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JAMA Ophthalmology Clinical Challenge
November 2018

Unilateral Eyelid Swelling With Submandibular Lymph Node Enlargement

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2018;136(11):1293-1294. doi:10.1001/jamaophthalmol.2018.0801

A woman in her early 50s with hypothyroidism and a 10-month history of painless lumps in her neck presented with achiness and decreased visual acuity in her right eye for 2 months. Associated symptoms included dysphagia and fever and chills. A previous otolaryngology evaluation revealed an intranasal mass with enlargement of multiple submandibular lymph nodes. A needle aspiration biopsy of 1 of the submandibular lymph nodes revealed atypical cells with mature lymphocytes. Computed tomography of the sinus confirmed a nasal polyp and a soft tissue mass in the right lacrimal gland region. The excised nasal polyp was benign. Incisional biopsy of the lacrimal gland lesion revealed chronic inflammatory infiltrate composed of predominantly T cells with scattered B cells and mature plasma cells, but no evidence of a lymphoproliferative process. The patient was referred for evaluation in our clinic.

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