Conjunctival Pediatric Follicular Lymphoma

Figure 1. A 21-year old man developed a left nasal, salmon-colored, epibulbar globular mass without prominent intralesional or surrounding conjunctival vascularization over 5 months. A, The surface of the lesion is glistening and uneroded. B, The tumor displays densely packed lymphocytes, with suggestion of an ill-defined follicular architecture (hematoxylin-eosin, original magnification ×10). The surface nonkeratinizing squamous epithelium is intact (arrows). Tumor cells are present at the deep margin of excision (arrowhead). After 8 months of follow-up, there has been no recurrence. C, A subepithelial mantle zone of densely packed small lymphocytes (SL) and a loosely organized follicular center (FC) below are shown (hematoxylin-eosin, original magnification ×100). Arrows indicate the thinned overlying epithelium. D, Small centroblasts with condensed chromatin, scant cytoplasm, and many mitotic figures (arrows) are shown in the follicles (hematoxylin-eosin, original magnification ×400).

Figure 2. Histological analysis (immunoperoxidase reaction, diaminobenzidine chromogen with toluidine blue counterstain, original magnification ×10). A, The B-lymphocyte marker CD20 is present among the follicular subunits (asterisks) with comparatively less immunostaining of the interfollicular zones (arrows). B, Expression of CD3 is not shown in the follicles (asterisks) but is shown in the interfollicular T lymphocytes (arrows). C, Monoclonal antibody for CD10 reacts with cells in the follicular center (asterisks) but fails to highlight the interfollicular small B and T lymphocytes. D, The follicular cells (asterisks) lack BCL-2 expression, unlike most adult follicular lymphomas, but BCL-2 expression is detected in the small bands of interfollicular B and T lymphocytes. Arrows indicate BCL-2 positivity among the benign cells at the deep surgical margin, which is probably responsible for the absence of a clinical recurrence.