Orbital lymphoid lesions: short series with cytohistological correlation

Orbit and ocular adnexae are common sites (10-15%) for developing lymphoid lesions but have diagnostic and staging difficulties similar to other extranodal sites. Out of 15 fine needle aspirates from orbital lesions received in last 5 years three female patients of age 56, 46 and 72 years  presented to FNAC clinic with upper eyelid swellings of  2 years, 3 years and 3 months  duration. Systemic examination was unremarkable. Hematological and Serum protein electrophoresis was normal. On MRI case 1 was suggestive of infective/neoplastic lesion. On CECT case 2 was suggestive of pseudotumor/lymphoma while case 3 was suggestive of pseudotumor. FNAC of case 1 showed polymorphous population of lymphoid cells, without any significant mitosis. FNAC of  case 2  showed a monotonous  population  of lymphoid cells and Case 3 showed a  relatively monotonous  population in a background of lymphoglandular bodies. Case 1: Responded to steroids. Case 2:  was  advised  a  biopsy  for  confirmation,  Case 3: Excision done in view of the recurrent nature with no response to steroids. Histopathology in Case 2 showed  a  non encapsulated  mass  with  proliferation   of  lymphoid  cells forming  nodules, IHC showed  a  monoclonal  pattern while Case 3 showed a nonencapsulated mass with nodular proliferation of  lymphoid cells involving the surrounding adipose tissue with formation of primary and secondary follicles and Immunohistochemistry (IHC) showed a polyclonal population. Three cases are being discussed to highlight the diagnostic dilemmas in orbital lymphoid lesions and relevance of IHC in such cases.