A 62-year-old man presents with a painless, slowly enlarging, salmon-pink, freely mobile fleshy mass in the inferior fornix of one eye. The lesion has been present for eight months. Biopsy would be expected to show:
- A Benign reactive lymphoid hyperplasia with germinal centres and polyclonal immunoglobulin expression
- B Spindle cells arranged in fascicles with mitotic figures
- C Monoclonal proliferation of small B lymphocytes positive for CD20 ✓
- D Full-thickness dysplasia of the squamous epithelium
Correct answer: C. Monoclonal proliferation of small B lymphocytes positive for CD20
Explanation
The salmon-patch appearance in the fornix of an older patient is classic for conjunctival extranodal marginal zone C-cell lymphoma of MALT type. It is typically painless, mobile, and may be bilateral. Histology shows a monomorphic population of small CD20-positive C cells with light chain restriction. Option A describes benign reactive lymphoid hyperplasia, which is polyclonal, and clonality is precisely what separates the two.
Reference: Albert and Jakobiec, Principles and Practice of Ophthalmology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.