Epstein-Barr virus-associated lymphoma of the orbit
An unusual presentation of EBV-associated diffuse large B-cell lymphoma in the bilateral orbits of an immunocompetent woman. An elderly, immunocompetent woman presented with an orbital mass which was biopsied and proven to be EBV-associated lymphoma. She presented to the emergency department with a 3-week history of worsening left upper eyelid edema and erythema. Symptoms continued to progress despite a 4-day course of trimethoprim/ sulfamethoxazole for suspected cellulitis. She denied a personal history of eye trauma or malignancy. Examination revealed an erythematous, non-fluctuant and non-mobile, painless lesion along the nasal aspect of the left upper eyelid. Computerized tomography (CT) of the orbits without contrast revealed a homogenous left upper lid soft tissue lesion. She underwent an anterior orbitotomy with incisional biopsy of the left orbital mass.

Microscopically, the biopsied specimen showed sheets of large atypical lymphoid cells with geographic necrosis. By immunohistochemistry, the malignant cells expressed CD20, CD79a, and PAX 5. Cells also showed positivity with Epstein-Barr encoding region (EBER) by in situ hybridization. Fluorescent in situ hybridization (FISH) was negative for MYC or BCL6 rearrangements and IGH/BCL2 fusion. These findings were suggestive of a diagnosis of EBV-positive DLBCL of the orbit.

Source: https://www.sciencedirect.com/science/article/pii/S2451993622003747?dgcid=rss_sd_all