title: Orbital lymphoma associated with Graves' disease: A case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Hajduković
authors.forename: Snežana
authors.initials: S
authors.lastname: Kuzmić-Janković
authors.forename: Tamara
authors.initials: T
authors.lastname: Kljaković-Avramović
authors.forename: Leposava
authors.initials: L
authors.lastname: Sekulović
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Tukić
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D049970:Graves Ophthalmopathy / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy