PMC5401722_01
External facial photograph and enhanced magnetic resonance (MR) images with contrast of a patient diagnosed with orbital T-cell lymphoma. (a) External photograph shows moon face countenance at the initial examination. (b) External photograph shows relief of moon face countenance 1.5 months after aggressive chemotherapy with alternate hyper CVAD therapy (cyclophosphamide, vincristine, adriamycin, and dexamethasone), and MA therapy (methotrexate and cytarabine) was performed. (c, e) MR images showing an enlargement of all of the extraocular muscles at presentation. (d, f) MR images showing an attenuation of such findings at 1.5 months during the chemotherapy.
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She was generally in good health at presentation except for a moon face countenance without pain (Figure 1). Magnetic resonance imaging with contrast showed discrete spindle-shaped enlargements of the bellies of all of the EOMs without a spillover into the orbital fat of both eyes (Figure 1).
Photomicrographs of the inferior rectus muscle with peripheral T-cell lymphoma. (a) Photomicrograph showing infiltration by many lymphocytes into the muscles (hematoxylin and eosin stain; magnification, x200). (b)-(f) Photomicrographs showing positivity for CD3 (b) and Granzyme B (c) and negativity for CD20 (d), CD79a (e), and MIB-1 index in 60% (f) (immunohistochemistry stain; magnification, x200).
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B (T-cell markers) and negative for CD20, CD56, and CD79a (B-cell markers) (Figure 2). Based on these results, she was diagnosed with stage 4, peripheral T-cell lymphoma. After the initiation of chemotherapy, her enlarged EOMs, limited eye motility, and moon face countenance were improved (Figure 2).