Cutaneous T-cell lymphoma presenting as a rapidly enlarging ocular adnexal tumor.

A 63-year-old man, in good health previously, developed swelling and erythema of the right upper eyelid which progressed to involve both eyelids and surrounding tissues. After one month, he had a 9.0 × 9.0 × 3.5 cm mass despite two attempts at incisional drainage and treatment with antibiotics. Multiple asymptomatic erythematous nodules (2–3 cm in diameter) developed on his back, trunk, and arms four weeks after onset of the eyelid erythema and swelling. Biopsies of two upper back papules and the eyelid disclosed cutaneous T-cell lymphoma, a lymphoproliferative malignancy of thymus derived lymphocytes originating in the skin. Systemic chemotherapy resulted in a marked decrease in the ocular adnexal mass but lymphomatous meningitis and quadriplegia developed. The patient died four months later; an autopsy was not performed. This case demonstrates that cutaneous T-cell lymphoma may rarely have its initial manifestation as a rapidly enlarging eyelid tumor.