PMC5296617_01
Ann Arbor staging for lymphoma
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T1
The upper and lower eyelids were swollen and erythematous with conjunctival chemosis (Figure 1 (Fig. 1)).
Conjunctival chemosis and proptosis of the right eye
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F1
Computed tomography (CT) scan of the orbit and paranasal sinuses (Figure 2 (Fig. 2)) revealed right periorbital soft tissue swelling and enhancement with enlargement of the right lacrimal gland.
CT scan imaging of the orbit and paranasal sinuses: A) Axial view (left) demonstrated right periorbital soft tissue swelling with right extraocular muscle bulkier compared to left side. There was enlargement of the right lacrimal gland. Soft tissue density was seen within ethmoidal air cells. B) Coronal view (right) demonstrated soft tissue density in the frontal sinus, ethmoidal air cells and mucosal thickening in both the maxillary sinuses with obliteration of both osteomeatal complex. There was erosion of the right lamina papyracea.
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F2
Histopathological specimens of the ethmoidal tissues (Figure 3 (Fig. 3)) revealed multiple fragments of fibrocollagenous tissue focally covered by respiratory epithelium containing seromucinous glands.
Ethmoid sinus biopsy specimen A: H&E stain (100x) showed a piece of lymphoid tissue covered by respiratory epithelium (black arrow) and the stroma was densely infiltrated by neoplastic lymphoid cells (red arrows) B: H&E stain (400x) showed dense infiltration of the stroma with neoplastic lymphoid cells. There were prominent scattered areas of necrosis and apoptotic bodies seen (black arrow).
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F3
TIA, EBER-ish and negative for CD20, CD10, tdt, cyclin-D1, CD4, CD8, CD5, CD30 and ALK (Figure 4 (Fig. 4)).