Conjunctival lymphoma: case report

To report the diagnosis and therapeutic approach in the case of a patient with conjunctival lymphoma.

A 54-year-old caucasian female presented to the hospital with a painless conjunctival mass in the right eye of at least three months duration. The ophthalmological examination showed a "salmon patch" conjunctival lesion in the inferior fornix. An incisional biopsy of the conjunctival lesion was performed, and the histopathological examination confirmed the diagnosis of extranodal marginal zone B-cell conjunctival lymphoma. The CT scan showed no systemic involvement. It was decided to start radiotherapy with brachytherapy.

Conjunctival lymphoma is a rare ocular malignancy arising from polyclonal proliferation of lymphocytes. The most common subtype is extranodal marginal zone B-cell lymphoma (EMZL), followed by diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and T-cell lymphoma (TL). Clinical manifestations are non-specific; they usually present as a unilateral or bilateral painless, salmon-pink conjunctival lesion, often without systemic symptoms. Definite diagnosis requires conjunctival biopsy and relies on histopathology and immunohistochemistry, with molecular profiling playing an increasing role in risk stratification. Treatment strategies include: radiotherapy, immunotherapy (Interferon-α2b, Rituximab), chemotherapy, and antibiotherapy. Prognosis is generally favorable, with high survival rates, especially in localized cases.

Conjunctival lymphoma can be easily overlooked during a routine examination; therefore, a thorough clinical evaluation, advanced imaging, histopathological, and immunohistochemical analysis are essential for appropriate management. Systemic staging and an interdisciplinary approach involving ophthalmology, medical oncology, and radiation oncology are necessary for optimal treatment planning and outcome.