Ocular pathology for clinicians. 6. Lymphoid tumor of the lid

A 56-year-old white man presented with bilateral inferior lid tumors with a rubbery consistency suggesting lymphoid lesions. An excisional biopsy specimen of the larger lesion in the left lower lid led to routine pathologic, immunologic, histochemical, and electron microscopic investigations. The tumor displayed a diffuse pattern microscopically and was composed of atypical lymphocytes with intermediate differentiation. The immunologic and histochemical marker studies revealed that 90% of the constituent lymphocytes were B-lymphocytes bearing IgM-IgD immunoglobulins on their surface membranes; the remaining 10% of the cells being reactive T-lymphocytes. A diagnosis of a monoclonal proliferation was established and a systemic workup revealed disseminated lymphoma. The use of immunoglobulin and histochemical analyses of ocular adnexal lymphoid tumors is outlined.