Korean researchers recently conducted a retrospective chart review of 199 patients who underwent conjunctival biopsy on suspicion of lymphoproliferative disease. They were looking to better understand the clinical manifestations of conjunctival lymphoma and clarify their associations with diagnostic markers and long-term prognosis. While most patients presented with typical findings, a surprising number had atypical features, the study found.

In total, 261 specimens were studied. The proportion ultimately diagnosed with mucosa-associated lymphoid tissue (MALT) lymphomas was 58.2%. In these patients, the researchers found that the most common slit lamp findings were the ‘salmon-patch’ appearance (73.7%), a follicular distribution (14.5%) and a nodular or subconjunctival mass (6.6%). They note that bilateral ocular manifestations were more common in patients with follicles compared with patients presenting the salmon-patch appearance.

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.” In cases of follicular lesions responding poorly to topical steroids, a conjunctival MALT lymphoma may be suspected, given that chronic inflammation may precede neoplasia in patients with extranodal marginal zone lymphoma.

Jung SK, Paik JS, Park GS, et al. Refractory follicular conjunctival lesions: overlook as just inflammation or not? Br J Ophthalmol. February 1, 2019. [Epub ahead of print].