Bilateral eyelid masses and enophthalmos as the initial manifestation of diffuse large B-cell lymphoma: a case report.

Background: Ocular adnexal lymphoma is considered an uncommon disease, but it is among the most common malignancies affecting the ocular adnexa. While diffuse large B-cell lymphoma constitutes 10% of ocular adnexal lymphomas, the initial presentation with bilateral eyelid swelling is quite rare and can be diagnostically challenging.

Case presentation: Here, we report a case of a 64-year-old Middle Eastern male patient with no prior history of malignancy who presented with a 5-month history of bilateral upper eyelid swelling, mild enophthalmos, and ptosis. The patient had no systemic symptoms. The masses were surgically resected, and histopathological examination confirmed the diagnosis of diffuse large B-cell lymphoma. Following surgical resection, the patient developed submandibular and parotid gland enlargements. Subsequent contrast-enhanced computed tomography scan revealed an enhancing mass posterior to the descending aorta. The patient received six cycles of rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone regimen. Despite the aggressive nature of diffuse large B-cell lymphoma, clinical remission has been achieved. Follow-up positron emission tomography revealed no residual disease.

Conclusion: Bilateral eyelid swelling is a rare initial sign of aggressive lymphoma, such as diffuse large B-cell lymphoma, even in the absence of systemic symptoms. Clinicians should consider malignancy in such atypical presentations to ensure early diagnosis and treatment.