• Putty-like
molding to undisplaced tissues so little Va or EOM loss;
usually no bone erosion or infiltration unless high-grade
lymphoma
• All
pts w/orbital lymphoid lesions need exam for systemic
lymphoma (by oncologist) w/orb/abd/chest CT;
CBC; check LN; bone marrow bx; CXR; bone/liver/spleen
scan
• Cytological
factors are more prognostic than mono/ polyclonal;
but most benign lesions (reactive hyperplasia) are mostly
T cells w/polyclonal Bs; malignant lymphoma usually more
monoclonal B cells
• Open
bx for pathology to give fresh tissue for touch preps;
immunohistochemistry; flow cytometry; and
gene rearrangement studies; in formalin for
micro, glutaraldehyde for EM
• Benign
reactive hyperplasia: up to 25% eventually develop systemic
lymphoma
• Atypical
lymphoid hyperplasia: up to 40% get systemic involvement
within 5 years
