Orbital lymphoma associated with Graves’ disease: A case report

  • Zoran Hajduković Clinic for Endocrinology, Military Medical Academy, Belgrade; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Snežana Kuzmić-Janković Clinic for Endocrinology, Military Medical Academy, Belgrade
  • Tamara Kljaković-Avramović Clinic for Ophthalmology, Military Medical Academy, Belgrade
  • Leposava Sekulović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute of Radiology, Military Medical Academy, Belgrade
  • Ljiljana Tukić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Haematology, Military Medical Academy, Belgrade
Keywords: exophthalmos, diagnosis, differential, graves disease, histological techniques,

Abstract


Introduction. The presence of bilateral exophthalmos and palpebral, periorbital edema associated with hyperthyroidism is most often considered as an initial sign of Graves’ ophthalmopathy. However, in up to 20% of cases, Graves’ ophthalmopathy might precede the occurence of hyperthyroidism, which is very important to be considered in the differential diagnosis, especially if it is stated as unilateral. Among other less common causes of non-thyroid-related orbitopathy, orbital lymphoma represents rare conditions. We presented of a patient with Graves’ disease, initially manifested as bilateral orbitopathy and progressive unilateral exophthalmos caused by the marginal zone B-cell non-Hodgkin lymphoma of the orbit.  Case report. A 64-year-old man with the 3-year history of bilateral Graves’ orbitopathy and hyperthyroidism underwent the left orbital decompression surgery due to the predominantly left, unilateral worsening of exophthalmos resistant to the previously applied glucocorticoid therapy. A year after the surgical treatment, a substantial exophthalmos of the left eye was again observed, signifying that other non-thyroid pathology could be involved. Orbital ultrasound was suggestive of primary orbital lymphoma, what was confirmed by orbital CT scan and the biopsy of the tumor tissue. Detailed examinations indicated that the marginal zone B-cell non-Hodgkin lymphoma extended to IV – B-b CS, IPI 3 (bone marrow infiltration: m+ orbit+). Upon the completion of the polychemiotherapy and the radiation treatment, a complete remission of the disease was achieved. Conclusion. Even when elements clearly indicate the presence of thyroid-related ophthalmopathy, disease deteriorating should raise a suspicion and always lead to imaging procedures to exclude malignancy.

Author Biography

Snežana Kuzmić-Janković, Clinic for Endocrinology, Military Medical Academy, Belgrade
+381-63-8307-544

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Published
2015/04/23
Section
Case report