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Douglas RS, Goldstein
SM, Katowitz JA, Gausas RE, Ibarra MS, Tsai D, Sharma
A, Nichols C.
Department of Ophthalmology, University
of Pennsylvania, Philadelphia 19104, USA.
OBJECTIVE: To describe a small series of
patients with orbital presentation of
posttransplantation lymphoproliferative disorder (PTLD).
DESIGN: Retrospective, interventional case
series.
PARTICIPANTS: Three patients with orbital
presentation of histologically diagnosed PTLD. METHODS: Review
of medical records.
MAIN OUTCOME MEASURES: Measured parameters
included vision, proptosis, and tumor extent.
RESULTS: Three cases of orbital PTLD are
described. In two of the cases, the tumor initially demonstrated
orbital signs and symptoms, whereas in the third case, orbital
and systemic signs were synchronous. Two of three patients
had disseminated disease discovered at the time of presentation.
One adult patient had synchronous presentation of PTLD in
the orbit and prostate. One pediatric patient had tumor dissemination
to the liver at the time of presentation. The PTLD tumors
were classified histologically as diffuse large cell lymphoma
of monomorphic or immunoblastic type in all three cases. Treatment
included local irradiation, decreased immunosuppression, and
antilymphocyte monoclonal antibodies.
CONCLUSIONS: Orbital presentation is a rare
manifestation of PTLD. However, ophthalmologists must consider
this diagnosis carefully in organ transplant recipients with
subtle orbital signs and symptoms at presentation. Early detection
may alter prognosis. In each case presented, the diagnosis
was established via lesion biopsy and subsequent histologic
or flow cytometric evaluation, or both.
Ophthalmology. 2002 Dec;109(12):2351-5.
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