Salmon patch conjunctival lesion

It is important for ophthalmologists to recognize the characteristics of ocular surface tumors and to have an understanding of their management. Eye examination revealed a salmoncolored raised lesion involving supranasal bulbar conjunctiva extending to superior fornix of the left eye. Jun 22, 2018 a conjunctival cyst is a cyst on your conjunctiva, which is a clear membrane covering your outer eye. Conjunctival melanoma conjunctival melanoma an episcleral nodule of conjunctival melanoma arrow. Diagnosis and management of malignant tumors of the eye. Multiple myeloma manifesting as a salmon patch conjunctival mass. This mass is clinically consistent with a lymphoma. Bulbar involvement is more common, usually more easily recognized, and is associated with a better prognosis than malt lymphoma of the palpebral conjunctiva. Physical examination revealed the presence of a pink salmonpatch. They typically have an indolent course presenting with a salmon pink patch in the bulbar conjunctiva. This may even be true after the patch has seemed to have disappeared. In our case, a salmon patch conjunctival tumor was biopsied and confirmed to be a benign complex choristoma.

Conjunctival lymphoma is an ocular surface tumor that usually appears as a painless. Collaboration between multiple disciplines is key in the advancement of the field. Most patients notice the reddish discoloration of the surface of the eyeball conjunctiva. Top a salmon patch conjunctival mass was noted in the temporal bulbar conjunctiva of left eye. The lesions of diffuse large b cell lymphoma may have a grayish coloration. Conjunctival salmon patch is a typical ocular surface ophthalmological sign with a distinct set of differential diagnoses, including most often ocular adnexal lymphoma.

A complex choristoma presenting as a salmon patch lesion in. The colour can be from pale to brown to a dark black. On exam, conjunctival lesions are classically described as salmon patch fleshy lesions. To report clinical, histopathological and molecular features of salmon patchlike conjunctival lesions in paediatric and adolescent patients, and discuss management of. Jul 27, 2017 salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. Conjunctival malt lymphoma characteristically manifests as a painless fleshycoloured salmonpatch lesion arising from the fornix. This opinion may be due to the great rarity of the lesion, to the lack of repeated biopsy studies, or to the fact that there is insufficient time to observe such cases.

Diagnosis and management of malignant tumors of the eyelid, conjunctiva, and orbit. The clinical impression of the average ophthalmologist is that this type of conjunctival lesion is of a benign character. Multiple myeloma manifesting as an ocular salmon patch a. An excisional biopsy was performed utilizing a notouch technique, given the possibility of a malignant lesion, with removal of the conjunctival tumor and placement of an amniotic membrane graft. This smooth, multilobulated mass can resemble follicular or papillary conjunctivitis. Classification, diagnosis, and management of conjunctival. An unusual presentation of pediatric conjunctival mucosa. Follicular lymphomas represent a small percentage of ocular adnexa lymphomas, particularly in japan.

To the best of our knowledge, this is the first pediatric case of conjunctival malt lymphoma diagnosed in the absence of a salmonpatch lesion. In the past, a cosmetic cover was the best advice for those affected, but now many can be successfully removed or their appearance improved by laser treatment. Here we report a case of conjunctival lymphoma in a young woman complicated by pregnancy. With a 30% mortality rate and an ability to easily metastasize, conjunctival melanoma is one of the most feared lesions a person can have, dr. In this report, the salmon patch conjunctival mass was an initial manifestation of multiple myeloma, but based on the results of bone marrow biopsy, and hematologic and image tests, the patient had an advanced multiple myeloma and poor prognosis. Conclusion conjunctival malt lymphoma presents in various ways, not only with the salmonpatch appearance. To report clinical, histopathological and molecular features of salmon patchlike conjunctival lesions in paediatric and adolescent patients, and discuss management of these patients and outcome. Conjunctival lymphoma is the second most common ocular adnexal tumor and generally manifests as a salmon pink patch on the fornix of the eye. These lesions are fleshy and often originate the fornix or adjacent to the limbus. Lymphoma of the conjunctiva new york eye cancer center.

Conjunctival nevus is usually a discrete, mobile lesion on the bulbar conjunctiva, most often in the interpalpebral area. These data, from an ocular tertiary referral center, suggest that conjunctival tumors in children are nearly always benign. Conjunctival melanoma conjunctival melanoma in a african american. Conjunctiva lymphoma may appear as a diffuse, slightly elevated pink mass, termed salmon patch. Classification, diagnosis, and management of conjunctival lymphoma. Common conjunctival lesions olivier continuing medical. Conjunctival malt lymphoma characteristically manifests as a painless fleshycoloured salmonpatch lesion arising from the fornix 6. Bottom heavy myeloma cells with eccentric nuclei and basophilic cytoplasm infiltrated in the underlying conjunctival stroma arrow.

Slit lamp image of right eye with salmon patch conjunctival lesion in the superior temporal conjunctiva. Marginal zone bcell lymphoma malttype lymphoma is the most frequent subtype identified on biopsy and immunohistochemical studies. The study concludes that conjunctival malt lymphoma presents in various ways, so biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the typical appearance of malt lymphoma. Investigation of refractory follicular conjunctival lesions. A complex choristoma presenting as a salmon patch lesion. Physical examination revealed the presence of a pink salmon patch involving her left medial conjunctiva. The most classic location for conjunctival lymphoma is the inferior fornix, although involvement in the superior fornix or elsewhere is not uncommon figure 4. The study concludes that conjunctival malt lymphoma presents in various ways, so biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the. A conjunctival cyst is a cyst on your conjunctiva, which is a clear membrane covering your outer eye. Salmonpatchlike conjunctival lesions are rare in the paediatricadolescent population.

Sickle cell retinopathy is an ocular manifestation of the spectrum of sickle cell disease, an inherited group of hemoglobinopathies with numerous systemic and ocular presentations. Conjunctiva is the primary site of involvement in onethird of cases. Casting a net to diagnose, treat cancerous lesions. A case of conjunctival follicular lymphoma mimicking. Case study a case of conjunctival follicular lymphoma. Ultrasound can be used to assess the depth of the lesion and scleral invasion. Conjunctival argyrosis conjunctival argyrosis conjunctival pigmentation due to drops containing a silver solution. If it causes irritation or if there is suspicion of malignant change, it should be excised. Conditions that may simulate pigmented conjunctival tumors include drug and metal deposits, mascara, foreign bodies, postinflammatory melanoses, and flat pigmentary patches from systemic conditions such as addisons disease. Salmon patch is the name given to a very common group of birthmarks seen in babies. Conjunctival lymphoma cl typically develops as a painless patch that is salmon pink in colour. The birthmarks are caused by expansions dilations in tiny blood vessels called capillaries.

Salmon patches require no treatment, whilst treatment of port wine stains depends on the body site, extent and nature of the lesion. Another presentation is that of a chronic follicular conjunctivitis fig. Diagnosis and treatment of conjunctival lymphoma american. Clinical features differentiating benign from malignant conjunctival tumors in children jama ophthalmol 2017 jan 26. Conjunctival lymphoma classically manifests as a pink salmoncolored, smoothsurfaced subconjunctival mass, sometimes with feeder vessels figure 2. Histopathologic diagnosis may be required to distinguish between various entities. As the tumor enlarges, patients seek medical attention.

Hemoglobin is an iron containing protein in red blood cells that transports oxygen. A type 2 excludes note represents not included here. Epub ahead of print, cl shields, k sioufi, ae alset, ns boal, mg casey, an knapp, ja sugarman, ma schoen, ps gordon, ea say, ja shields from medlinepubmed, a database of the u. Conjunctival extranodal marginal zone lymphoma is rare but should be considered in the differential diagnosis of a pink salmon patch. We present a case of a 47yearold hispanic woman who presented with left eye itching and irritation associated with a painless pink mass.

They typically have an indolent course presenting with a salmonpink patch in the bulbar conjunctiva. The differential diagnosis for such lesions in this age group includes mainly rlh and conjunctival lymphoma, of which the former is more common. The lesion often has a color similar to salmon, hence the term salmon patch. Conjunctival malt usually presents with mild symptoms of redness, irritation and photophobia. In melanoma, the epithelium is usually thin, and a subepithelial lesion is present. Because they are collections of blood vessels in the skin, they tend to look darker or redder when a baby is crying, excited, or upset. The ocular tumor was treated successfully with external beam radiotherapy. There was no relapse of the bulbar conjunctival lesions, but the patient died after initial diagnosis, following therapy resistance. This cyst often looks like a clear bubble on the surface of the eye. We report a 68yearold female patient who presented with a salmon pink patch like lesion of the left conjunctiva, suspected of being malt lymphoma. The naevus is a discrete, flat or slightly elevated sessile lesion. When a salmon patch occurs on the face, it is often called an angel kiss, and when it occurs on the back of the neck, it is known as a stork bite. B conjunctival lesions disappeared at the end of the first course of mogamulizumab. Recurrence of disseminated disease was heralded by salmon patch involvement of the conjunctiva.

If misdiagnosed as chronic conjunctivitis initially, biopsy should be considered if unresponsive to conventional therapies. Conjunctiva, conjunctival tumor, extranodal marginal zone lymphoma, lymphoma, optical coherence tomography, salmon patch background. Feeder vessels and rapid growth are not typically seen in lymphoma. The differential diagnosis for an elevated salmoncolored conjunctival patch most commonly includes benign lymphoid hyperplasia and conjunctival lymphoma. Paediatric and adolescent elevated conjunctival lesions in. Conjunctival tumors are difficult to distinguish clinically, and a differential diagnosis often includes the possibility of a malignancy. A conjunctival lymphoid tumor is classically described as having a salmon patch appearance clinically. Conjunctival lymphoma conjunctival lymphoma salmon patch.

Objective to report clinical, histopathological and molecular features of salmon patchlike conjunctival lesions in paediatric and adolescent patients, and discuss management of these patients and outcome. The small cohort of malignant lesions precluded determining if these features were independent of one another. In cases of follicular lesions responding poorly to topical steroids, a conjunctival malt. Dec 20, 2017 ocular surface tumors are rare but potentially deadly diseases of the conjunctiva andor cornea. The lesion disappeared after radiation at the dosis of 2 gy per session totaling 24 gy while wearing protective prosthesis.

Conjunctival malt lymphoma presents in various ways, not only with the salmon patch appearance. We suggest that multiple myeloma be included in the differential diagnosis of a salmon patch conjunctival lesion. What is the differential diagnosis of this condition. The patient then developed a small patch like lesion on the conjunctiva. The clinical presentation of conjunctival malt lymphomas is non. Differentiating benign vs malignant conjunctival tumors in. Westcott scissors are used to make an incision through the conjunctiva overlying the lesion. Superior and inferior fornices should be carefully examined to detect occult lesions. Sixty percent of conjunctival melanomas arise from primary acquired melanosis pam and 20% from nevi. Unilateral conjunctival infiltration of adult tcell.

However, histologic and immunohistologic examinations were consistent with follicular lymphoma. Nevi represent more than 50 percent of conjunctival lesions and are the most benign of the pigmented lesions. The patient population usually includes young to middle aged adults and the presenting sign is usually chronic redness 3. Please note salmoncolored raised lesion involving nasal bulbar conjunctiva extending to superior fornix. It may become more pigmented with time and this change is misinterpreted by the patient, and. Management of conjunctival pigmented lesions by optometrist. He associated the lesion with the onset of a red eye and episodic foreign body. Therefore, biopsy should be considered if suspicion is raised, even though the conjunctival lesion does not exhibit the typical appearance of malt lymphoma. A glistening salmon patch lesion in the bulbar conjunctiva. Conjunctival lymphoma is most commonly a primary neoplasm, although 10 to 30 percent are secondary tumors in patients with disseminated lymphoma 3. They note that bilateral ocular manifestations were more common in patients with follicles compared with patients presenting the salmonpatch appearance.

Aug 28, 2014 conjunctival extranodal marginal zone lymphoma is rare but should be considered in the differential diagnosis of a pink salmon patch. May 15, 2019 brlh and lymphoma are on opposite ends of the spectrum, with brlh appearing clinically as a localized salmon patch and histopathologically benign whereas lymphoma also appears as a salmon patch but with more aggressive histopathologic features, with mitotic activity and classified as malignant. While benign, complex choristomas are grossly indistinguishable from malignant. Purpose we describe a rare case of a complex choristoma appearing as a salmonpatch lesion in the nasal conjunctiva. Macroscopic findings revealed a right conjunctival lesion of a tan irregular papulae appearance 4.

The etiology is unknown but is thought to be due to chronic inflammation. Ocular adnexal lymphomas constitute 2% of nonhodgkin lymphoma case and up to onethird of them occur in patients with disseminated lymphoma. A complex choristoma presenting as a salmon patch lesion in the. Oct applications in conjunctival disease intechopen. The photograph shows a pink raised conjunctival lesion with an. This video demonstrates biopsy of a salmon patch lesion under the inferior medial portion of the conjunctiva. Although it generally has a smooth surface, it can also appear as a multinodular lesion or as follicular conjunctivitis fig. Distinct clinical clues may be suggestive of a subtype, such as emzl demonstrating a mobile, nonlobulated salmonpink patch or follicular lymphoma demonstrating a multinodular appearance. The usual localization is at the fornix, usually hidden by the eyelid in the superior and inferior quadrants and not in the horizontal exposed parts of the bulbar conjunctiva or the limbus. The size of conjunctival lesion was approximately 10 mm. Conjunctival lymphoma is an ocular surface tumor that usually appears as a painless, salmonpink, fleshy patch. Salmon patch is the typical clinical presentation of conjunctival lymphoma, and, unlike orbital lymphoma, such conjunctival lesions rarely present as blepharoptosis 2, 12. A salmon patch like appearance observed in left conjunctiva. Conjunctival pigmented lesions college of optometrists.

It commonly occurs in the forniceal conjunctiva, appearing. In summary, a salmon patch conjunctival mass is a manifestation of multiple myeloma. Clinical recognition of salmon patch infiltrate requires the consideration of a number of factors, and it is the first important step in diagnosing and managing conjunctival lymphoproliferative lesions including marginal zone bcell lymphoma. Sections of this conjunctival biopsy were examined at a microscopic level and with numerous lymphoid immunohistochemical stains showed a solid lympho.