival rate was 77.8% and 5-year disease free survival was 77.8%. Cataract and dry eye occurred in one patient (9.9%) respectively. CONCLUSION: Radiation therapy is a very effective and safe treatment modality for conjunctival lymphoma. The local control rate of radiotherapy was excellent and complications were acceptable. Radiation therapy is also an effective treatment modality for recurrent conjunctival lymphoma. It generally requires more than three months to achieve complete response following radiation therapy, thus we recommend evaluating the response to radiation therapy at three months after completion of treatment.

A Case of Primary Mantle Cell Lymphoma on the Conjunctiva

MCL (Mantle cell lymphoma) is a subtype of B-cell non-Hodgkin`s lymphoma and has been established as a clinicopathologic entity in 1991. Although the prognosis of MCL is poor because it is systemically disseminated at the time of diagnosis in most patients and responds poorly to chemotherapy, the authors experienced a primary mantle cell lymphoma without systemic lymphadenopathy through chest PA, orbit neck chest abdomen CT, bone marrow biopsy, and bone scan in a 56-year-old man who presented with conjunctival mass in right eye. The patient was treated with surgical excision and radiotherapy due to confinement to the conjunctiva. We also report the case with a recent review of the ophthalmic literature.