Abstract
Pediatric primary orbital lymphomas are exceptionally rare entities and represent a very small subset of both childhood orbital tumors and extra-nodal non-Hodgkin lymphomas. They often present with non-specific clinical features that can closely mimic inflammatory or other malignant orbital conditions, thereby posing significant diagnostic challenges. We report a rare case of an orbital lymphoma in an infant presenting with rapidly progressive, painless unilateral eyelid swelling. Magnetic resonance imaging demonstrated a well-defined extraconal orbital mass that appeared isointense on T1-weighted images and iso- to hypointense on T2-weighted sequences, with homogeneous post-contrast enhancement. The lesion exhibited marked diffusion restriction with significantly reduced apparent diffusion coefficient (ADC) values, indicative of a highly cellular neoplasm and in this context, most favorable diagnosis of lymphoma was considered. Histopathological evaluation, supported by immunohistochemistry and flow cytometry, confirmed an aggressive B-cell lymphoma, and molecular analysis revealed features consistent with Burkitt lymphoma. Staging fluorodeoxyglucose positron emission tomography demonstrated residual metabolically active disease confined to the orbit without evidence of systemic involvement. The patient was initiated on intensive multi-agent chemotherapy with an early favorable clinical response. A systematic review of the literature was subsequently done, which highlighted the extreme rarity of primary pediatric orbital lymphomas, with a predominance of high-grade B-cell histology, particularly Burkitt lymphoma. This case highlights the critical role of diffusion-weighted imaging and low ADC values in differentiating orbital lymphomas from other pediatric orbital masses, thereby facilitating early diagnosis, accurate lesion characterization, and timely initiation of therapy. Radiological awareness of these characteristic imaging features is essential to avoid diagnostic delay and to improve clinical outcomes in this rare but aggressive disease, given its marked responsiveness to treatment.
Keywords: apparent diffusion coefficient, burkitt lymphoma, diffusion-weighted imaging, orbital mass, padiatric orbital lymphoma
Introduction
Non-Hodgkin lymphomas (NHLs) are malignant neoplasms involving the lymph nodes, spleen, and other components of the reticuloendothelial system [1]. Orbital lymphomas are an uncommon form of NHLs arising from lymphoid tissue within the orbit and account for approximately 1-2% of all NHLs and 8-10% of extra-nodal lymphomas [2]. Orbital lymphomas are exceedingly rare in the pediatric population. These tumors may originate from the conjunctiva, eyelid, lacrimal gland, or lacrimal sac as well as from orbital structures including the extraocular muscles and typically present with eyelid swelling, ptosis, proptosis, and diplopia [2,3]. In this context, we present a rare case of an orbital lymphoma in a 14-month-old male child, highlighting its imaging characteristics with histopathological correlation. In addition, we provide a systematic synthesis of the existing literature to contextualize this entity within the broader spectrum of pediatric orbital tumors. This study aims to highlight the diagnostic value of magnetic resonance imaging (MRI) advanced imaging sequences, particularly diffusion-weighted imaging (DWI), and to highlight the importance of early radiological recognition in facilitating prompt diagnosis and initiation of therapy. Given the aggressive nature of the disease, yet its marked responsiveness to treatment, heightened awareness of these features is essential to improve clinical outcomes in this rare but significant condition.
Case presentation
A 14-month-old male child, the firstborn of a non-consanguineous marriage, with a recent diagnosis of Kawasaki disease, presented with progressively increasing swelling of the left eye over a period of 15 days. The swelling was insidious in onset, gradually progressive, and was leading to restriction in the field of vision; however, it was not associated with pain, trauma, or ocular discharge. The child was born at term by normal vaginal delivery with a birth weight of 2.8 kg and had an uneventful neonatal period without the need for intensive care. Immunization was up to date, and developmental milestones were appropriate for age.
On general examination, the child was alert and hemodynamically stable. Baseline vital parameters at presentation were as follows: blood pressure was 80/52 mmHg, pulse rate was 124 beats per minute, and oxygen saturation was 99% on room air.
Ophthalmic evaluation of the left eye revealed diffuse swelling of the upper eyelid. On palpation, the lesion had well-defined margins and was solid, soft, non-mobile, non-tender, and non-pulsatile (Figure 1). There was no change in size with the Valsalva maneuver. The cornea was clear, the pupil was reactive, and the lens was transparent.
Figure 1. Clinical photograph of the left eye showing diffuse swelling of the upper eyelid (red arrow).
The cornea was clear, the pupil was reactive, and the lens was transparent. Intraocular pressure measured by I-Care tonometry was 16 mmHg in the right eye and 17 mmHg in the left eye. Dry refractometry demonstrated a spherical correction of +0.50 diopters bilaterally.
In view of these clinical findings and the age of the patient, contrast-enhanced magnetic resonance imaging of the orbits was performed for further evaluation.
Contrast-enhanced MRI of the orbits demonstrated a well-defined extraconal mass in the superior compartment of the left orbit extending from the 10 to 2 o’clock position, measuring 4.4 × 2.9 × 1.3 cm (anteroposterior x transverse x craniocaudal). The mass was inseparable from the superior oblique muscle; it displaced the lacrimal gland and superior rectus muscle inferiorly and resulted in proptosis with posterior scleral flattening.
The lesion was isointense on T1-weighted (T1W) images (Figures 2a, 2b) and isointense to hypointense on the T2-weighted (T2W) (Figure 2c) image and relatively hyperintense on short tau inversion recovery (STIR) (Figure 2d), with homogeneous post-contrast enhancement (Figures 3a, 3b).
Figure 2. Contrast-enhanced magnetic resonance imaging of the orbits demonstrating the lesion as isointense on T1-weighted axial fat-saturated and T1-weighted sagittal images (a, b), isointense to hypointense on the T2-weighted axial image (c) and relatively hyperintense on the coronal short tau inversion recovery (STIR) sequence (d).
Figure 3. Axial magnetic resonance images of the orbits showing a fat-saturated T1-weighted image of the lesion in the left orbit (a) and post-contrast image demonstrating homogeneous enhancement of the lesion (b).
The lesion demonstrated marked diffusion restriction on DWI, and the corresponding apparent diffusion coefficient (ADC) was markedly reduced at 390 × 10⁻⁶ mm²/s (Figures 4a, 4b).
Figure 4. Diffusion-weighted imaging (DWI) of the orbits showing a hyperintense signal on DWI in the lesion in the left orbit (a) and corresponding hypointense signal on the ADC map (390 × 10⁻⁶ mm²/s) (b), consistent with significant restricted diffusion.
ADC: Apparent diffusion coefficient
There was no evidence of fat stranding or intracranial extension of the lesion. No obvious bony erosion was noted.
The contralateral orbit was normal. Based on the imaging findings, a neoplastic etiology was considered, with a lymphoma being the most favorable diagnosis, and other differential considerations including orbital rhabdomyosarcoma and inflammatory pseudotumor.
An excisional biopsy of the lesion was performed for definitive diagnosis. Histopathological examination revealed a malignant round cell tumor. Immunohistochemistry showed slight positivity for leukocyte common antigen and negativity for terminal deoxynucleotidyl transferase, desmin, myogenin, and MyoD1. Further immunophenotyping demonstrated weak CD20 expression, diffuse nuclear positivity for PAX-5, and positivity for CD19 and CD10, with weak BCL2 expression, while markers including CD3, CD34, myeloperoxidase (MPO), and CD117 were negative, favoring a diagnosis of an aggressive B-cell non-Hodgkin lymphoma (Figures 5a-5c).
Figure 5. a: CD10 IHC, x100. The atypical lymphoid cells are strongly and diffusely immunopositive for CD10. b: CD19 IHC, x100. The atypical lymphoid cells are diffusely immunopositive for CD19. c: H&E stained, x200, the orbital mass shows diffuse infiltration by intermediate-sized atypical lymphoid cells, which show brisk mitotic activity.
IHC: Immunohistochemistry; CD: cluster of differentiation
Fluorodeoxyglucose positron emission tomography (FDG-PET) was subsequently performed following excision for staging and to evaluate for any additional primary lesions. It demonstrated an FDG-avid soft tissue lesion along the superior aspect of the left orbit at the postoperative site with a maximum standardized uptake value (SUVmax) of 6.7, raising the suspicion of a residual lesion or postoperative inflammatory changes. There was associated anterior displacement of the globe without evidence of bony erosion or distant disease (Figures 6a-6c).
Figure 6. Coronal bone window of non-contrast computed tomography shows soft tissue thickening (red star) with no evidence of bony erosion (a). Positron emission tomography–computed tomography images show uptake in the lesion (b and c).
In order to rule out residual disease or inflammatory changes, ultrasonography-guided fine-needle aspiration cytology (FNAC) was performed (Figure 7). FNAC from the residual orbital lesion was undertaken, and flow cytometric immunophenotyping confirmed a predominant mature B-cell population expressing CD19, CD10, CD38, and PAX-5 with a Ki-67 proliferation index exceeding 95%, consistent with residual disease.
Figure 7. Ultrasonography image showing the needle tip (red arrow) at the time of insertion with the bulk of the lesion (star) appearing as a hypoechoic solid lesion.
Subsequently, fluorescence in situ hybridization (FISH) analysis demonstrated an IGH::MYC rearrangement t(8;14)(q24;q32) in 95% of tumor cells, while other recurrent cytogenetic abnormalities were negative. These findings supported the diagnosis of an aggressive high-grade B-cell lymphoma with MYC rearrangement most consistent with Burkitt lymphoma.
Bone marrow evaluation was subsequently performed, and flow cytometry revealed prominent hematogones without evidence of a blast population, indicating the absence of marrow involvement.
The patient was initiated on chemotherapy with the modified multicentric protocol 842 regimen A, a standard treatment for pediatric high-grade B-cell lymphomas [4]. The regimen included cyclophosphamide administered at 800 mg/m² on day 1, followed by 200 mg/m² on days 2 to 4, doxorubicin at 20 mg/m², vincristine at 1.4 mg/m², and cytarabine at 500 mg/m² every 12 hours for two doses. Intrathecal methotrexate and cytarabine were administered for central nervous system prophylaxis. Rituximab was added as targeted therapy, and granulocyte colony-stimulating factor was provided to support marrow recovery. Treatment cycles were planned at 21-day intervals, subject to adequate hematological recovery. Follow-up PET-CT showed a marked reduction in the soft tissue lesion with no uptake (Figure 8). The patient showed a significant reduction in swelling after three cycles, as demonstrated in the clinical image (Figure 9).
Figure 8. Follow-up PET shows no residual soft tissue lesion with no uptake after three cycles of chemotherapy.
Figure 9. Clinical photograph showing near total reduction in swelling and good response to treatment.
Discussion
Pediatric orbital lymphomas are an exceedingly rare manifestation of lymphomas, accounting for less than 1% of all childhood orbital tumors and approximately 1-5% of pediatric NHL cases [3,5]. The clinical presentation in children is often non-specific and commonly includes proptosis, ptosis and inflammatory eyelid swelling [3,6]. In contrast to adults, pediatric cases may present with atypical features not typically associated with orbital masses such as convergent squint, strabismus or esotropia, which may contribute to delays in diagnosis. In rare and extreme instances, the disease may be so advanced at birth that an intrauterine origin has been postulated [3].
Radiological evaluation using CT and MRI is fundamental for diagnosis and lesion characterization [6]. Orbital lymphomas most frequently involve the superolateral orbit and often affect the superior oblique muscle, presenting as enhancing soft-tissue masses that may extend into the intraconal and, less commonly, the intracranial compartments as reflected in the present case [6,7].
Priego et al. reported that orbital lymphomas typically lack tumoral calcification and do not demonstrate bony involvement, erosion, or hyperostosis [7]. Our case similarly showed no evidence of calcification, bony involvement, erosion, or hyperostosis.
Naves et al. reported that most orbital lymphomas appear isointense to extraocular muscles on T1W images and relatively hypointense on T2W sequences, attributed to their high cellularity [8]. These lesions also demonstrate homogeneous enhancement and markedly reduced apparent diffusion coefficient values, with a proposed threshold below 612 × 10⁻⁶ mm²/s; however, this threshold has been described in adult lymphomas, and a specific pediatric cut-off has not yet been established [8]. In our case, the lesion was isointense on T1W images and iso to hypointense on T2W images, with significantly reduced ADC values and homogeneous enhancement. Although T2 signal characteristics may vary depending on tumor cellularity and internal composition, restricted diffusion with low ADC remains a reliable imaging marker for lymphoma, including in the pediatric population.
Orbital rhabdomyosarcoma, the most common primary malignant orbital tumor in children, is characterized by rapid progression and aggressive local behavior. On imaging, it typically appears hyperintense on T2W images and is often associated with bony erosion and close relation to the extraocular muscles [8].
Kralik et al. demonstrated that diffusion characteristics may aid differentiation: rhabdomyosarcoma shows restricted diffusion but generally higher ADC values than lymphoma, whereas lymphoma demonstrates very low ADC values due to marked cellularity. Similar findings were also reflected in our case [9].
Ren et al. described an orbital pseudotumor, also termed idiopathic orbital inflammatory disease, as a benign inflammatory condition that can mimic orbital neoplasms in adults and children. It may involve any orbital structure, including the extraocular muscles, lacrimal gland, orbital fat, sclera and optic nerve sheath; however, it typically presents as a painful and aggressive lesion [10]. In contrast, our case demonstrated a non-tender swelling, thereby making pseudotumor less likely.
Based on a comprehensive correlation of clinical findings, imaging characteristics, histopathology, immunohistochemistry, and FISH, a final diagnosis of aggressive high-grade B-cell lymphoma with MYC rearrangement, most consistent with Burkitt lymphoma, was made.
Review of literature
A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, and Google Scholar was performed for studies published up to 2025 using the following search terms: “pediatric orbital lymphoma” OR “childhood orbital lymphoma” OR “orbital non-Hodgkin lymphoma in children” OR “ocular adnexal lymphoma pediatric”.
Eligibility Criteria
Inclusion criteria comprised patients younger than 18 years of age with histopathologically confirmed primary orbital or ocular adnexal lymphoma, including case reports, case series, or observational studies providing individual patient data, imaging findings available, and articles published in English.
Exclusion criteria included studies involving only adult populations, review articles without extractable patient-level data, non-orbital lymphomas, and duplicate or overlapping datasets.
Following screening and eligibility assessment, 12 studies, encompassing approximately 15 pediatric patients with orbital lymphoma, were included in the qualitative synthesis (Figure 10).
Figure 10. PRISMA review flow diagram.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Table 1 summarizes the published literature on primary pediatric orbital lymphoma and highlights the marked rarity, heterogeneous histopathological spectrum, and variable imaging appearance of this entity. Early reports by Leidenix et al. [11], Alford et al. [12], and King et al. [13] demonstrated aggressive orbital masses with varying degrees of bony destruction and intracranial extension in lymphoblastic and T-cell lymphomas. Faridpooya et al. [14] described a well-circumscribed extraconal lesion without osseous involvement, whereas Amit et al. [2] reported a homogeneous superior extraconal orbital mass in T-cell lymphoma. Grasso et al. [15] and Alkatan et al. [16] documented Burkitt and T-cell lymphomas with extraocular muscle involvement and associated orbital wall erosion. Knudson et al. [17] and Parikh et al. [18] described a diffuse large B-cell lymphoma involving adjacent sinonasal structures and the lacrimal sac, respectively. Keren et al. [3], in the largest pediatric series to date, demonstrated extensive skull base involvement, intracranial extension, and osseous destruction in multiple cases of Burkitt lymphoma. More recently, Saxena et al. [19] and Nguyen et al. [6] emphasized the diagnostic value of MRI and diffusion restriction in lesion characterization. Similar to prior studies, our case demonstrated a homogeneous enhancing extraconal lesion with marked diffusion restriction and superior oblique muscle involvement, reinforcing the importance of advanced MRI sequences in early diagnosis and differentiation from other pediatric orbital masses.
Table 1. Review of literature of reported cases of primary pediatric orbital lymphoma.
F: Female; M: Male; NR: Not reported; CT: Computed Tomography; MRI: Magnetic Resonance Imaging; PET: Positron Emission Tomography
| Author | Year | Age | Sex | Diagnosis | Presentation | Imaging Findings (Modality + Muscle + Bone) |
| Leidenix et al. [11] | 1993 | 8 years | F | T-cell lymphoma | Lid swelling | CT: Large, lateral, anterior left orbital soft tissue mass Muscle: NR. Bone: erosion into the anterior cranial fossa through the roof of the orbit. |
| Alford et al. [12] | 1999 | 12 years | M | B-lymphoblastic lymphoma | Proptosis | CT/MRI: Dense mass involving the left orbit, the left pterygopalatine fossa, left maxillary sinus and left nasal cavity; Muscle: extraocular muscles (unspecified); Bone: extension through the cribriform plate into the anterior cranial fossa |
| King et al. [13] | 2000 | 8 years | M | Lymphoblastic lymphoma | Ptosis, diplopia | CT/MRI: homogeneous mass in the superior and superolateral orbit. Muscle: NR; Bone: Minor bony destruction and marrow space obliteration |
| Faridpooya et al. [14] | 2006 | 6 years | M | B-lymphoblastic lymphoma | Red eye, swelling | MRI: Well-circumscribed periorbital extraconal lesion with smooth margins involving the left lacrimal gland Muscle: NR Bone: none |
| Amit et al. [2] | 2012 | 6 years | M | T-cell lymphoma | Proptosis | CT: Large left orbital extra-conal homogenous mass along the superior and medial orbital wall. Muscle: NR; Bone: None. |
| Grasso et al. [15] | 2016 | 3 years | M | Burkitt lymphoma | Proptosis | MRI: Homogeneous hypointense solid, well-defined, extraconal mass occupying the superior and lateral part of the right orbit Muscle: Encasement of the superior rectus and the lateral rectus; Bone: Erosion of the lateral wall of orbit. |
| Alkatan et al. [16] | 2018 | 3 years | M | T-cell lymphoma | Lid swelling | MRI/CT: Solid enhancing mass lesion, involving the lateral and inferior walls of his left orbit, and extending into the intraconal compartment; Muscle: Inferior rectus ; Bone: Osseous destruction at the left inferior lateral orbital margin. |
| Knudson et al. [17] | 2019 | 11 years | M | Diffuse large B-cell lymphoma | Proptosis | CT/MRI: Heterogeneously enhancing mass involving the superior-medial right orbit, right anterior ethmoid air cells, right frontal sinus, and the anterior cranial fossa; Muscle: displacement of the right superior rectus, superior oblique, and medial rectus. Bone: Destruction of the right lamina papyracea. |
| Parikh et al. [18] | 2019 | 13 years | M | Diffuse large B-cell lymphoma | Eyelid swelling | MRI: Lobulated lesion to the bony space in the medial left orbit and extending to the left nasolacrimal duct. Muscle: NR Bone: None |
| Keren et al. [3] | 2022 | 5 years 2 month | M | Burkitt lymphoma | Visual loss | MRI: Enhancing lesion central sphenoid sinus and posterior ethmoid sinus; Muscle: NR; Bone: Erosion of the orbital apices, anterior cranial fossa, pituitary fossa, and left cavernous sinus |
| Keren et al. [3] | 2022 | 2 years 9 month | M | Burkitt lymphoma | Proptosis | MRI: Skull base disease centred on the left sphenoid bone with Muscle: NR; Bone: intracranial extension through sphenoid sinus. |
| Keren et al. [3] | 2022 | 3 years | M | Burkitt lymphoma | Ptosis | MRI: Large tumour centred on the basisphenoid with extensive central skull base involvement. Muscle: NR; Bone: Involvement of the basisphenoid with extradural extension to the anterior and middle cranial fossae, indicating skull base erosion. |
| Keren et al. [3] | 2022 | 1 month | F | Burkitt lymphoma | Bilateral proptosis | MRI: Extensive infiltration of an intraorbital mass on the lateral aspect of the left orbit with bone destruction and soft tissue extension to the left side of the face.; Muscle: NR; Bone: orbital wall |
| Saxena et al. [19] | 2023 | 17 years | — | Burkitt lymphoma | Proptosis | MRI: Ill-defined, retrobulbar, intraconal lesion extending up to the orbital apex, causing significant proptosis Muscle: NR Bone: No bony erosion. |
| Nguyen et al. [6] | 2024 | 13 years | M | High-grade B-cell lymphoma | Proptosis, eyelid swelling | MRI: Diffusion restriction; Muscle: multiple EOM encasement (unspecified); Bone: none |
| Present case | 2026 | 1 year 4 months | M | B-lymphoblastic lymphoma | Eyelid swelling | MRI + PET: Extraconal mass; muscle: superior oblique; bone: none; FDG avid |
Conclusions
In conclusion, a pediatric primary orbital lymphoma remains an exceptionally rare but important diagnostic consideration in children presenting with orbital masses. This PRISMA-based review highlights its rarity, with fewer than 20 reported cases, a predilection for young boys and a typical presentation with proptosis or eyelid swelling, most commonly associated with high-grade B-cell histology, particularly the Burkitt subtype with potential for systemic involvement. Imaging consistently demonstrates a homogeneous orbital mass with restricted diffusion, reinforcing the important role of advanced MRI techniques in early diagnosis. Our case emphasizes that a low ADC value provides important diagnostic support in pediatric orbital lymphoma; however, an exact pediatric-specific ADC cut-off has not yet been established. Despite its aggressive nature, prompt recognition and early systemic chemotherapy can result in excellent clinical outcomes, as demonstrated in our patient. However, due to the limited number of reported cases, the generalizability of these findings remains limited, highlighting the need for larger studies to validate quantitative imaging parameters and refine diagnostic imaging criteria in the pediatric population.
Acknowledgments
We gratefully acknowledge Dr Shantanu S. Pande, Associate Professor in Nuclear Medicine in AIIMS Nagpur for his valuable contribution to the PET-CT diagnosis and imaging interpretation, which significantly supported this study.
Disclosures
Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Kumar Rajnish Anand, Deepshikha Arora, Shilpa Pande, Avinash Dhok, Prashant Ramteke
Acquisition, analysis, or interpretation of data: Kumar Rajnish Anand, Deepshikha Arora, Shilpa Pande
Drafting of the manuscript: Kumar Rajnish Anand, Deepshikha Arora
Critical review of the manuscript for important intellectual content: Kumar Rajnish Anand, Deepshikha Arora, Shilpa Pande, Avinash Dhok, Prashant Ramteke
Supervision: Shilpa Pande, Avinash Dhok
References
- 1.Non-Hodgkin's lymphoma: a review. Singh R, Shaik S, Negi BS, Rajguru JP, Patil PB, Parihar AS, Sharma U. J Family Med Prim Care. 2020;9:1834–1840. doi: 10.4103/jfmpc.jfmpc_1037_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Primary orbital non-Hodgkin's lymphoma. Amit S, Purwar N, Agarwal A, Kanchan S. BMJ Case Rep. 2012;2012 doi: 10.1136/bcr-2012-006847. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Paediatric orbital lymphoma; a case series and review of the literature. Keren S, Lapira M, McCallum E, et al. Eye (Lond) 2023;37:1002–1008. doi: 10.1038/s41433-022-02266-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Favorable outcomes and reduced toxicity with a novel vinblastine-based non-high dose methotrexate (HDMTX) regimen (modified MCP-842) in pediatric anaplastic large cell lymphoma (ALCL): experience from India. Vijayasekharan K, Prasad M, Pradhan ND, et al. Leuk Lymphoma. 2020;61:912–918. doi: 10.1080/10428194.2019.1695054. [DOI] [PubMed] [Google Scholar]
- 5.A rare case of massive pediatric orbital non-Hodgkin lymphoma with underlying acute myeloid leukemia: delayed presentation and chemotherapy response. Arvind P Shreya, Priti K, Shivani J, et al. Ind J Ophthalmol. 2026;6:41–43. [Google Scholar]
- 6.Pediatric orbital high-grade B-cell lymphoma: a case report and review of the literature. Nguyen KK, Regner MF, Olson SB, Ng JD. Ophthalmic Plast Reconstr Surg. 2025;41:0–2. doi: 10.1097/IOP.0000000000002885. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Orbital lymphoma: imaging features and differential diagnosis. Priego G, Majos C, Climent F, Muntane A. Insights Imaging. 2012;3:337–344. doi: 10.1007/s13244-012-0156-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Practical approach to orbital lesions by anatomic compartments. Gotti Naves G, José de Oliveira Cabral H, de Oliveira HR, Scoppetta TL, Zuppani HB, Assunção FB. Radiographics. 2024;44:0. doi: 10.1148/rg.240026. [DOI] [PubMed] [Google Scholar]
- 9.Orbital infantile hemangioma and rhabdomyosarcoma in children: differentiation using diffusion-weighted magnetic resonance imaging. Kralik SF, Haider KM, Lobo RR, Supakul N, Calloni SF, Soares BP. J AAPOS. 2018;22:27–31. doi: 10.1016/j.jaapos.2017.09.002. [DOI] [PubMed] [Google Scholar]
- 10.Differentiation of orbital lymphoma and idiopathic orbital inflammatory pseudotumor: combined diagnostic value of conventional MRI and histogram analysis of ADC maps. Ren J, Yuan Y, Wu Y, Tao X. BMC Med Imaging. 2018;18:6. doi: 10.1186/s12880-018-0246-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Primary T-cell immunoblastic lymphoma of the orbit in a pediatric patient. Leidenix MJ, Mamalis N, Olson RJ, McLeish WM, Anderson RL. Ophthalmology. 1993;100:998–1002. doi: 10.1016/s0161-6420(13)31527-9. [DOI] [PubMed] [Google Scholar]
- 12.Precursor B-cell lymphoblastic lymphoma presenting as an orbital mass. Alford MA, Nerad JA, Conlan RM, Comito M, Giller RH. Orbit. 1999;18:17–24. doi: 10.1076/orbi.18.1.17.2723. [DOI] [PubMed] [Google Scholar]
- 13.Null cell lymphoblastic lymphoma of the orbit. King AJ, Fahy GT, Brown L. Eye (Lond) 2000;14 ( Pt 4):665–667. doi: 10.1038/eye.2000.165. [DOI] [PubMed] [Google Scholar]
- 14.Precursor B lymphoblastic lymphoma of the orbit in a child: an unusual presentation of a non-Hodgkin lymphoma. Faridpooya K, Mulder MM, Merks JH, de Smet MD, Pals ST, Saeed P. Orbit. 2006;25:153–157. doi: 10.1080/01676830600575501. [DOI] [PubMed] [Google Scholar]
- 15.Sporadic Burkitt's lymphoma/acute B-cell leukaemia presenting with progressive proptosis and orbital mass in a child. Grasso D, Borreggine C, Ladogana S, De Santis R, Delle Noci N, Grilli G, Macarini L. Neuroradiol J. 2016;29:231–235. doi: 10.1177/1971400916639964. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Orbital T-cell lymphoma in youngest recorded patient - early diagnosis, management, and successful outcome: a case report and review of the literature. Alkatan HM, Alrashed SH, Al-Rikabi AC, Al-Faky YH. J Med Case Rep. 2018;12:139. doi: 10.1186/s13256-018-1630-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Pediatric diffuse large B‑cell lymphoma of the frontal sinus: a case report. Knudson SA, Day KM, Harshbarger RJ. Cleft Palate Craniofac J. 2019;56:1089–1095. doi: 10.1177/1055665619831165. [DOI] [PubMed] [Google Scholar]
- 18.Primary lacrimal sac diffuse large B-cell lymphoma in a child. Parikh D, Rodgers R, Kodsi S. J AAPOS. 2019;23:53–55. doi: 10.1016/j.jaapos.2018.06.009. [DOI] [PubMed] [Google Scholar]
- 19.Sporadic Burkitt lymphoma involving the orbit: a report of two cases and review of literature. Saxena S, Koka K, Scott JX, Mukherjee B. Orbit. 2023;42:426–430. doi: 10.1080/01676830.2021.2020849. [DOI] [PubMed] [Google Scholar]