3. Incidental Diagnosis of Four Lid Orbital Lymphoma During a Blepharoplasty

OBJECTIVE: To report the first case of secondary orbital lymphoma (OL) in all four eyelids found incidentally during an aesthetic four lid blepharoplasty. METHODS: N/A (case report) RESULTS: A 76-year-old male with symmetric dermatochalia and marked fat prolapse of all four eyelids was interested in improving the aesthetic appearance of his lids. His history was significant for RAI Stage 0 chronic lymphocytic leukemia diagnosed 15 years prior to consultation. During the upper lid blepharoplasty, an orbital mass associated with the orbital fat and lacrimal gland was identified. The mass had an irregular, firm consistency and gray discoloration. The suspicion for malignancy was significant, so the mass was biopsied, and the rest of the procedure was aborted. Pathology was consistent with chronic lymphocytic leukemia/small lymphocytic lymphoma. CONCLUSION: To our knowledge, this is the first case of secondary OL in all four eyelids found incidentally during an aesthetic four lid blepharoplasty. In the U.S., over 300,000 blepharoplasties are performed annually. While encountering incidental tumors is uncommon, it is critical not to overlook the possibility of OL disguising itself as herniated fat pads, even in all four eyelids. Obtaining a thorough history and physical is paramount. While a palpable mass and proptosis are most commonly found in OL, patients may have a relatively benign exam. If intraoperative appearance is questionable, we recommend obtaining a biopsy and aborting the planned procedure, especially in patients with history of lymphoma and in procedures where the orbital fat has a firm consistency and gray discoloration. CORRESPONDING AUTHOR: Daniella Anderson, MD, 2911 Remy Ct NE, Grand Rapids, MI 49505. [email protected]. (805)358-7064