Sir,
Conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas are localized low-grade extra-nodal tumours that are managed with radiotherapy, cryotherapy, surgical excision, or even observation.
Intra-lesional interferon injection for conjunctival lymphomas was first cited as early as 1996 by Cellini et al;1 its successful use has been reported since then.2, 3 We report a case where its use has been invaluable in a patient with recurrent conjunctival MALT lymphoma following external beam radiation.
Case report
A 55-year-old woman presented with a 2-week history of red watery right eye and swelling of her right lower lid. On examination, she had a salmon pink mass in the right inferior bulbar conjunctiva (Figure 1a). The rest of the ocular examination was normal. Conjunctival biopsy confirmed this to be an extra-nodal marginal-zone MALT-type lymphoma. The patient was treated with external beam radiation (24 Gy in 12 fractions) to the right inferior conjunctiva with complete regression of the lymphoma.
At 10 months post radiotherapy, she was noted to have a similar pink lesion in the right superior bulbar conjunctiva (Figure 1b). A biopsy confirmed recurrent MALT lymphoma (Figure 1c).
Owing to recent external beam radiotherapy it was felt inappropriate to re-treat her with the same modality and she was treated with intra-lesional interferon injection.
She received a 4-week course of 3 times a week intra-lesional injections of 1.5 mega-units in 0.25 ml of Interferon α2A, with complete regression of the lesion.
She remains disease free at 10 months follow-up.
Comment
Radiotherapy has been widely used as a treatment for MALT lymphoma with successful results, but ocular complications such as corneal ulcers, radiation-induced cataract, ocular surface disorders,4 and recurrence have been reported.
Intra-lesional interferon has been successfully used for treatment of conjunctival MALT lymphoma. A recurrence rate of 15% on a long-term follow-up (65 months) has been reported.5
We believe this is the first case reported where intra-lesional Interferon α2A was used in recurrent conjunctival MALT lymphoma after external beam radiation, and we recommend considering it in similar cases.
References
Cellini M, Possati GL, Puddu P, Caramazza R . Interferon alpha in the therapy of conjunctival lymphoma in an HIV+ patient. Eur J Ophthalmol 1996; 6 (4): 475–477.
Blasi MA, Gherlinzoni F, Calvisi G, Sasso P, Tani M, Cellini M et al. Local chemotherapy with interferon-alpha for conjunctival mucosa-associated lymphoid tissue lymphoma: a preliminary report. Ophthalmology 2001; 108 (3): 559–562.
Lucas RS, Mortimore R, Sullivan TJ, Waldie M . Interferon treatment of childhood conjunctival lymphoma. Br J Ophthalmol 2003; 87: 1191.
Bessel EM, Henk JM, Whitelocke JF, Wright EJ . Ocular morbidity after radiotherapy of orbital and conjunctival lymphoma. Eye 1987; 1: 90–96.
Blasi MA, Tiberti AC, Valente P, Laguardia M, Sammarco MG, Balestrazzi A et al. Intra-lesional interferon-α for conjunctival mucosa-associated lymphoid tissue lymphoma: long-term results. Ophthalmology 2012; 119 (3): 494–500.
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Zayed, M., Sears, K., Salvi, S. et al. Intra-lesional interferon injection for recurrent conjunctival MALT lymphoma. Eye 27, 680–682 (2013). https://doi.org/10.1038/eye.2013.46
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DOI: https://doi.org/10.1038/eye.2013.46
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