Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility...Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility disorders (diarrhea, constipation). The clinical presentation can also be alarming with rectal bleeding and obstructive symptoms that may be misinterpreted as a neoplastic process. In this paper, we report the case of a 58-year-old female patient with a previous history of appendicetomy. She presented with persistent abdominal pain, chronic constipation and black colored stools, following Covid-19 infection. The physical examination was unremarkable. Colonoscopy examination found a bulging, non-ulcerated mass, measuring 3.5 cm in greatest dimension, located at the right colic angle. Thoraco-abdomino-pelvic computed tomography was performed and showed right colonic wall thickening and enhanced nodule formation. Furthermore, metastatic localization was not detected. After a multidisciplinary meeting, a laparotomy with right hemicolectomy was performed. Histopathological examination of the surgical specimen revealed nodular lymphoid hyperplasia with CD20+, CD5−, CD10+ and BCL2−phenotype on immunohistochemistry. Besides, lymphocytes in interfollicular area are CD3+ T cells. Patient outcome was favorable after surgery and no additional treatment was necessary. Nodular lymphoid hyperplasia of the colon is a benign process whose endoscopic appearance can sometimes raise suspicion of malignancy. The diagnosis can only be established by histological evaluation. Immunohistochemistry is also essential to confirm the diagnosis and to rule out low-grade lymphoma. Clinical evolution is often favorable. However, endoscopic follow-up is necessary in all cases.展开更多
BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CA...BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver.The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy.However,histopathological analysis revealed RLH.The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging.On diffusion-weighted imaging(DWI),we encountered linear hyperintensity along the portal tract consecutive to the liver lesion,which is a new characteristic radiologic finding.This finding corresponded to the lymphoid cell infiltration of the portal tract.Furthermore,there was strongly restricted diffusion on the apparent diffusion coefficient map.We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.展开更多
We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the liver.She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological an...We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the liver.She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological analysis revealed RLH.The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging,which could be a useful clue for identifying RLH in the liver.Histologically,the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.展开更多
Reactive lymphoid hyperplasia(RLH) of the liver is an extremely rare lesion characterized by the proliferation of non-neoplastic lymphocytes forming follicles.Hepatic RLH is known to be associated with gastrointestina...Reactive lymphoid hyperplasia(RLH) of the liver is an extremely rare lesion characterized by the proliferation of non-neoplastic lymphocytes forming follicles.Hepatic RLH is known to be associated with gastrointestinal carc inoma and autoimmune diseases including primary biliary cirrhosis(PBC).We report a case of hepatic RLH in a patient with PBC and gastric cancer.A 68 year old Japanese woman with a 10 year history of liver enzyme abnormality was admitted.Laboratory testing revealed that her anti-mitochondrial antibody was markedly elev ated.Five mo after the diagnosis of PBC,she was foun d to have gastric cancer.Abdominal computed tom og raphy disclosed a liver nodule in S8,suggesting metas tatic gastric carcinoma.Histopathologically,the resected liver lesion comprised of a nodular proliferation of small lym phocytes with lymphoid follicles.This is the first reported case of hepatic RLH in a patient with both PBC and gastric cancer.Pre-operative diagnosis of hepatic RLH by clinical imaging is extremely difficult.Therefore,a need le biopsy could be useful to make a diagnosis of hepat ic RLH,especially to differentiate from metastatic gastroin t estinal carcinoma.展开更多
Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of multiple small nodules, normally between between 2 and 10 mm in diameter, distributed along the small intestine(more often...Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of multiple small nodules, normally between between 2 and 10 mm in diameter, distributed along the small intestine(more often), stomach, large intestine, or rectum. The patho-genesis is largely unknown. It can occur in all age groups, but primarily in children and can affect adults with or without immunodeficiency. Some patients have an associated disease, namely, common variable immu-nodeficiency, selective IgA deficiency, Giardia infection, or, more rarely, human immunodeficiency virus infec-tion, celiac disease, or Helicobacter pylori infection. Nodular lymphoid hyperplasia generally presents as an asymptomatic disease, but it may cause gastrointes-tinal symptoms like abdominal pain, chronic diarrhea, bleeding or intestinal obstruction. A diagnosis is made at endoscopy or contrast barium studies and should be confirmed by histology. Its histological characteristics include markedly hyperplasic, mitotically active germi-nal centers and well-defined lymphocyte mantles found in the lamina propria and/or in the superficial submu-cosa, distributed in a diffuse or focal form. Treatment is directed towards associated conditions because the disorder itself generally requires no intervention. Nodu-lar lymphoid hyperplasia is a risk factor for both intes-tinal and, very rarely, extraintestinal lymphoma. Someauthors recommend surveillance, however, the duration and intervals are undefined.展开更多
Objective To detect whether Epstein Barr virus (EBV) harbors in nasopharyngeal lymphoid hyperplasia (NPLH) which is frequently to be seen in Guangzhou, a high incidence area of nasopharyngeal carcinoma (NPC), ...Objective To detect whether Epstein Barr virus (EBV) harbors in nasopharyngeal lymphoid hyperplasia (NPLH) which is frequently to be seen in Guangzhou, a high incidence area of nasopharyngeal carcinoma (NPC), and to explore the relation between NPLH and development of NPC Methods Twenty four 10% formalin fixed, paraffin embedded biopsies oef patients with NPLH and elevated serum IgA antibody titer (≥1∶20) against viral capsid antigen of EB virus (IgA/VCA) were collected from the archives of the Department of Pathology, Sun Yat sen University of Medical Sciences during the period of January to June, 1993 PCR plus Southern blotting hybridization for detection of EBV DNA W fragment and in situ hybridization for detection of EB virus encoded small RNAs (EBERs) were performed All the patients were followed up more than 5 years Results Twenty two of 24 (91 7%) NPLH tissues contained EBV DNA A few definitely EBERs positive B lymphocytes could be found in 17 out of 24 specimens (70 8%) Neither NPC nor any EBV associated malignancies were developed in all of these 24 patients up to date Conclusion Most of the NPLH tissues taken from the patients with an elevated serum IgA/VCA titer carry EBV, which is harbouring in the nuclei of a few infiltrating and hyperplastic B lymphocytes The NPLH without epithelial dysplasia can not be recognized as a precancerous lesion, and EBV infection in these lesions is not an important event, having no substantial significance in development of NPC展开更多
Background:Conjunctival lymphoma,conjunctival amyloidosis and benign reactive lymphoid hyperplasia(BRLH)are conditions that often have a similar appearance on the ocular surface.The use of high resolution anterior seg...Background:Conjunctival lymphoma,conjunctival amyloidosis and benign reactive lymphoid hyperplasia(BRLH)are conditions that often have a similar appearance on the ocular surface.The use of high resolution anterior segment optical coherence tomography(HR-OCT)enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions.In this study,we characterize the morphological differences seen in conjunctival lymphoma,conjunctival amyloidosis and BRLH on HR-OCT imaging.Methods:A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma,conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute.Patients were excluded if HR-OCT imaging was not performed on initial presentation.Results:Thirty-four total eyes of 27 patients were identified.Twenty eyes had conjunctival lymphoma(16 patients),8 eyes had conjunctival amyloidosis(6 patients)and 6 eyes had BRLH(5 patients).All conditions appeared clinically as pink,red or yellow subepithelial lesions but had different features on HR-OCT.In lymphoma,HR-OCT images typically showed homogenous,dark subepithelial lesions with smooth borders,containing monomorphic dot-like infiltrates.HR-OCT images of amyloidosis typically showed heterogeneous,dark lesions with irregular borders,often containing hyperreflective linear infiltrates.HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue,at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective,subepithelial tissue.Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions.Conclusions:Distinctive features on HR-OCT of conjunctival lymphoma,conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination.Future studies can further validate this technology’s use with more subtle and challenging lesions.展开更多
Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk o...Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.展开更多
BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are l...BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.展开更多
Purpose:To determine whether the use of polymerase chain reaction for B-cell gene rearrangement in patients with orbital lymphoid infiltrate disorders could be useful in the diagnosis of lymphoma,especially,in differe...Purpose:To determine whether the use of polymerase chain reaction for B-cell gene rearrangement in patients with orbital lymphoid infiltrate disorders could be useful in the diagnosis of lymphoma,especially,in differentiating benign lesion from malignant one.Methods:In addition to clinical,pathological,and immunohistochemical evaluations,48 cases of orbital lymphoid infiltrate disorders were examined for immunoglobulin heavy(IgH)gene rearrangement by means of PCRto amplify the FR3region with formalin-fixed and paraffin-embedded tissues.Results:Gene rearrangement in the third frame-work of the IgH region was detected in specimens obtained from15cases of malignant lymphoma,4of reactive lymphoid hyperplasia and3of orbital pseudotumor.All of these patients showed a discrete band(100bp)which reflected monoclonal proliferation of B lymphocytes.5cases of malignant lymphoma,6ofreactive lymphoid hyperplasia and 15of orbital pseudotumor did not show a discrete band on PCR.Conclusions:The FR3 region gene rearrangement of Ig heavy in patients with orbital lymphoid infiltrate disorders may be an additional diagnostic tool in differentiating benign from malignant lymphoid diseases and in offering a useful adjunct for diagnosis in difficult or unclear cases.It is a reliable and practical method of gene diagnosis in orbital lymphoid infiltrate disorders and helps to identify the molecular mechanism of malignant lymhoma.Eye Science2000;16:15-21.展开更多
文摘Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility disorders (diarrhea, constipation). The clinical presentation can also be alarming with rectal bleeding and obstructive symptoms that may be misinterpreted as a neoplastic process. In this paper, we report the case of a 58-year-old female patient with a previous history of appendicetomy. She presented with persistent abdominal pain, chronic constipation and black colored stools, following Covid-19 infection. The physical examination was unremarkable. Colonoscopy examination found a bulging, non-ulcerated mass, measuring 3.5 cm in greatest dimension, located at the right colic angle. Thoraco-abdomino-pelvic computed tomography was performed and showed right colonic wall thickening and enhanced nodule formation. Furthermore, metastatic localization was not detected. After a multidisciplinary meeting, a laparotomy with right hemicolectomy was performed. Histopathological examination of the surgical specimen revealed nodular lymphoid hyperplasia with CD20+, CD5−, CD10+ and BCL2−phenotype on immunohistochemistry. Besides, lymphocytes in interfollicular area are CD3+ T cells. Patient outcome was favorable after surgery and no additional treatment was necessary. Nodular lymphoid hyperplasia of the colon is a benign process whose endoscopic appearance can sometimes raise suspicion of malignancy. The diagnosis can only be established by histological evaluation. Immunohistochemistry is also essential to confirm the diagnosis and to rule out low-grade lymphoma. Clinical evolution is often favorable. However, endoscopic follow-up is necessary in all cases.
文摘BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver.The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy.However,histopathological analysis revealed RLH.The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging.On diffusion-weighted imaging(DWI),we encountered linear hyperintensity along the portal tract consecutive to the liver lesion,which is a new characteristic radiologic finding.This finding corresponded to the lymphoid cell infiltration of the portal tract.Furthermore,there was strongly restricted diffusion on the apparent diffusion coefficient map.We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.
文摘We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the liver.She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological analysis revealed RLH.The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging,which could be a useful clue for identifying RLH in the liver.Histologically,the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.
文摘Reactive lymphoid hyperplasia(RLH) of the liver is an extremely rare lesion characterized by the proliferation of non-neoplastic lymphocytes forming follicles.Hepatic RLH is known to be associated with gastrointestinal carc inoma and autoimmune diseases including primary biliary cirrhosis(PBC).We report a case of hepatic RLH in a patient with PBC and gastric cancer.A 68 year old Japanese woman with a 10 year history of liver enzyme abnormality was admitted.Laboratory testing revealed that her anti-mitochondrial antibody was markedly elev ated.Five mo after the diagnosis of PBC,she was foun d to have gastric cancer.Abdominal computed tom og raphy disclosed a liver nodule in S8,suggesting metas tatic gastric carcinoma.Histopathologically,the resected liver lesion comprised of a nodular proliferation of small lym phocytes with lymphoid follicles.This is the first reported case of hepatic RLH in a patient with both PBC and gastric cancer.Pre-operative diagnosis of hepatic RLH by clinical imaging is extremely difficult.Therefore,a need le biopsy could be useful to make a diagnosis of hepat ic RLH,especially to differentiate from metastatic gastroin t estinal carcinoma.
文摘Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of multiple small nodules, normally between between 2 and 10 mm in diameter, distributed along the small intestine(more often), stomach, large intestine, or rectum. The patho-genesis is largely unknown. It can occur in all age groups, but primarily in children and can affect adults with or without immunodeficiency. Some patients have an associated disease, namely, common variable immu-nodeficiency, selective IgA deficiency, Giardia infection, or, more rarely, human immunodeficiency virus infec-tion, celiac disease, or Helicobacter pylori infection. Nodular lymphoid hyperplasia generally presents as an asymptomatic disease, but it may cause gastrointes-tinal symptoms like abdominal pain, chronic diarrhea, bleeding or intestinal obstruction. A diagnosis is made at endoscopy or contrast barium studies and should be confirmed by histology. Its histological characteristics include markedly hyperplasic, mitotically active germi-nal centers and well-defined lymphocyte mantles found in the lamina propria and/or in the superficial submu-cosa, distributed in a diffuse or focal form. Treatment is directed towards associated conditions because the disorder itself generally requires no intervention. Nodu-lar lymphoid hyperplasia is a risk factor for both intes-tinal and, very rarely, extraintestinal lymphoma. Someauthors recommend surveillance, however, the duration and intervals are undefined.
文摘Objective To detect whether Epstein Barr virus (EBV) harbors in nasopharyngeal lymphoid hyperplasia (NPLH) which is frequently to be seen in Guangzhou, a high incidence area of nasopharyngeal carcinoma (NPC), and to explore the relation between NPLH and development of NPC Methods Twenty four 10% formalin fixed, paraffin embedded biopsies oef patients with NPLH and elevated serum IgA antibody titer (≥1∶20) against viral capsid antigen of EB virus (IgA/VCA) were collected from the archives of the Department of Pathology, Sun Yat sen University of Medical Sciences during the period of January to June, 1993 PCR plus Southern blotting hybridization for detection of EBV DNA W fragment and in situ hybridization for detection of EB virus encoded small RNAs (EBERs) were performed All the patients were followed up more than 5 years Results Twenty two of 24 (91 7%) NPLH tissues contained EBV DNA A few definitely EBERs positive B lymphocytes could be found in 17 out of 24 specimens (70 8%) Neither NPC nor any EBV associated malignancies were developed in all of these 24 patients up to date Conclusion Most of the NPLH tissues taken from the patients with an elevated serum IgA/VCA titer carry EBV, which is harbouring in the nuclei of a few infiltrating and hyperplastic B lymphocytes The NPLH without epithelial dysplasia can not be recognized as a precancerous lesion, and EBV infection in these lesions is not an important event, having no substantial significance in development of NPC
基金Ronald and Alicia Lepke Grant,The Lee and Claire Hager Grant,The Jimmy and Gaye Bryan Grant,The H.Scott Huizenga Grant,The Grant and Diana Stanton-Thornbrough,The Robert Baer Family Grant,The Emilyn Page and Mark Feldberg Grant,The Gordon Charitable Foundation,The Jose Ferreira de Melo Grant,The Richard and Kathy Lesser Grant and The Richard Azar Family Grant(institutional grants),the Department of Veterans Affairs,Veterans Health Administration,Office of Research and Development,Clinical Sciences Research EPID-006-15S(Dr.Galor),R01EY026174(Dr.Galor)NIH Center Core Grant P30EY014801Research to Prevent Blindness Unrestricted Grant.
文摘Background:Conjunctival lymphoma,conjunctival amyloidosis and benign reactive lymphoid hyperplasia(BRLH)are conditions that often have a similar appearance on the ocular surface.The use of high resolution anterior segment optical coherence tomography(HR-OCT)enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions.In this study,we characterize the morphological differences seen in conjunctival lymphoma,conjunctival amyloidosis and BRLH on HR-OCT imaging.Methods:A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma,conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute.Patients were excluded if HR-OCT imaging was not performed on initial presentation.Results:Thirty-four total eyes of 27 patients were identified.Twenty eyes had conjunctival lymphoma(16 patients),8 eyes had conjunctival amyloidosis(6 patients)and 6 eyes had BRLH(5 patients).All conditions appeared clinically as pink,red or yellow subepithelial lesions but had different features on HR-OCT.In lymphoma,HR-OCT images typically showed homogenous,dark subepithelial lesions with smooth borders,containing monomorphic dot-like infiltrates.HR-OCT images of amyloidosis typically showed heterogeneous,dark lesions with irregular borders,often containing hyperreflective linear infiltrates.HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue,at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective,subepithelial tissue.Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions.Conclusions:Distinctive features on HR-OCT of conjunctival lymphoma,conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination.Future studies can further validate this technology’s use with more subtle and challenging lesions.
文摘Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.
文摘BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.
文摘Purpose:To determine whether the use of polymerase chain reaction for B-cell gene rearrangement in patients with orbital lymphoid infiltrate disorders could be useful in the diagnosis of lymphoma,especially,in differentiating benign lesion from malignant one.Methods:In addition to clinical,pathological,and immunohistochemical evaluations,48 cases of orbital lymphoid infiltrate disorders were examined for immunoglobulin heavy(IgH)gene rearrangement by means of PCRto amplify the FR3region with formalin-fixed and paraffin-embedded tissues.Results:Gene rearrangement in the third frame-work of the IgH region was detected in specimens obtained from15cases of malignant lymphoma,4of reactive lymphoid hyperplasia and3of orbital pseudotumor.All of these patients showed a discrete band(100bp)which reflected monoclonal proliferation of B lymphocytes.5cases of malignant lymphoma,6ofreactive lymphoid hyperplasia and 15of orbital pseudotumor did not show a discrete band on PCR.Conclusions:The FR3 region gene rearrangement of Ig heavy in patients with orbital lymphoid infiltrate disorders may be an additional diagnostic tool in differentiating benign from malignant lymphoid diseases and in offering a useful adjunct for diagnosis in difficult or unclear cases.It is a reliable and practical method of gene diagnosis in orbital lymphoid infiltrate disorders and helps to identify the molecular mechanism of malignant lymhoma.Eye Science2000;16:15-21.
