J Korean Ophthalmol Soc.  2016 Jul;57(7):1150-1153. 10.3341/jkos.2016.57.7.1150.

A Case of Primary Hodgkin Lymphoma in the Orbit

• Park HH
• Choi SU
• Lee JK

• KMID: 2317578
• DOI: http://doi.org/10.3341/jkos.2016.57.7.1150

Abstract

PURPOSE
Hodgkin lymphoma involving the orbit and ocular adnexal tissue is very rare and usually appears in the form of a metastatic tumor at the end stage of the disease. Primary Hodgkin lymphoma in the orbit has not been previously reported, and herein we report a case of primary Hodgkin lymphoma occurring in the bilateral orbit.
CASE SUMMARY
A 64-year-old male presented with a left lower eyelid mass that increased in size over 2 years. The patient had no specific past medical history or family history except diabetes. During the physical examination, a fixed mass was gently palpated in the left lower eyelid. Mild upgaze limitation was observed during extraocular muscle movement examination in both eyes. Orbital computed tomography and magnetic resonance imaging showed soft tissue masses involving the bilateral inferior rectus muscle and left lower eyelid. The patient was diagnosed with nodular sclerosing Hodgkin lymphoma after pathological examination following incisional biopsy. The patient was transferred to the oncology department for tumor staging. Positron emission tomography showed no involvement of other organs except both orbits. After systemic chemotherapy and radiation therapy, the patient was under observation for 14 months without ophthalmic and systemic complications or recurrence.
CONCLUSIONS
The authors present a case of primary nodular sclerosing Hodgkin lymphoma that occurred in the orbit. After systemic chemotherapy and radiation therapy, the patient was in good general condition.

Keyword

Bilateral; Hodgkin lymphoma; Orbit; Primary

MeSH Terms

Biopsy
Drug Therapy
Eyelids
Hodgkin Disease*
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging
Orbit*
Physical Examination
Positron-Emission Tomography
Recurrence

Figure

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  Figure 1. A magnetic resonance imaging (MRI) of the orbit. T1-weighted orbital coronal MRI showing a diffuse mass in the right inferior rectus muscle (A, arrow) and left lower eyelid (B, arrowhead).

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  Figure 2. Histopathological examination of nodular sclerosing Hodgkin lymphoma. (A) Dense collagen band (arrow) and the mixture of different cell types; small lymphocytes, plasma cells, eosinophils, binucleated owl-face Reed-Sternberg cell (arrowhead) (H&E stain, ×200). (B) CD30 stains Reed-Sternberg and Hodgkin cells (arrow) (CD30, ×400). (C) CD15 staining showing cell membrane positivity in the large cells (arrowhead) (CD15, ×400).

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  Figure 3. A magnetic resonance imaging (MRI) of the orbit after chemotherapy and radiation therapy. T1-weighted orbital coronal MRI showing noticeably reduced mass in the right inferior rectus muscle (A, arrow) and normal left lower eyelid area (B, arrowhead).

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  Figure 4. Preoperative and postoperative chemotherapy and radiation therapy photographs of the patient. In the preoperative photograph, left lower eyelid appeared protruding compared to the right lower eyelid (A), and postoperative photography showing both lower eyelid protruding lesions disappeared after chemotherapy and radiation therapy (B).

Reference

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