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A case of ocular marginal zone non-Hodgkin B-cell lymphoma of mucosa-associated lymphoid tissue of the conjunctiva masquerading as chalazion is reported in a 57-year-old Chinese man, known to have diabetes mellitus. He presented with painless swelling of the lower lid and redness in the right eye for 3 months duration. A diagnosis of chalazion was made, and incision and curettage were performed by a general ophthalmologist. The swelling worsened and spread to the whole lower lid. Magnetic resonance imaging showed a lesion involving the right periorbital region limited to the anterior orbital septum that was hypointense on T1 and hyperintense on T2. A diagnosis of periorbital cellulitis with possibility of lymphoma was suggested.
When he came to our eye clinic for expert opinion, his visual acuity, anterior segment and fundus were normal except early cataract changes in both eyes. There was a hard, non-tender, immobile mass within the lower eyelid associated with conjunctival injection and chemosis. Histopathology of the conjunctival biopsy showed features of low-grade non-Hodgkin B-cell lymphoma and the immunohistochemistry report was suggestive of marginal zone lymphoma. He was treated with chemotherapy (cyclophosphamide, vincristine, prednisolone) and radiotherapy, following which the swelling resolved.
When patients do not respond to treatment as expected after incision and curettage of chalazion, a high index of possibility of malignancy should be kept in mind whenever a recurrence of hard swelling is observed at the same site in the eyelid. All suspicious lesions should be biopsied to find out the correct diagnosis.