title: Histopathologic findings and frequency of clonality detected by the polymerase chain reaction in ocular adnexal lymphoproliferative lesions.
abstract: We report the reclassification according to recently described histologic categories of 48 patients with ocular adnexal lymphoproliferative lesions with long-term follow-up (mean, 8.1 yr). We used available formalin-fixed, paraffin-embedded, and frozen tissues to assess the frequency of immunoglobulin heavy chain gene rearrangement detectable by polymerase chain reaction in these lesions. We reviewed patient records, obtained follow-up data, and examined hematoxylin- and eosin-stained slides. DNA extracted from tissues was amplified with consensus V- and J-region primers to detect immunoglobulin heavy chain gene rearrangement. We examined 28 orbital, 10 lacrimal, and 10 conjunctival lesions, of which 2 lesions were lymphoid hyperplasias, 3 were indeterminate, and 43 were lymphomas. Of the 44 patients with follow-up, systemic lymphoma developed in 24 (55%), of whom 11 died of the disease, and 6 are alive with disease. Thirty-one patients had sufficient DNA for polymerase chain reaction analysis; 9 specimens were nonclonal, 21 were clonal, and 1 failed to amplify. The nonclonal lesions included one hyperplasia, one indeterminate lesion, and seven lymphomas; two of these patients died of the disease, and one is alive with disease. The clonal lesions included 1 indeterminate lesion and 20 lymphomas. Systemic lymphomas developed in 16 patients; 8 died of the disease, and 4 are alive with disease. Of the lesions histologically classified as lymphoma, 74% were clonal. We conclude that most ocular adnexal lymphoproliferative lesions can be histologically classified as lymphomas, that systemic lymphoma will develop in at least 50% of these patients if they are followed for sufficient time, and that most lesions classified as lymphomas will be clonal using polymerase chain reaction techniques. Lack of amplification using a consensus primer strategy may account for the inability to detect clonality by polymerase chain reaction in some histologically identified lymphomas.
authors.affiliation: Department of Pathology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
authors.forename: V A
authors.initials: VA
authors.lastname: White
authors.forename: R D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: B K
authors.initials: BK
authors.lastname: McNeil
authors.forename: W Y
authors.initials: WY
authors.lastname: Chang
authors.forename: L V
authors.initials: LV
authors.lastname: Brewer
authors.forename: J
authors.initials: J
authors.lastname: Rootman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002999:Clone Cells; D003230:Conjunctival Neoplasms / Q000737:chemistry / Q000145:classification / Q000473:pathology*; D017931:DNA Primers / Q000737:chemistry; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000145:classification / Q000473:pathology*; D008223:Lymphoma / Q000737:chemistry / Q000145:classification / Q000473:pathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000737:chemistry / Q000145:classification / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000737:chemistry / Q000145:classification / Q000473:pathology*; D016133:Polymerase Chain Reaction
chemical_list: D017931:DNA Primers; D004273:DNA, Neoplasm