Conjunctival Biopsy - Lymphoid Lesions

Background

The conjunctiva normally contains a background population of lymphocytes, especially in the fornix. The conjunctiva may be involved in systemic lymphoma, or lymphoma, especially of the type associated with mucosal tissues (MALT lymphomas) may originate in the conjunctiva.

Biopsy Techniques

In taking a biopsy of a patient with suspected conjunctival lymphoma, it is important to handle the tissues gently. It is easy for the surgeon to induce a crush artifact. The surgeon should prepare the biopsy properly for submission to the lab.

Conjunctival lymphoid lesions should not be placed into saline; saline may induce lymphocytic lysis and interfere with the interpretation of the biopsy.

Fresh tissue should be set aside for immunohistochemistry or flow cytometry. Tissue may be transported to the laboratory in special media. Contact us if you require special transport media for immunological marker studies. We also have facilities to perform gene rearrangement studies in appropriate cases.

Divide the biopsy sample into two pieces: one piece for immunologic studies, and the other piece for high-quality light microscopy.

Work-up

Patients who receive the diagnosis of conjunctival lymphoma should be investigated for evidence of systemic disease. The work-up frequently involves a complete physical examination, blood tests, imaging studies of the chest and abdomen, and bone marrow biopsy. If the disease is confined to the conjunctiva, local radiation treatment is frequently recommended.

 

Primary conjunctival lymphoma