title: Nasal dissemination of a single-clone IgH-rearranged conjunctival MALT lymphoma through the nasolacrimal duct: A case report.
abstract: The aim of the present study was to report a rare case of single-clone, immunoglobulin heavy chain (IgH)-rearranged mucosa-associated lymphoid tissue (MALT) lymphoma in the conjunctiva, with nasal cavity dissemination through the nasolacrimal duct. A 24-year-old female was diagnosed with MALT lymphoma of the nasal cavity at the Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University (Tapei, Taiwan) in October 2008. A biopsy of the relapsing conjunctival lesion revealed a MALT lymphoma by pathological staining, while a single-clone, IgH-rearranged tumor lesion in the nasal cavity and conjunctiva was confirmed using continuous sinus computed tomography scans and polymerase chain reaction. Tumor lesions were negative forHelicobacter pyloriandChlamydiainfection, but exhibited bilateral neck lymph node dissemination. A combination of radiation therapy (a total dosage of 46.8 Gray, in two phases covering the left lacrimal sac, nasal cavity and bilateral neck region) and topical ciprofloxacin plus steroid (0.3% ciprofloxacin 4 times a day and betamethasone eye ointment before sleep for 1 month) was provided as an effective therapeutic strategy, and no recurrence was found in the next 3 years. The nasolacrimal duct serves as a channel for conjunctival tumor spreading and is easily neglected. IgH-involved translocation in MALT lymphoma is a factor in the progression of the disease, and aggressive combination therapy is essential for a high-risk, disseminated IgH-rearranged MALT lymphoma.
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Liao
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Chia-Che
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Sheng-Po
authors.initials: SP
authors.lastname: Yuan
authors.affiliation: Department of Ophthalmology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei 11031, Taiwan R.O.C.; Institute of Engineering in Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
authors.forename: Jennifer Hui-Chun
authors.initials: JH
authors.lastname: Ho
authors.affiliation: Post-Baccalaureate Health Professions Program, UC Berkeley Extension, Berkeley, CA 94704, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Roan
authors.affiliation: Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan R.O.C.; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan R.O.C.
authors.forename: Phui-Ly
authors.initials: PL
authors.lastname: Liew
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Ming-Tang
authors.initials: MT
authors.lastname: Lai
authors.affiliation: Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei 11698, Taiwan R.O.C.
authors.forename: Feipeng
authors.initials: F
authors.lastname: Lee
keywords: conjunctiva; immunoglobulin heavy chain translocation; mucosa-associated lymphoid tissue lymphoma; nasal cavity; nasolacrimal duct