Subconjunctival mucosa-associated lymphoid tissue (MALT) lymphoma arising in Tenon’s capsule

Purpose We report the first case of subconjunctival mucosa-associated lymphoid tissue (MALT) lymphoma arising in Tenon’s capsule (fascia bulbi). Methods A 75-year-old woman presented with painless swelling of the superior bulbar conjunctiva in her left eye. During the biopsy of the bulbar lymphoid lesion, it was noticed that the conjunctiva was movable and that the lesion was located in the subconjunctiva. The tissues were studied by conventional light microscopy, immunohistochemistry, flow cytometry, and gene rearrangement analysis. Results Histopathological examination revealed that a diffuse lymphoid infiltrate consisting of small-sized lymphoid cells was present in Tenon’s capsule but not in the substantia propria of the conjunctiva. Immunohistochemical and flow cytometric studies documented tumor cells of B-lymphocyte lineage. Molecular analysis demonstrated positive immunoglobulin heavy chain gene rearrangement. The final diagnosis was subconjunctival MALT lymphoma arising in Tenon’s capsule. Conclusion Ophthalmologists and pathologists need to distinguish the subconjunctival lymphoma that arises in Tenon’s capsule from the conjunctival lymphoma in the substantia propria during diagnosis of epibulbar lymphoid tumors. This material is not under consideration for presentation and has not been previously presented. The authors received no specific financial support for this study and have no financial interest in any company or product discussed in it.