Article Figures & Data
Figures
- Fig 1.
Orbital lymphoma (MALT lymphoma) in a 79-year-old woman. A, Transverse fat-saturated T2-weighted image; B, Transverse postcontrast fat-saturated T1-weighted image; C, Transverse DWI; D, ADC map; and E, Hematoxylin and eosin (HE)-stained biopsied specimen of the orbital tumor at low power field. An infiltrative mass involves the left lacrimal gland and extraocular muscles, appears isointense compared with the brain cortex on a fat-saturated T2-weighted MR image (A), and shows homogeneous contrast enhancement, similar to that of the right extraocular muscle (arrow) (B). The mass appears as strongly hyperintense on DWI (C) and hypointense on the ADC map (D). Notably, noninvolved extraocular muscles do not show hyperintensity similar to that of the mass on DWI (C). Lesion ADC and CER were 0.56 × 10−3 mm2/s and 1.69, respectively. HE-stained biopsied specimen (E) demonstrated numerous small-to-medium-sized atypical lymphocytes around reactive lymph follicles, with greater high cellular attenuation, however, interstitial fibrosis or edematous change was not prominent.
- Fig 2.
IgG4-related ophthalmic disease in a 67-year-old woman. A, Transverse fat-saturated T2-weighted image; B, transverse postcontrast fat-saturated T1-weighted image; C, transverse DWI; D, ADC map; and E, Hematoxylin and eosin (HE)-stained biopsied specimen of the lacrimal gland at low power field. The mass-like enlarged lacrimal glands are isointense compared with the brain cortex on the fat-saturated T2-weighted image (A) and show homogeneous contrast enhancement, similar to that of the extraocular muscles (B). The lesions appear mildly hyperintense on DWI (C) and slightly hypointense on the ADC map (D). Lesion ADC and CER were 0.94/0.75 (right/left) ×10−3 mm2/s and 2.05/2.07 (right/left), respectively. HE-stained biopsied specimen (E) showed a large germinal center with accompanying lymphoplasmacytic infiltration and abundant interstitial fibrosis with edematous changes. On immunochemical stained section analysis (not shown), many IgG4-positive plasma cell (>40%) were identified, and this is compatible with IgG4-related ophthalmic disease.
- Fig 3.
Orbital lymphoma (mantle cell lymphoma) in a 71-year-old man. A, Transverse fat-saturated T2-weighted image; B, transverse fat-saturated postcontrast T1-weighted image; C, transverse DWI; and D, ADC map. The lesions involve the bilateral lacrimal glands, appear isointense compared with the brain cortex on fat-saturated T2-weighted image (A), and show homogeneous contrast enhancement, similar that of the extraocular muscles (B). The lesions are strongly hyperintense on the DWI (C) and hypointense on the ADC map (D). Lesion ADC and CER were 0.47/0.48 (right/left) ×10−3 mm2/s and 1.49/1.46 (right/left), respectively. The low ADC and CER values could suggest orbital lymphoma though the imaging features are similar to that of IgG4-related ophthalmic disease (Fig 2).
- Fig 4.
Reactive lymphoid hyperplasia in a 65-year-old man. A, Coronal fat-saturated T2-weighted image. A number of vessel signal voids are observed in the bilaterally enlarged lacrimal glands on T2-weighted image (“flow void sign”) (arrows).
- Fig 5.
ADCs and CERs of orbital lymphoma and benign OPLDs. A and B, Scatterplot and box-and-whisker plot show the distribution of ADCs and CERs, and each mean value in the orbital lymphoma and benign OLPDs lesions. The mean ADC and CER of orbital lymphomas are significantly lower than those of benign OLPDs (P < .01). The standard deviation of the ADC of orbital lymphomas was lower (±0.051) compared with that of benign OLPDs (±0.246), and ADCs of only 2 benign OLPDs (encircled) overlapped with those of orbital lymphomas in the ADC range.
Tables
Orbital Lymphoma (n = 29) Benign OLPDs (n = 18) P Value Age 72.2 ± 11.3 (47–88) 57.6 ± 14.7 (27–80) P = .001a Sex Male 18, Female 11 Male 10, Female 8 P = .763 Histologic subtypes MALT lymphoma 21 (72) IgG4-related ophthalmic disease 14 (78) DLBCL 4 (14) RLH 4 (22) Follicular lymphoma 3 (10) Mantle cell lymphoma 1 (3) Laterality Bilateral 12 (41) Bilateral 15 (83) P = .006a Unilateral 17 (59) Unilateral 3 (17) Note:—Data in parentheses are ranges for age and percentages for histologic subtypes and laterality. DLBCL indicates diffuse large B-cell lymphoma; RLH, reactive lymphoid hyperplasia.
↵a There were significant differences in age and laterality between the 2 groups.
Orbital Lymphoma (n = 29) Benign OLPDs (n = 18) P Value Shape Well-defined 7 (24) Well-defined 10 (56) P = .0006a Ill-defined 21 (72) Ill-defined 3 (17) Lobulated 1 (3) Lobulated 5 (17) Signal intensity T1WI Iso 28 (97) Iso 18 (100) P = .2548 Low 1 (3) T2WI Iso 27 (93) Iso 16 (89) P = .6147 Low 2 (7) Low 2 (11) DWI High 17 (100) High 14 (93) P = .2794 Iso 1 (7) Homogeneity and degree of contrast enhancement Homogeneous 23 (85) Homogeneous 15 (100) P = .2787 Inhomogeneous 4 (15) High 2 (13) P = .0519 Iso 27 (100) Iso 13 (87) Presence of “flow void sign” 17 (59) 17 (94) P = .0084a Findings suggestive of sinusitis 8 (28) 16 (89) P < .001a Note:—Data in parentheses are percentages.
↵a There were significant differences in shape of the lesions, presence of the “flow void sign,” and findings suggestive of sinusitis between the 2 groups.
Mean ADC ± SD ADC range P Value Orbital lymphoma (n = 17) 0.54 ± 0.05 0.44–0.64 P < .001a MALT lymphoma (n = 12) 0.47–0.64 DLBCL (n = 2) 0.44–0.56 Follicular lymphoma (n = 2) 0.53–0.57 Mantle cell lymphoma (n = 1) 0.47 Benign OLPDs (n = 15) 0.81 ± 0.18 0.58–1.24 IgG4-related ophthalmic disease (n = 12) 0.58–1.24 RLH (n = 3) 0.73–0.85 Note:—There were significant differences in ADC between the 2 groups. SD indicates standard deviation; DLBCL diffuse large B-cell lymphoma; RLH, reactive lymphoid hyperplasia.
Mean CER ± SD CER Range P Value Orbital lymphoma (n = 27) 1.70 ± 0.25 1.27–2.24 P = .0096a MALT lymphoma (n = 20) 1.27–2.24 DLBCL (n = 3) 1.36–1.71 Follicular lymphoma (n = 3) 1.76–1.94 Mantle cell lymphoma (n = 1) 1.55 Benign OLPDs (n = 15) 2.07 ± 0.46 1.27–3.03 IgG4-related ophthalmic disease (n = 11) 1.27–3.03 RLH (n = 4) 1.66–2.14 ↵a There were significant differences in CER between the 2 groups. SD indicates standard deviation; DLBCL, diffuse large B-cell lymphoma; RLH, reactive lymphoid hyperplasia.
