PMC4281442_01
Contrast enhanced axial T2 weighted image showing enlarged right lacrimal gland (blue arrow) with soft tissue compromise suggestive of chronic inflammation.
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fig1
An orbital MRI was ordered to study the ophthalmological symptoms (Figure 1), which showed changes suggestive of a chronic, granulomatous inflammation in the right lacrimal gland.
Orbit (a) histological appearance with diffuse lymphoid infiltrate H&E stain 10x and (b) immunohistochemistry study showing uniform B-cell population CD20, 40x.
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fig2
Histopathological studies (Figures 2 and 3) revealed a predominantly B, lymphoid, and small-cell infiltrate. A renal biopsy showed segmental necrotizing glomerulonephritis (Figure 2) with 60% and 21% cellular and fibrous extracapillary proliferation, respectively, compatible with type 3 extracapillary proliferative glomerulonephritis (type 3, pauci-immune).
Glomerulus with extracapillary proliferation. Left side with PAS stain, 20x, and to the right with methenamine-silver stain, 20x.
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fig3
Histopathological studies (Figures 2 and 3) revealed a predominantly B, lymphoid, and small-cell infiltrate.