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Conjunctiva contains specialised lymphoid tissue and is a part of the mucosa-associated lymphoid tissue (MALT) system acting as a barrier to both endoantigens and exoantigens. Reactive lymphoid hyperplasia (RLH) is a result of antigen stimulation of the conjunctival MALT system. RLH affects males and females equally, and tends to occur in young patients.1 It has morphological, immunohistochemical and molecular genetic features, which indicate that the lesion consists of polyclonal B-lymphocytes and T-lymphocytes in similar proportions.
On the other hand, non-Hodgkin lymphomas (NHL) of B-cell type can also arise within this conjunctival MALT system. Between one-third and one quarter of all ocular adnexal lymphoma are located in the conjunctiva.2 ,3 Conjunctival lymphoma consists of mainly four subtypes of B-NHL. The two low-grade malignant neoplasias are extranodal marginal B-cell lymphoma (EMZL) and follicular lymphoma, while the two high-grade B-NHLs are diffuse large B-cell lymphoma and mantle cell lymphoma. EMZL constitutes about one half of the conjunctival B-NHL.1
EMZL typically arises in conditions of chronic antigenic stimulation, as evidenced by the association of Helicobacter pylori, Campylobacter jejuni, Borrelia burgdorferi and hepatitis C virus with EMZLs that arise in the stomach, small intestine, skin and spleen, respectively.4 Of note, when EMZL is diagnosed at an early stage, removal of …