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Benign reactive lymphoid hyperplasia of the conjunctiva in childhood
  1. Adel G AlAkeely1,
  2. Hind M Alkatan2,3,
  3. Adel H Alsuhaibani2,
  4. Hisham AlKhalidi3,
  5. Leen Abu Safieh1,
  6. Sarah E Coupland4,
  7. Deepak P Edward1,5
  1. 1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
  2. 2Department of Ophthalmology, King Saud University Medical City, Riyadh, Saudi Arabia
  3. 3Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia
  4. 4Department of Cellular Pathology, Royal Liverpool University Hospital, UK
  5. 5Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
  1. Correspondence to Dr Hind Manaa Alkatan, Departments of Ophthalmology and Pathology, King Saud University Medical City, Riyadh, Saudi Arabia; hindkatan{at}; hkatan{at}


Background/aim Our aim is to the report the clinical and histopathological features of benign reactive lymphoid hyperplasia (BRLH) of the conjunctiva in children and the outcomes of treatment.

Methods A retrospective chart review was performed for children aged 0–18 years, diagnosed with conjunctival BRLH from January 2000 to December 2013 at two large ophthalmology hospitals in the Middle East. Data were collected on patient demographics, features of the lesions, the site of the lesion, location, adnexal involvement, lymph nodes involvement, local spread, histopathology and molecular genetic studies of the cases (if available), outcomes of treatment and recurrence.

Results There were 24 patients with lymphoid lesions classified as conjunctival BRLH during the 12-year period evaluated in this study. The mean age at diagnosis was 11.6 years. Twenty-three patients were males (96%). Systemic medical history included three patients with bronchial asthma, one patient with Down's syndrome, one patient with generalised skeletal malformation and one patient with gastritis. The initial uncorrected visual acuity was 20/30 or better in 93.5% of the eyes. At presentation, the tumour was unilateral in 12 cases (50%). The conjunctival mass was located on the bulbar conjunctiva in all cases. The mass was present nasally in 96% of lesions. No cases (that were tested) had an infectious aetiology. PCR demonstrated monoclonality suggestive of lymphoma in two cases; however, this did not alter the final diagnosis as BRLH per histopathological criteria and clinical course,

Conclusions All investigated cases of paediatric conjunctival BRLH had a benign clinical course with no local or systemic dissemination and a male predominance. Recurrence was rare, and in our cohort, it was not associated with malignant transformation.

  • Conjunctiva
  • Pathology
  • Neoplasia

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  • Twitter Follow Adel Al Akeely at @adelalakeely and Leen Safieh at @leensafieh

  • Funding This work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.

  • Contributors All authors have given final approval of this version to be published. AGA, HMA, AHA and HA participated in drafting the manuscript, study design, data collection and screening, data analysis and evidence synthesis and revising the manuscript. LAS, SEC and DPE participated in literature search, data collection, data analysis and evidence synthesis and drafting the manuscript. AGA and HMA participated in hypothesis generation, evidence synthesis and revising the manuscript. AGA, HMA, AHA, HA, LAS, SEC and DPE participated in study design, data collection, screening and revising the manuscript.

  • Competing interests None.

  • Ethics approval Institutional Review Board at King Khaled Eye Specialist Hospital and King Saud University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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