Primary CD4 + T-Cell Lymphoproliferative Disorder of Conjunctiva

Area of Science:

• Ophthalmology
• Hematology
• Oncology

Background:

• Primary cutaneous CD4+ small/medium T-cell lymphoma was reclassified as a lymphoproliferative disorder in 2016.
• This reclassification was based on the lack of documented dissemination or mortality.
• Distinguishing between reactive hyperplasia and neoplastic processes in T-cell disorders can be challenging.

Purpose of the Study:

• To present a case of a primary CD4+ T-cell lymphoproliferative disorder localized to the conjunctiva.
• To compare this case with existing classifications of T-cell lymphoproliferative disorders.

Main Methods:

• A case report detailing a single patient's presentation and diagnosis.
• A comprehensive review of the relevant medical literature.

Main Results:

• An 81-year-old male presented with asymptomatic bilateral conjunctival masses.
• Biopsies revealed a proliferation of mature CD4+ lymphocytes with T-cell receptor gamma gene rearrangement.
• Histopathology and immunophenotyping showed similarities to primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, but with some atypical features.

Conclusions:

• The described conjunctival disorder shares characteristics with primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder but presents unique features.
• Multicentric clonal expansion of T cells does not automatically signify lymphoma.
• Lymphoproliferative disorders with overlapping features of reactive hyperplasia and lymphoma require vigilant monitoring.