Orbital mantle cell lymphoma presenting as myasthenia gravis

ABSTRACT

A 69-year-old man, previously treated with pyridostigmine for myasthenia gravis (manifesting as ptosis and diplopia) was evaluated for several concomitant bilateral anterior orbital masses. Imaging revealed 3 discrete, solid masses within and around the orbits. An incisional biopsy demonstrated atypical lymphocytes positive for CD20 and Cyclin-D1, consistent with mantle cell lymphoma. The patient received induction chemotherapy with a rituximab-based regimen. He experienced resolution of his diplopia and ptosis after one cycle of chemotherapy and achieved complete remission of the orbital masses and myasthenia symptoms after 6 cycles. Myasthenia gravis is most commonly associated with thymoma, but may also be observed with other malignancies. Recognition that orbital lymphoma may coexist with myasthenia gravis will help in expediting the diagnosis of future cases and in guiding treatment decisions.

KEYWORDS:

• Mantle cell lymphoma
• orbit
• myasthenia gravis

Acknowledgements

Drs. Justin Karlin and Maria Kirzhner had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A signed consent permitting the use of clinical photographs of this patient was obtained. No outside financial or material support was used to perform this research. We wish to thank Jeannie D. Haman, PhD, of Murfreesboro, Tennessee, for editing assistance.

Disclosure statement

No financial support or grant was used to support this work. The authors have no proprietary or commercial interest in any materials discussed in this article.

The authors alone are responsible for the content and writing of the article.