Bilateral Large Orbital Lymphoma With Proptosis.

Area of Science:

• Oncology
• Ophthalmology
• Hematology

Background:

• Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive adult lymphoid malignancy.
• Orbital involvement in DLBCL, while rare, necessitates prompt diagnosis and multidisciplinary management.

Observation:

• A 63-year-old male with comorbidities presented with bilateral proptosis, lid swelling, and decreased vision.
• Clinical examination revealed bilateral proptosis, chemosis, restricted extra-ocular movement, and elevated intraocular pressure.
• Imaging confirmed bilateral orbital masses, and biopsy diagnosed activated B-cell subtype (ABC) DLBCL.

Findings:

• The patient received R-CHOP chemotherapy, leading to resolution of proptosis, chemosis, and extra-ocular movement restriction.
• Despite treatment, the patient experienced persistent poor vision in the right eye due to corneal perforation and scarring.
• MUM-1 positivity confirmed the activated B-cell subtype (ABC) of the orbital DLBCL.

Implications:

• Early diagnosis and prompt, multidisciplinary treatment are vital for managing aggressive diffuse large B-cell orbital lymphoma.
• While R-CHOP chemotherapy can be effective, long-term visual outcomes may be affected by complications like corneal perforation.
• This case highlights the importance of a comprehensive approach in treating orbital lymphomas to optimize patient prognosis and function.