Primary Lymphoma of the Lacrimal Gland on PET/CT Imaging

A 58-year-old male patient reported painless pressure in his left eye, starting a few months ago.Examination showed mild proptosis with no limitation in eye movements, watery eyes, or redness.The patient had no systemic symptoms such as weight loss, night sweats, or fever.Ocular MRI revealed a 23x9 mm homogeneous, non-invasive mass in the left lacrimal gland (A).Biopsy confirmed a diagnosis of lacrimal gland marginal zone lymphoma.FDG PET/CT imaging for staging showed a soft tissue lesion in the left lacrimal gland with an SUVmax of 3.16 (B).No other FDG-enhancing lesions were found.He was diagnosed with primary lacrimal gland lymphoma (Stage IE) and treated with 24 Gray radiotherapy over 12 days (C).Primary lymphoma of the orbita and adnexa involves only these areas (Stage IE Ann Arbor classification).Secondary orbital lymphomas also show systemic involvement.Advanced diagnostics like PET, MRI, and endoscopy have detected lymphoid involvement in other body parts in cases of orbital or adnexal lymphoma, indicating secondary lymphomas may be more common than previously thought (1).Primary lymphoma of the orbita and adnexa primarily affects individuals aged 50-70 and is most often non-Hodgkin type.Lacrimal gland lymphomas make up 2-26% of ocular adnexal lymphomas, mainly extranodal marginal zone lymphoma (MALT lymphoma) (2).Common clinical findings include painless proptosis, eyelid edema, orbital mass, and ptosis.Dry eyes are not expected (3,4).Treatments include radiotherapy, surgical resection, chemotherapy, and monoclonal anti-CD20 antibody therapy.Radiotherapy is the primary treatment, with chemotherapy providing additional benefits (5).