Lymphoid hyperplasia presents as a minimally elevated, salmon-colored subepithelial tumor with a pebbly appearance corresponding to follicle formation (Fig 12-15); it is clinically indistinguishable from conjunctival lymphoma. The lesion is often moderately or highly vascularized. Primary localized amyloidosis (discussed in Chapter 8) can have a similar appearance. Most patients with lymphoid hyperplasia are older than 40 years, although in rare instances, extranodal lymphoid hyperplasia has occurred in children.
Figure 12-15 Conjunctival lymphoid hyperplasia.
Lymphoid hyperplasia may resolve spontaneously, but these lesions have been treated with local excision, topical corticosteroids, or radiation. Biopsy specimens require special handling to complete many of the histochemical and immunologic studies. Fresh tissue is required for immunohistochemistry, flow cytometry, and gene rearrangement studies. Because systemic lymphoma could potentially develop in a patient with an apparently benign polyclonal lymphoid lesion, general medical consultation is advisable.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.