title: Orbital presentation of posttransplantation lymphoproliferative disorder: a small case series.
abstract: OBJECTIVE
  To describe a small series of patients with orbital presentation of posttransplantation lymphoproliferative disorder (PTLD).
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  Three patients with orbital presentation of histologically diagnosed PTLD.
  
  
  METHODS
  Review of medical records.
  
  
  METHODS
  Measured parameters included vision, proptosis, and tumor extent.
  
  
  RESULTS
  Three cases of orbital PTLD are described. In two of the cases, the tumor initially demonstrated orbital signs and symptoms, whereas in the third case, orbital and systemic signs were synchronous. Two of three patients had disseminated disease discovered at the time of presentation. One adult patient had synchronous presentation of PTLD in the orbit and prostate. One pediatric patient had tumor dissemination to the liver at the time of presentation. The PTLD tumors were classified histologically as diffuse large cell lymphoma of monomorphic or immunoblastic type in all three cases. Treatment included local irradiation, decreased immunosuppression, and antilymphocyte monoclonal antibodies.
  
  
  CONCLUSIONS
  Orbital presentation is a rare manifestation of PTLD. However, ophthalmologists must consider this diagnosis carefully in organ transplant recipients with subtle orbital signs and symptoms at presentation. Early detection may alter prognosis. In each case presented, the diagnosis was established via lesion biopsy and subsequent histologic or flow cytometric evaluation, or both.
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia 19104, USA. rsdouglas69@yahoo.com
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Douglas
authors.forename: Scott M
authors.initials: SM
authors.lastname: Goldstein
authors.forename: James A
authors.initials: JA
authors.lastname: Katowitz
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Gausas
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ibarra
authors.forename: Donald
authors.initials: D
authors.lastname: Tsai
authors.forename: Atul
authors.initials: A
authors.lastname: Sharma
authors.forename: Charles
authors.initials: C
authors.lastname: Nichols
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000532:radiotherapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed