Peripheral Blood and Bone Marrow Involvement in Orbital Lymphoma
Julia A Adams, Gerald E Byrne, Magdalena B Czader, Mehdi Nassiri. Indiana University School of Medicine, Indianapolis, IN; University of Miami Miller School of Medicine, Miami, FL
Background: Lymphoma is the most common primary orbital tumor in adults. Ocular adnexal lymphoid infiltrates are a diagnostic challenge and their clinical course has not been comprehensively studied in light of recent molecular and immunophenotypic findings.
Design: Three hundred ninety one (391) cases of suspected orbital and conjunctival lymphoproliferative lesions were evaluated in the Hematopathology Divisions of the Department of Pathology at Indiana University School of Medicine (1983-2012) and University of Miami (1983-2002). Morphologic and immunophenotypic features (immunohistochemistry and/or flow cytometry) and clonality (PCR, or Southern blot) were evaluated in all cases. From this group, patients who underwent staging bone marrow exam or peripheral blood flow cytometry performed after diagnosis of orbital lymphoma were selected for this study.
Results: Out of a total of 391 orbital biopsies for suspected lymphoma, 251 cases were confirmed to be lymphoma. 28 patients had a staging bone marrow performed after a new diagnosis of orbital lymphoma. Of these 8 (36%) were diagnostic for involvement by lymphoma, 2 were suspicious for involvement, and 18 showed no bone marrow involvement. Three of the positive cases were in patients with primary orbital mantle cell lymphoma (MCL), Burkitt lymphoma (BL), and extranodal marginal zone lymphoma (ENMZL). The remaining 5 cases with bone marrow involvement were diagnosed with secondary orbital lymphoma, including 2 MCL, 1 lymphoplasmacytic lymphoma (LPL), 1 B lymphoblastic leukemia/lymphoma, and 1 chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The 2 suspicious cases were in patients with primary diffuse large B-cell lymphoma (DLBCL) and primary orbital follicular lymphoma (FL). Thirteen bone marrow were studied by flow cytometry, with 3 positive for MCL and 1 suspicious for FL. Peripheral blood flow cytometry was performed in 24 cases, with 2 cases (8%) positive for involvement by ENMZL, 1 case (4%) positive for CLL/SLL, 3 atypical cases (13%), and 18 polyclonal cases (75%).
Conclusions: This finding further questions the clinical utility of staging bone marrow in low grade orbital lymphoma once the systemic involvement is excluded by imaging studies.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 248, Tuesday Afternoon