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Diagnosis of conjunctival B-cell lymphoma by polymerase chain reaction heteroduplex analysis
Erich C Strauss1, John F Warren, Todd P Margolis
1Department of Ophthalmology, University of California San Francisco Medical Center, California, San Francisco, USA. strauss@itsa.ucsf.edu
Insights
Polymerase chain reaction heteroduplex analysis diagnosed conjunctival B-cell lymphoma when histology was inconclusive. This molecular technique differentiates benign lymphoid hyperplasia from low-grade lymphoma in ocular adnexa.
Area of Science:
- Ophthalmology
- Oncology
- Molecular Diagnostics
Background:
- Giant papillary conjunctivitis can mimic other conjunctival conditions.
- Distinguishing benign lymphoid hyperplasia from low-grade B-cell lymphoma is clinically significant.
- Molecular techniques offer potential for improved diagnostic accuracy.
Observation:
- A case of unilateral blepharoptosis secondary to an extensive palpebral conjunctival follicular-like process was observed.
- Initial clinical and histological assessment suggested benign lymphoid hyperplasia.
- Immunohistochemical studies were also consistent with benign lymphoid hyperplasia.
Findings:
- Polymerase chain reaction heteroduplex analysis identified low-grade B-cell lymphoma.
- This molecular finding contrasted with the histological and immunohistochemical results.
- The patient received focal radiation therapy with no signs of lymphoma on preliminary follow-up.
Implications:
- Polymerase chain reaction heteroduplex analysis can diagnose conjunctival B-cell lymphoma even without supportive histological or immunohistochemical evidence.
- This molecular technique provides a method for independent diagnostic distinction between benign lymphoid hyperplasia and low-grade B-cell lymphoma of the ocular adnexa.
- This advancement may lead to earlier and more accurate diagnosis and treatment of ocular adnexal lymphomas.
Purpose:
To report a case initially assessed as giant papillary conjunctivitis and subsequently as B-cell lymphoma by the molecular technique of polymerase chain reaction heteroduplex analysis.
Design:
Observational case report.
Methods:
Clinical, histologic, immunohistochemical, and polymerase chain reaction heteroduplex analysis findings are presented.
Results:
A 32-year-old man developed unilateral blepharoptosis secondary to an extensive palpebral conjunctival follicular-like process. Excisional biopsy showed a dense small lymphocyte infiltrate consistent with benign lymphoid hyperplasia by histology and immunohistologic marker studies. Polymerase chain reaction heteroduplex analysis revealed low-grade B-cell lymphoma, however. Systemic examination was negative. Focal radiation therapy was performed, and preliminary results show no signs of lymphoma.
Conclusions:
Polymerase chain reaction heteroduplex analysis established a diagnosis of conjunctival B-cell lymphoma in the absence of supporting histology and immunohistochemistry studies. This technique may provide independent, diagnostic distinction between benign lymphoid hyperplasia and low-grade B-cell lymphoma of the ocular adnexa.
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