안구 부속기의 점막연관 림프조직형 림프종의 증례보고

MALT Lymphoma of Ocular Adnexa: A Case Report

  • 조정남 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 김융수 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 정찬민 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 서인석 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 조지웅 (한림대학교 의과대학 강남성심병원 외과학교실) ;
  • 박혜림 (한림대학교 의과대학 강남성심병원 해부병리학교실) ;
  • 최재구 (한강성심병원 성형외과학교실)
  • Cho, Jeong Nam (Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Kim, Yoong Soo (Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Chung, Chan Min (Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Suh, In Suck (Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Cho, Ji Woong (Department of General Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Hye Rim (Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Choi, Jae Gu (Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University Medical Center)
  • 투고 : 2008.01.22
  • 발행 : 2008.05.10

초록

Purpose: Lymphoma originated from mucosa associated lymphoid tissue(MALT) is most common in gastrointestinal system, and rarely found in salivary gland, thyroid, bronchus or orbit. We experienced a case of MALT lymphoma which was originated from conjunctiva and involving lower eyelid without metastasis. Methods: A 40-year-old man suffered palpable mass on right lower eyelid without pain. Orbital computed tomographic and ultrasonographic findings showed a conical mass($1.9{\times}1.2{\times}0.9cm$ size) inside lower eyelid. The mass was completely excised under local anesthesia and histopathological examination was followed. Results: Microscopic finding showed a multiple follicular colonization. In the follicle, small lymphocytes and plasma cells differentiated to centrocyte-like cell, monocyte B cell, plasma cell were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. After excision, SPECT, abdominal CT was carried out and there were no evidence of extraorbital disease. Conclusion: Biopsy and pathological examination should be performed in patients who complain palpable mass on lower eyelid because of possibility of MALT lymphoma. Although MALT lymphoma is rarely metastasized, it is necessary to evaluate the extraorbital involvement using SPECT or other radiologic exams. For detecting extraorbital involvement, periodic follow-up examination is need.

키워드

참고문헌

  1. Isaacson P, Wright DH: Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer 52: 1410, 1983 https://doi.org/10.1002/1097-0142(19831015)52:8<1410::AID-CNCR2820520813>3.0.CO;2-3
  2. White WL, Ferry JA, Harris NL, Grove AS Jr: Ocular adnexal lymphoma. A clinicopathologic study with identification of lymphomas of mucosa-associated lymphoid tissue type. Ophthalmology 102: 1994, 1995 https://doi.org/10.1016/S0161-6420(95)30764-6
  3. Cho YJ, Lim JH, Park KS: MALT(mucosa associated lymphoid tissue) type lymphoma of the ocular adnexa. J Korean Ophthalmol Soc 43: 357, 2002
  4. Knowles DM 2nd, Jakobiec FA: Ocular adnexal lymphoid neoplasms: clinical, histopathologic, electron microscopic and immunologic characteristics. Hum Pathol 13: 148, 1982 https://doi.org/10.1016/S0046-8177(82)80118-4
  5. Isaacson PG: Update on MALT lymphomas. Best Pract Res Clin Haematol 18: 57, 2005 https://doi.org/10.1016/j.beha.2004.08.003
  6. Knowles DM, Jacobiec FA, McNally L, Burke JS: Lymphoid hyperplasia and malignant lymphoma occurring in the ocular adnexa(orbit, conjunctiva, and eyelids): a prospective multiparametric analysis of 108 cases during 1977 to 1987. Hum Pathol 21: 959, 1990 https://doi.org/10.1016/0046-8177(90)90181-4
  7. Cahill M, Barnes C, Moriarty P, Daly P, Kennedy S: Ocular adnexal lymphoma-comparison of MALT lymphoma with other histological types. Br J Ophthalmol 83: 742, 1999 https://doi.org/10.1136/bjo.83.6.742
  8. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JKC, Cleary ML, Delsol G, De Wolf-Peeters C, Falini B, Catter KC, Grogan TM, Isaacson PG, Knowles DM, Mason DY, Muller-Hermelink HK, Pileri SA, Piris MA, Ralfkiaer E, Warnke RA: A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 84: 1361, 1994