Erfolgreiche Bestrahlung eines periokulären Lymphomes

Background: MALT (mucosa associated lymphoma tissues) reveal specific histological specifications, such as cells like B-lymphocytes with circular structure, B-lymphocytes in the epithelium and a region of larger B-lymphocytes, from the centre to the epithelium. The difference between local and systemic infiltration of tissue is important, and hence MALT must be diagnosed via an interdisciplinary approach. Patient: A 45-year old female patient presented initially to our institution in December 1997. She complained of swelling and redness of her upper eyelid which had developed during the last 9 months. Additionally, her visual acuity in the involved eye had decreased steadily over the last 6 months. Ophthalmological examination revealed a swollen right upper eyelid associated with bilateral salmon-coloured conjunctival lesions of the inferior fornices. Additionally, there was a serous detachment of the neurosensory retina in the peripapillary area of the right eye. Systemic work-up including biopsy of the ocular lesions revealed the presence of a localised B-cell lymphoma of the MALT type. Initial treatment with topical and systemic steroids resulted only in a temporary improvement of signs and symptoms. Another treatment trial with steroids was unsuccessful and radiotherapy was therefore performed. Radiotherapy resulted in a complete remission and no signs of recurrent disease during a follow-up period of 4 years. Conclusions: In patients with isolated MALT lymphomas of the periocular regions radiation may be a successful treatment modality. Side effects as observed in former radiation procedures can be avoided by state-of-the-art treatment modalities. Treatment with steroids may be associated with merely temporary improvement of signs and symptoms. In these patients an interdisciplinary approach utilizing ophthalmology, internal medicine, pathology and radiology is imperative.