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Eyelid lymphoma in a patient with a gold weight implant
Linfoma palpebral en paciente con implante de pesa de oro
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Di Nisio, J.O. Croxatto, M.C. Mansur, J.P. Aldecoa, D. Weil" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L.A." "apellidos" => "Di Nisio" "email" => array:1 [ 0 => "ldinisio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.O." "apellidos" => "Croxatto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.C." "apellidos" => "Mansur" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.P." "apellidos" => "Aldecoa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "D." "apellidos" => "Weil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Patología Oftalmológica, Fundación Oftalmológica Argentina Jorge Malbrán, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Byplast, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma palpebral en paciente con implante de pesa de oro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 566 "Ancho" => 750 "Tamanyo" => 63167 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tumoration @implant site, right eye.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinic case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">Male patient, 72, who presented with an exposure keratopathy in the right eye caused by lagophthalmos. History of tumor resection in the ipsilateral pontocerebellum angle (schwannoma). The patient underwent surgery for implanting a gold weight in the upper right eyelid.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Eight months later the patient presented with erythema and edema in the upper eyelid at the implant site (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Local and systemic antibiotics and anti-inflammatory medication was prescribed with partial response. Accordingly, incisional biopsy was taken that reported extranodal marginal area B cell lymphoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Following Oncohematology instructions, local radiotherapy was applied at a dose of 2000<span class="elsevierStyleHsp" style=""></span>cGy. Due to the persistence of slight inflammation it was decided to extract the gold weight. The material was referred to anatomopathological analysis that confirmed the proliferation of small, hyperchromatic nucleus lymphoid cells separated by edema and areas of cicatricial connective tissue necrosis caused by radiation. In areas less affected by radiation, middle size lymphocyte surfaces with slightly irregular nuclear contours were observed as well as Dutcher body morphology lymphocytes. Immunohistochemistry demonstrated that the cells were positive for CD20 and negative for CD5, CD10, CD23 and cyclin D1 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which led to the diagnostic of extranodal marginal area B-cell lymphoma.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The lesion resolved completely, without evidencing 3 years later any recurrence of the disease (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ocular adnexal lymphoma (OAL) represents between 11 and 20% of all orbital tumors and account for 34% of malign orbit tumors.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> The majority of lymphomas developing in this area are low grade B-cell lymphomas.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4,5</span></a> Overall, 78 of patients with OAL do not have history of lymphoma,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and the majority are identified at diagnostic. Radiotherapy is considered to be the most effective treatment in these cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The insertion of a gold weight implant in the upper eyelid after facial palsy was first described by Smellie in 1966,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and is a widely utilized method for treating lagophthalmos.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A range of complications have been reported such as implant migration and extrusion, infection, astigmatism, contact dermatitis<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> and noninfectious inflammation at the implant site.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Dinces et al. reported 6 patients who had a gold weight implanted and exhibited localized persistent inflammation which was resolved only with implant removal.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Bair et al. reported 3 patients with noninfectious inflammatory reaction between 3 and 12 months after implanting gold weights. Histopathology demonstrated intense chronic inflammatory infiltrate in the peri-prosthesis tissue, with lymphocyte predominance. These reactions seem to be an exaggerated lymphocytic response that could be caused by the gold weight implant.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Oral antibiotics with the first line of treatment for the patients who exhibited erythema and edema in the eyelid. Non-responding patients were prescribed corticoids (topical, subcutaneous or oral) or had to the implant extracted.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Even though hypersensitivity to gold is rare, there is an increase in the incidence of said sensitivity. In recent years, several cases of contact dermatitis or gold allergy have been reported after the insertion of a gold implant<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> in the upper eyelid for treating lagophthalmos caused by facial palsy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">It has been verified that different stimuli could play a role in the development of lymphoma although said stimuli vary with each patient, with the existence of some infections, inflammatory processes and the immunological condition of individuals.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> Lymphoma could develop in the mucosa-associated lymphoid tissue (MALT) acquired in the context of chronic inflammation and/or infectious or self immune inflammatory disorders.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, there is a widespread debate in the literature on the etiological factors of non-Hodgkin lymphoma (NHL). Even though the main factor causing NHL is not yet identified, it has been observed that some infectious, genetic and/or immunological/self immune factors play a role in the pathological mechanism.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> It could possibly be a multifactorial disorder in which extrinsic factors (environmental, infectious) as well as intrinsic factors (genetic, immunologic) play a synergic role in the etiology of this disease.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present case it was not possible to establish a direct relationship between the gold weight and the development of the lymphoma, even less with a single case. In addition, the authors have not found in the literature reports of lymphoproliferative processes subsequent to gold weight implants.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The presence of a foreign material could produce chronic inflammation that could stimulate the development of lymphoproliferative disorders.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors state that they have not received any type of funding and will not receive any direct or indirect profit in relation to this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres818613" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec815661" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres818612" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec815662" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinic case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-08" "fechaAceptado" => "2016-09-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec815661" "palabras" => array:5 [ 0 => "Lagophthalmos" 1 => "Gold weight eyelid implant" 2 => "Inflammatory reaction" 3 => "Lymphoproliferative disorders" 4 => "Lymphoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec815662" "palabras" => array:5 [ 0 => "Lagoftalmos" 1 => "Implante de pesa de oro" 2 => "Reacción inflamatoria" 3 => "Enfermedad linfoproliferativa" 4 => "Linfoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A male patient with an exposure keratopathy caused by lagophthalmos. A gold weight was implanted in the right upper eyelid. Eight months later, he presented with erythema and swelling of right upper eyelid. An incisional biopsy was performed, reporting extranodal marginal zone B cell lymphoma.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">When a tumor at the site of a gold weight implant is refractory to treatment, it is essential to perform an incisional biopsy to establish the histopathological diagnosis. Ocular adnexal lymphomas are relatively common. The presence of foreign material can cause chronic inflammation that could be the stimulus for the development of a lymphoproliferative disorder.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Paciente varón con queratopatía de exposición secundaria a lagoftalmos. Se colocó un implante de pesa de oro en el párpado superior derecho. Ocho meses después presentó eritema y edema en el sitio del implante. Se realizó una biopsia incisional que reveló un linfoma de células B de zona marginal extranodal.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ante la presencia de una tumoración en el sitio del implante de una pesa de oro resistente al tratamiento médico, es esencial realizar una biopsia incisional para el diagnóstico anatomopatológico. Los linfomas de anexos oculares son relativamente comunes. La presencia de un material extraño puede provocar una inflamación crónica que podría ser el estímulo para el desarrollo de un desorden linfoproliferativo.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Di Nisio LA, Croxatto JO, Mansur MC, Aldecoa JP, Weil D. Linfoma palpebral en paciente con implante de pesa de oro. Arch Soc Esp Oftalmol. 2017;92:181–183.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 566 "Ancho" => 750 "Tamanyo" => 63167 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tumoration @implant site, right eye.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 590 "Ancho" => 1446 "Tamanyo" => 332584 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A) Diffuse lymphocyte infiltrate: small and intermediate lymphocytes with grouped chromatin. Part of said chromatin could be due to previous radiotherapy (H&E ×200). (B) Lymphoid cells express positive CD20 antibody (negative for CD3, CD5, CD10 and Bcl-2) (×200).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 214 "Ancho" => 982 "Tamanyo" => 52723 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Three years after implant extraction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphoma of the ocular adnexa: a study of 353 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Ferry" 1 => "C.Y. 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