Efficacy of selective laser trabeculoplasty after canaloplasty

CD38 (Fig. 2c) and CD138 (Fig. 2d), and negative for CD20, CD3, CD30 and Epstein–Barr virus in situ hybridization. ALK expression was positive, with a granular cytoplasmic pattern (Fig. 2e). Ki67 was expressed in 90% to 95% of cells. FISH analysis with a dual-colour break-apart rearrangement probe (CymoGenDx) showed the typical split signal pattern consistent with a rearrangement involving the ALK gene (Fig. 2f). The patient received six cycles of a cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) protocol, associated with prophylactic intrathecal chemotherapy including methotrexate, cytarabine and dexamethasone (MADIT), in the first day of each CHOP cycle. Because of the aggressive nature of the tumour, treatment was complemented with radiation therapy and autologous stem-cell transplantation. The response was complete, with no recurrence during a 2-year follow-up period. Large B-cell lymphomas are a clinically and biologically heterogeneous group of lymphomas formed by immature cells similar to immunoblasts, encompassing lesions that express mature B-cell markers, such as CD 20, and neoplasms with plasmocytic differentiation designated as plasmablastic lymphomas. LBCL-ALK+ lymphoma is a rare example of the latter type, usually diagnosed in young immunocompetent patients, with a negative profile for Epstein–Barr virus and Human Herpes virus 8, and primarily involving lymph nodes. Since the first description of LBCL-ALK+, around 70 cases with nodal or extranodal involvement have been reported. This number howevermay be underestimated, as several reports of presumedplasmablastic lymphomas lack a reference to ALK staining. If this specific marker is not performed, the tumour may be easily misdiagnosed, as Colomo and co-workers have already highlighted. This has important prognostic and treatment implications because ALK-positive LBCL tumours are more aggressive than ALK-negative lesions and new therapeutic options acting as ALK inhibitors are being developed with promising results. In the present case, the main challenge was an atypical presentation as a well-circumscribed lesion causing globe indentation and displacement withmarked inflammatory-like signs, not commonly seen in lymphoproliferative lesions. Incisional biopsywas an essential step for a correct diagnosis and management. Even without detectable systemic involvement, the diagnosis warranted an aggressive therapy involving chemotherapy, radiotherapy and autologous stem-cell transplantation, with an excellent outcome.