Orbital T-cell lymphoma in youngest recorded patient - early diagnosis, management, and successful outcome: a case report and review of the literature

J Med Case Rep. 2018 May 14;12(1):139. doi: 10.1186/s13256-018-1630-2.

Abstract

Background: Primary orbital peripheral T-cell lymphoma, not otherwise specified is an exceedingly rare disorder with a very poor outcome, and to the best of our knowledge only a few cases have been reported in the English literature. We present the youngest reported case describing the successful outcome after management with a thorough review of the English literature of all the reported cases of primary peripheral T-cell lymphoma, not otherwise specified.

Case presentation: Our patient is a 3-year-old Syrian boy who presented with gradual progressive orbital swelling. A physical examination showed a left orbital dystopia and a superior medial displacement of the globe. Extraocular motility was limited in upward elevation of his left eye. A computed tomography scan and magnetic resonance imaging of his orbit showed a mass involving the lateral and inferior walls of his left orbit and extending intraconally. A diagnosis of peripheral T-cell lymphoma, not otherwise specified was made by careful histopathological examination and Berlin-Frankfurt-Munster protocol was initiated. A 6-month follow up with orbital magnetic resonance imaging showed no sign of orbital or brain involvement.

Conclusions: Through this report we emphasize two takeaway lessons: (1) always have a high level of suspicion of this entity regardless of the age of the patient; and (2) careful histopathological examination is very important for prompt confirmation of the diagnosis and early commencement of proper treatment.

Keywords: Case report; Chemotherapy; Lymphoproliferative; Orbit; T-cell lymphoma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Age Distribution
  • Antineoplastic Combined Chemotherapy Protocols
  • Asparaginase
  • Child, Preschool
  • Daunorubicin
  • Early Detection of Cancer*
  • Humans
  • Lymphoma, T-Cell* / diagnostic imaging
  • Lymphoma, T-Cell* / drug therapy
  • Lymphoma, T-Cell* / pathology
  • Magnetic Resonance Imaging
  • Male
  • Orbit / diagnostic imaging
  • Orbit / pathology
  • Orbital Neoplasms / diagnostic imaging
  • Orbital Neoplasms / drug therapy
  • Orbital Neoplasms / pathology
  • Prednisone
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vincristine

Substances

  • Vincristine
  • Asparaginase
  • Prednisone
  • Daunorubicin

Supplementary concepts

  • PVDA protocol