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Updated: May 29, 2025
A Non-invasive Way to Isolate and Phenotype Cells from the Conjunctiva
Published on: July 5, 2017
Primary CD4 + T-Cell Lymphoproliferative Disorder of Conjunctiva
Curtis E Margo1,2, Kendra D DeAngelis1,2
1Departments of Pathology and Cell Biology, and Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL; and.
Insights
This case study describes a rare CD4+ T-cell lymphoproliferative disorder affecting the conjunctiva. The findings highlight the complexity of classifying T-cell disorders and the need for careful patient monitoring.
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.
Purpose:
The purpose of this study was to describe a patient with a primary CD4 + T-cell lymphoproliferative disorder of conjunctiva.
Methods:
Case report and review of the literature.
Results:
An 81-year-old man was referred for asymptomatic bilateral conjunctival masses that on biopsy revealed a proliferation of mature CD4 + lymphocytes associated with T-cell receptor γ gene rearrangement. The histopathology and immunophenotypic profile in the absence of disease elsewhere bore resemblance to primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder.
Conclusions:
In 2016, the World Health Organization reclassified primary cutaneous CD4+ small/medium T-cell lymphoma to a lymphoproliferative disorder because neither dissemination nor death had been documented. This case displays similarities with the latter but has nonconforming features. Multicentric clonal expansion of T cells do not inevitably indicate lymphoma. Lymphoproliferative disorders that display features of reactive hyperplasia and lymphoma and are not easily classified need to be carefully monitored.
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