[Unilateral pediatric-type follicular lymphoma of the conjunctiva]

Pediatric-type follicular lymphoma is a rare entity, predominantly involving lymph nodes in the head and neck of children and young adults. Ocular adnexal involvement, particularly of the conjunctiva, is exceptionally uncommon in this age group.

An 11-year-old boy presented with a painless, salmon-colored mass on the nasal bulbar conjunctiva of the left eye, which had been progressively enlarging over several months. The lesion was firm, mobile, well-defined, broad-based, and non-transilluminating on clinical examination.

An excisional biopsy was performed. Histopathological analysis revealed features suggestive of follicular lymphoma. Immunohistochemistry supported this diagnosis. Fluorescence in situ hybridization (FISH) identified an IGH gene rearrangement. Additional molecular studies, including B-cell clonality assessment and next-generation sequencing (NGS), confirmed the presence of an IgkA gene rearrangement.

The combined histopathological, immunophenotypic, and molecular findings confirmed the diagnosis of pediatric-type follicular lymphoma of the conjunctiva, in accordance with the 2016 WHO classification.

Pediatric-type follicular lymphoma of the conjunctiva is a rare and often under-recognized presentation of orbital adnexal lymphoma in children. Due to its nonspecific clinical features, a high index of suspicion is necessary when evaluating salmon-colored conjunctival lesions. Histopathological and molecular analyses are essential for accurate diagnosis. This case represents the 10th reported instance in the medical literature, highlighting the importance of multidisciplinary evaluation in such rare presentations.