Treatment of a patient with adnexal lymphoma with Rituximab Oktay Bilgir a,⇑ , Ferda Bilgir b , Mehmet Calan a , Arif Yuksel a , Ferit Sari a , Özgür Öztekin c a Department of 2nd Internal Medicine, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey b Department of Internal Medicine, Buca State Hospital, Izmir, Turkey c Department of Radyology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey article info Article history: Received 1 December 2010 Accepted 20 January 2011 Keywords: Lymphoma Orbita Rituximab abstract Orbital lymphoma is a very rare type of primary Non-Hodgkin lymphoma. The disorder is often small B-cell lymphoma, although large cell morphology may also be identified in rare cases. It may sometimes be confused with non-malignant, benign-course lymphoid hyper- plasia. Although involvement is usually unilateral (80%), bilateral cases are also reported. Response to radiotherapy is achieved in the majority of cases, whereas the prognosis is poor in orbital involvement with large cell lymphoma and response to combined chemo- therapy is inadequate. In this paper, we report a case with a diagnosis of unilateral adnexal involvement, who previously received CHOP treatment and developed a relapse 6 months later, then responded to treatment with Rituximab. Ó 2011 Elsevier Ltd. All rights reserved. 1. Introduction Orbital lymphoma was first described in 1952 and rep- resents 1% of all Non-Hodgkin lymphomas [1]. Of ocular adnexal lymphomas, 46–74% involve the orbita, 20–33% involve the conjunctiva and 5–20% involve the eyelid [2]. Possible involvements of other systems should also be investigated since systemic involvement is noted in 10– 30% of these patients [3]. Most of the ocular adnexal lym- phomas (60–80%) are mucosa-associated lymphoid tissue (MALT) lymphoma, which is a low-grade lymphoma. Other rarer lymphomas are low-grade follicular lymphoma, dif- fuse large B-cell lymphoma and mantle cell lymphoma [4,5]. More than half of these patients demonstrate extra- orbital involvement. Moreover, almost 30% of patients with MALT lymphoma are characterized by extraorbital involvement. There are several modalities in the treatment of ocular adnexal lymphomas but external-beam radiotherapy is considered the gold standard for the treatment of primary extraorbital lymphoma. In addition to external-beam radiotherapy, single-agent or multiple-agent chemothera- pies, as well as radiotherapy combined with chemotherapy may also be administered. The pathology of primary intraocular lymphoma is the main factor on which the treatment is based. The majority of patients diagnosed with indolent lymphoma respond to radiotherapy, while the response rate to combined chemo- therapy regimens is very low in patients with aggressive lymphoma (diffuse large cell) and these patients often de- velop relapse [6,7]. In this paper, we report a response achieved with monoclonal antibody treatment (Rituximab) which was administered to a patient with primary adnexal lymphoma who developed relapse following previous chemotherapy. 2. Case report The patient (H.G.) is 67-year-old female. She presented in October 2006 with swelling in the right eyelid. The pa- tient was diagnosed with ‘Extranodal Marginal Zone B-Cell Lymphoma’ based on the incisional biopsy taken from the eyelid. The lymphoma patient had the following findings: CD20(+), CD3(À), Cyclin D(À), CD10(À), CD23(À) and 1473-0502/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.transci.2011.01.002 ⇑ Corresponding author. Address: Department of 2nd Internal Medi- cine, Izmir Bozyaka Training and Research Hospital, 1420/3 Sokak, No: 18 Ezgi Saglik Sitesi.K.5, N.9, Alsancak-Izmir, Turkey. Tel.: +90 2324640780; fax: +90 2322614444. E-mail address: obilgir2001@yahoo.com (O. Bilgir). Transfusion and Apheresis Science 44 (2011) 135–137 Contents lists available at ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci