Tissue Necrosis in Epstein-Barr Virus-Negative Orbital Diffuse Large B-Cell Lymphoma

Area of Science:

• Ophthalmology
• Oncology
• Pathology

Background:

• Orbital tumors can present with varied symptoms, including visual disturbances and localized swelling.
• Accurate diagnosis of orbital lesions is crucial for effective treatment planning.
• Epstein-Barr virus (EBV) is associated with certain lymphomas, necessitating specific diagnostic testing.

Observation:

• An 82-year-old male presented with a 5-month history of diplopia and a 3-month history of painful left eyelid swelling.
• Imaging revealed a lesion involving left extraocular muscles, orbital fat, and the optic nerve.
• Initial biopsy showed necrosis and CD20 positivity, prompting a second biopsy.

Findings:

• Histopathological and immunohistochemical analysis of the second biopsy confirmed Epstein-Barr virus-negative diffuse large B-cell lymphoma, germinal center B-cell type.
• The tumor involved multiple orbital structures, including extraocular muscles and orbital fat.
• Negative Epstein-Barr virus serology was noted.

Implications:

• This case highlights the importance of thorough histopathological examination and potentially repeat biopsies for diagnosing orbital lymphomas.
• Prompt and accurate diagnosis of orbital diffuse large B-cell lymphoma is essential for initiating appropriate oncological treatment.
• Understanding the specific subtype (germinal center B-cell type) may influence treatment strategies and prognosis.