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Conj lymphma clinic app.
- 1. Case Presentation Clinical Approach Dr. Niwar Ameen Duhok Eye Hospital 2018
- 2. History • 57 year old • Male • C.C : ordinary eye examination • Important +ve & -ve Findings : Ocular - VA 6/12 BCVA 6/6 - Painless bulbar conjunctival lesion 1cm x 1cm - No Cataract - Posterior Segment examination, normal - No Hx of ocular surgery and trauma Systemic involvement -ve -ve Medical Hx
- 3. • Make Effective Presentations • Using Awesome Backgrounds • Engage your Audience • Capture Audience Attention
- 4. What could be the DDx of conjunctival mass??
- 5. DDX Benign causes: • Benign reactive lymphoid hyperplasia • Conjunctival naevus • Benign ocular surface tumors (squamous papilloma, pyogenic granuloma, and lymphangiectasis), Malignant tumors • SCC and amelanotic melanoma Inflammatory causes: • Scleritis, episcleritis Others causes • Presence of a foreign body, amyloid deposition • Chronic follicular conjunctivitis
- 6. Clinical approach • Age • Duration (acute, chronic) • Progression (slow, rapid) • Associated symptoms (irritation, pain, discomfort) • History of Surgeries • History of Trauma • Medical Hx of (immunosuppression or malignancy)
- 7. Examination What to be looked for?
- 8. Findings • 4S (Site, Size, Shape, Surface) • Any feeder vessel ? • Exact anatomic location (conj, subconj or episec) • Extent of the lesion 1. IO involvement 2. Orbital extension 3. Lymph node spread
- 9. Investigations When and what to be done?
- 10. High index of suspicion
- 11. • Nothing if diagnosis is going with benigns • If malignantly suspicious then do the following 1. US biomicroscopy, gonioscopy to assess IOcular 2. CT, MRI to assess Iorbital 3. Biopsy : - • Whenever Lymphoma is suspected • Both eyes should biopsied even uninvolved eye from inferior fornix
- 12. Conjunctival lymphoma • Conjunctival lymphoma is an ocular surface tumor that usually appears as a painless, salmon-pink, “fleshy” patch. Although it generally has a smooth surface, it can also appear as a multinodular lesion or as follicular conjunctivitis
- 13. Salmon color
- 16. Conj lymphoma chronic Follicular conjunctivitis
- 18. Conjunctival naevus - Typically in 1st and 2nd decade - Pigmentation is variable
- 19. Conjunctival Papilloma - Strongly associated with HPV infection type 6-11 - Location (limbal, fornix or caruncle) - Prominent feeder vessel
- 20. Amelanotic conjunctival melanoma - 75% arise from PAM - 6th decade presentation
- 21. OSSN - a spectrum of benign, pre-malignant and malignant slowly progressive epithelial lesions of the conjunctiva and cornea. - Older adults are usually affected unless a predisposing systemic condition is present. - Risk factors include UV light exposure, a pale complexion, ciclosporin, smoking, petroleum product exposure, (AIDS) and xeroderma pigmentosum.
- 22. • Conjunctival lymphoma may arise • de novo • extension from orbital lymphoma • associated with systemic lymphoma at diagnosis (up to 30%). • Most conjunctival lymphomas are of B cell origin, arising from mucosa associated lymphoid tissue (MALT) and tending to be indolent.
- 23. Management • Work-up with oncologist • Rx : EBRT is the treatment of choice.