Steven A. Newman, M.D., University of Virginia School of Medicine; Bourne, David T
Subject
Orbit; Marginal Zone Lymphoma; IGH-PCR; Immunohistochemistry
Presenting Symptom
A 64 year old gentleman was referred for progressive horizontal diplopia.
History
In September 2006 he had been referred for a second opinion regarding a 5 year history of intermittent swelling around the right orbit, worsening over 7 months associated with double vision, and proptosis (C,D).
Clinical
Acuity was 20/25. 24-2 demonstrated moderate diffuse depression OD > OS, and some arcuate VF changes OS. Palpebral fissures were 13 and 10 with an upper lid range of 15 and 12. Hertels 28/19 with some resistance to retropulsion. There was no APD, but definite limitation in elevation > abduction, adduction, and depression OD with 100 seconds stereopsis. Applanation tensions were 16 and 12. OCT demonstrated minimal thinning of NFL superiorly and nasally, but symmetric OU. CT scan (A,B) demonstrated R orbital pathology.
Neuroimaging
Flow Cytometry
Pathology
Review of the original orbital pathology failed to confirm malignancy and a repeat orbital biopsy was planned.
Disease/Diagnosis
Persistent and recurrent low grade B cell lymphoma (marginal zone) demonstrated by gene rearrangement studies.
Treatment
Chlorambucil
Relation is Part of
Case presented at the NANOS 2013 Walsh Session, February 10
Contributor Primary
Bruce, Beau B
Contributor Secondary
Phillips, Paul H
Publisher
Spencer S. Eccles Health Sciences Library, University of Utah
Date
2013-02-10
Type
Image/MovingImage
Format
video/mp4
Source
45th Annual Frank Walsh Society Meeting
Holding Institution
North American Neuro-Ophthalmology Association (NANOS), Copyright 2013. For further information regarding the rights to this collection, please visit http://library.med.utah.edu/NOVEL
