HISTOPATHOLOGIC FINDINGS AND FREQUENCY OF CLONALITY DETECTED BY THE POLYMERASE CHAIN-REACTION IN OCULAR ADNEXAL LYMPHOPROLIFERATIVE LESIONS

We report the reclassification according to recently described histolo gic categories of 48 patients with ocular adnexal lymphoproliferative lesions with long-term follow-up (mean, 8.1 yr), We used available for malin-fixed, paraffin-embedded, and frozen tissues to assess the frequ ency of immunoglobulin heavy chain gene rearrangement detectable by po lymerase chain reaction in these lesions. We reviewed patient records, obtained follow-up data, and examined hematoxylin- and eosin-stained slides, DNA extracted from tissues was amplified with consensus V- and J-region primers to detect immunoglobulin heavy chain gene rearrangem ent. We examined 28 orbital, 10 lacrimal, and 10 conjunctival lesions, of which 2 lesions were lymphoid hyperplasias, 3 were indeterminate, and 43 were lymphomas. Of the 44 patients with follow-up, systemic lym phoma developed in 24 (55%), of whom 11 died of the disease, and 6 are alive with disease, Thirty-one patients had sufficient DNA far polyme rase chain reaction analysis; 9 specimens were nonclonal, 21 were clon al, and I failed to amplify, The nonclonal lesions included one hyperp lasia, one indeterminate lesion, and seven lymphomas; two of these pat ients died of the disease, and one is alive with disease, The. clonal lesions included 1 indeterminate lesion and 20 lymphomas, Systemic lym phomas developed in 16 patients; 8 died of the disease, and 4 are aliv e with disease, Of the lesions histologically classified as lymphoma, 74% were clonal. We conclude that most ocular adnexal lymphoproliferat ive lesions can be histologically classified as lymphomas, that system ic lymphoma will develop in at least 50% of these patients if they are followed for sufficient time, and that most lesions classified as lym phomas will be clonal using polymerase chain reaction techniques, Lack of amplification using a consensus primer strategy may account for th e inability to detect clonality by polymerase chain reaction in some h istologically identified lymphomas.