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Conjunctival Intralymphatic Small Cell Lymphocytostasis Associated With a Salmon Patch

Frederick A. Jakobiec, MD, DSc1,2; Alia Rashid, MBChB1,2; Erik Letko, MD3
[+] Author Affiliations
1David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston
2Harvard Medical School, Boston, Massachusetts
3Corneal Consultants of Colorado, Littleton
JAMA Ophthalmol. 2014;132(11):1379-1381. doi:10.1001/jamaophthalmol.2014.2821.
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Lymphoid tumors of the conjunctiva, also referred to clinically as salmon patches, have a favorable prognosis.1,2 They are composed of reactive lymphoid hyperplasias and low-grade lymphomas. To our knowledge, associated intralymphatic lymphocytostasis has received no attention in the ophthalmic literature, and we describe it herein.

Article InformationCorresponding Author: Frederick A. Jakobiec, MD, DSc, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Ste 328, Boston, MA 02114 (fred_jakobiec@meei.harvard.edu).

Published Online: August 7, 2014. doi:10.1001/jamaophthalmol.2014.2821.

Conflict of Interest Disclosures: None reported.

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Figure 1.
Clinical and Microscopic Features of Conjunctival Intralymphatic Lymphocytostasis

A, Indistinct follicles in the inferior fornix coexist with a salmon-colored, diffuse, mild thickening of the inferior epibulbar surface (arrowheads). B, Two lymphoid aggregates beneath the epithelium (arrowheads) are composed of small lymphocytes and connected to each other by a narrow band of lymphocytes (hematoxylin-eosin, original magnification ×40). C, An attenuated but uneroded continuous epithelium (arrowhead) covers the surface over a lymphocytic aggregate (asterisk) composed of small lymphocytes (inset) (hematoxylin-eosin, original magnification ×100 [C] and ×200 [inset]). D, CD20+ B lymphocytes are responsible for the subepithelial nodular lymphoid formations (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×400). In situ hybridization for κ (E) and λ (F) light chains is demonstrated (original magnification ×400). Both are identified in small numbers with this method. G, Beneath the subepithelial lymphoid aggregates (asterisk) are dense collections of intravascular lymphocytes (black arrowheads) accompanied by a light dispersal in the surrounding substantia propria (white arrowheads) (hematoxylin-eosin, original magnification ×40). H, High-power magnification shows details of the small, round, regular lymphocytes in a vascular channel (hematoxylin-eosin, original magnification ×400).

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Figure 2.
Immunohistochemical Findings in Conjunctival Intralymphatic Lymphocytostasis

Immunohistochemical findings with immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain. A, The intravascular lymphocytic compactions are overwhelmingly CD3+ T lymphocytes, which are also scattered in the surrounding substantia propria (original magnification ×100). B, There is a subpopulation of CD20+ B lymphocytes lodged among the dominant intravascular T lymphocytes (original magnification ×400). C, A focus of CD3+ T lymphocytes is also located beneath the surface epithelium (arrowhead) (original magnification ×100). D, Ki67 stains fewer than 5% of the intravascular lymphocytes undergoing DNA replication in G phase prior to mitosis (dark nuclei) (original magnification ×400). E, D2-40, an endothelial cell marker of lymphatic channels (arrowheads), delineates the intraluminal lymphocytes (original magnification ×400). Inset, The stain more clearly demonstrates the positively staining lymphatic wall, which contains fewer obscuring lymphocytes (original magnification ×400). F, CD31, which characterizes vascular endothelium, contains empty lumens (arrowheads) and fails to envelop any lymphocytes (original magnification ×200).

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