A case of orbital lymphoproliferative lesion diagnosed as malignant lymphoma after recurring 11 years later
Background: Most primary lymphoproliferative lesions in the ocular adnexa, including the eyelid, conjunctiva, and orbit, are diagnosed as low-grade malignant lymphomas.  Recurrence and dissemination of these tumors are rare in Japan.  The long-term prognosis for this disorder still remains to be clarified. Case and Method: A 53-year-old woman was first referred to us for right orbital tumor in 1986.  After subtotal resection of the tumor, the patient received no additional treatment.  She visited us in 1997 with the complaint of bilateral orbital tumor.  Biopsied specimens were examined histologically using hematoxylin-eosin and immunohistological staining.  Southern blot hybridization was used to detect immunoglobulin gene rearrangement.  The paraffin-embedded specimen obtained in 1986 was also examined for immunoglobulin gene rearrangement using nested polymerase chain reaction technique.  Findings: The specimens from 1997 and 1986 were both diagnosed as lymphoid type of inflammatory pseudotumor, based on polyclonal B cell immunohistological staining.  Immunoglobulin gene rearrangement was present in both specimens. Conclusions: The orbital tumor resected in 1986 was a low-grade malignant lymphoma which disseminated systematically 11 years later.  This case shows a long-term course of orbital lymphoproliferative lesion with positive immunoglobulin gene rearrangement.  It also shows the importance of follow-up over 10 years in the case of low-grade malignant lymphoma of the ocular adnexa.