Steven Leibowitz, MD
  • 100 UCLA Medical Plaza, Suite 747, Los Angeles, California,90024
    310-272-0808
  • 653 Town Center Drive, Suite 102, Las Vegas, Nevada,89144
    702-242-5555
  • 8641 Wilshire Blvd, Suite 312, Beverly Hills, California,90211
    310-272-0808
  • 5301 Truxton Avenue, Suite 200, Bakersfield, California,93309
    661-412-2322
  • 299 N. Pecos Road, Henderson, Nevada,89074
    702-242-5555
Procedures

Orbital Tumors - Lymphoma

General

  • almost exclusively in adults
  • continuum including benign reactive lymphoid hyperplasia (pseudolymphoma) to atypical lymphoid hyperplasia to low-grade then high grade malignant lymphoma;
  • also Orbital inflammatory syndrome pseudotumorplasmacytoma (including myeloma)
  • bimodal peak 30’s and 60’s
  • unilateral or bilateral
  • palpable rubbery mass fixed to orbital rim
  • maligant lymphoma & reactive lymphoid hyperplasia cause gradual (over a year or more) progressive, painless proptosis (vs. Obital inflammatory syndrome), lacrimal enlargement
  • usually on conjunctiva, anterior orbit so palpable or visible
  • eyelid or bilateral orbital involvement suggests systemic disease
  • putty-like molding to undisplaced tissues so little Visual Acuity (VA) or EOM loss; usually no bone erosion or infiltration unless high-grade lymphoma
  • lymphoma in retrobubar fat is infiltrative

Imaging

  • all patients w/ orbital lymphoid lesions need exam for systemic lymphoma (by oncology) with orbital, abdominal, chest CT;
    • CBC
    • bone marrow biopsy
    • chest x-ray (CXR)
    • bone/liver/spleen scan

Pathology

  • cytologic factors are more prognostic than mono/polyclonal; but
    • most benign lesions (reactive hyperplasia) are usually mostly T cells with polyclonal Bs;
    • malignant lymphoma usually more monoclonal B cells
  • both polyclonal and monoclonal varieties can develop systemic disease
  • open biopsy for path to give fresh tissue for touch preps; immunohistochemistry; flow cytometry; and gene rearrangement studies; in formalin for micro; gluteraldehyde for electron microscopy

Treatment & Course

  • X-Ray Therapy (XRT) for most orbital lymphoid lesions that are confined to orbit (50% of lymphomas)
  • Chemotherapy for systemic, therapy can be controversial
  • Course
    • up to 25% of patients have systemic lymphoma later on with benign reactive hyperplasia:
    • 40% of patients get systemic involvlement within 5 years with atypical lymphoid hyperplasia:
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