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Surgical Treatment of an Endolymphatic Sac Tumor

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Bilateral Large Orbital Lymphoma With Proptosis.

Dharshini Balasubaramaniam^1,2, Sujaya Singh¹, Fazilawati A Qamarruddin²

¹Ophthalmology, Universiti Malaya, Kuala Lumpur, MYS.

|April 27, 2023

Summary

Diffuse large B-cell lymphoma (DLBCL) is an aggressive eye cancer. Prompt diagnosis and multidisciplinary treatment, including R-CHOP chemotherapy, are crucial for managing orbital DLBCL and improving patient outcomes.

Keywords:

chemosis diffuse large b-cell lymphoma ocular adnexal lymphoma orbital lymphoma proptosis

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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.