PRIMARY EXTRANODAL LOW-GRADE B-CELL LYMPHOMA OF MUCOSA-ASSOCIATED LYMPHOID TISSUE TYPE OF THE CONJUNCTIVA MISDIAGNOSED AS GIANT PAPILLARY CONJUNCTIVITIS IN A YOUNG WOMAN

年輕人之結膜穹窿粘膜淋巴瘤誤診為巨乳突結膜炎－－個案報告

阮國華(Kuo-Hua Juan) ； 彭美玲(Mei-Ling Peng) ； 張集武(Chi-Wu Chang)

《中華民國眼科醫學會雜誌》 53卷2期 (2014/10) Pp. 146-152

https://doi.org/10.30048/ACTASOS.201410_53(2).0008

摘要

目的：本文報告一例年輕人之結膜穹窿粘膜淋巴瘤誤診為巨乳突結膜炎－－個案報告。方法：觀察性病例報告。結果；一位二十二歲女性長期有配帶隱形眼鏡的習慣，近日來因異物感日趨嚴重而至診所就診，在診所檢查時發現有巨大乳突散佈在上下結膜穹窿，由於患者有長期配帶隱形眼鏡習慣，故先以類固醇藥水來加以治療此巨大乳突結膜炎，然而再接受過一段時間的治療，病況仍無改善，故轉至本院進一步治療，在本院嘗試接受過兩次結膜下類固醇注射，但症狀依舊，故病人接受了結膜腫瘤切除手術，病理化驗確認為邊緣區B細胞淋巴瘤，黏膜相關淋巴組織，無全身性侵犯，追蹤半年，無局部復發或全身轉移情況。結論；結膜惡性腫瘤很少見，而原發性的非何杰金氏淋巴瘤更是少見，其所表現常常並無特別症狀，且時常隱藏在結膜穹窿當中，故當我們面對一個巨大乳突結膜炎患者時，若其對傳統治療方法無效時，淋巴瘤必須列為鑑別診斷之一。

並列摘要

Purpose: We report a young woman of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma that was initially misdiagnosed as allergic giant papillary conjunctivitis because of the tumor shape, peripheral tumor location (the tumor was hidden in the fornix), and the patient was a soft contact lens wearer. Methods: Case report. A 22-year-old woman diagnosed with allergic giant papillary conjunctivitis was referred to our clinic because she was unresponsive to standard medical treatments. Routine anterior segment examination did not reveal any lesions, but further careful examination with a strong eyelid draw revealed minimally elevated tumors in the peripheral fornix under the lid. Excisional biopsy was performed. Results: Histopathologic and immunohistologic examinations indicated the presence of extranodal low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) subtype. She underwent no additional therapy. There was no evidence of recurrence in the patient during the follow-up period. Conclusions: Detection of conjunctival lymphoma could be challenging. If no apparent lesion is present and the patient has nonspecific symptoms, the inner surface of the eyelid should be carefully examined. Elaborate eyelid eversion, with eyeball movement, should be performed to avoid misdiagnosing or overlooking peripheral conjunctival lymphomas.

並列關鍵字

MALT lymphoma ； ocular adnexal lymphoma ； extranodal low-grade B-cell lymphoma ； reactive lymphoid hyperplasia ； GPC (Giant papillary conjunctivitis)