Orbital Reactive Lymphoid Hyperplasia: case series and literature review
Author: Deji Ajanaku
Base Hospital / Institution: Alder Hey Hospital, Liverpool
ePoster presentation
Abstract ID: 25-131
Purpose
This study aimed to describe a case series of patients diagnosed with orbital reactive lymphoid hyperplasia (RLH) at a single tertiary care centre. Lymphoid hyperplasia is a benign lymphoproliferative disorder. Two subtypes have been described: ‘reactive’ and ‘atypical’, with the latter demonstrating morphological or immunohistochemical features suggestive of malignant transformation.
Methods
A retrospective search of notes at Liverpool University Hospitals NHS Foundation Trust (LUHFT) was performed using an electronic medical records system called Medisight via its audit function. All patients with a histological diagnosis of RLH from 2021-2023 were included. Cases were excluded where: the diagnosis was equivocal; the location was not within the orbit; and where there was non-attendance of clinic appointments. Our hospital does not review or treat paediatric patients, and hence patients under the age of 16 would not have been identified by the search, but this was not a specific exclusionary criterium.
Results
Fourteen patients were identified from the electronic Medisight records between 2021 and 2023. Two patients were excluded as their RLH was diagnosed within the conjunctiva; one patient due to being lost to follow up after diagnosis, and another due to an equivocal histopathological diagnosis (possible thyroid orbitopathy).
Conclusion
This case series demonstrates an uncommon but important diagnosis that can mimic other lymphoproliferative and inflammatory conditions. Presentation can be variable, such as palpable mass, proptosis, or diplopia. Management options differ from other orbital pathologies, and hence orbital imaging and a histopathological diagnosis is essential. Oral steroids are the mainstay of treatment, however adjunctive treatment such as immunomodulatory therapies should be part of the armamentarium for recalcitrant cases. Observation is not an unreasonable management option in select cases. Our understanding of orbital RLH will continue to progress especially as our ability to reliably differentiate from other lymphoproliferative pathologies improves.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Matthew | Fenech | Arrowe Park Hospital |
| Nima | Ghadiri | Liverpool University Hospital Foundation Trust |
| Sarah | E. Coupland | Liverpool University Hospital Foundation Trust |
