JMA Journal

Figure 1. Clinical and magnetic resonance imaging findings.
(A) Oculomotor impairment of the right eye: upward (a), right (b), forward (c), left (d), and downward (e) gazes. Right-dominant, non-mass-like enhancements in the adipose tissues in both orbits in axial (B) and coronal (C) sections of gadolinium-enhanced T1-weighted imaging.

Figure 2. Histopathologic findings of the ocular adnexa of the right orbit.
(A) Lymphoma cells proliferated within the lumina of small blood vessels in the choroid of the right eye (hematoxylin and eosin [H&E] staining). (B) Proliferation of lymphoma cells inside CD31-positive vascular endothelial cells with minimal extravascular invasion in the choroid of the right eye (CD31 immunohistochemical staining). (C) The extraocular muscles of the right eye showing atrophic muscle fibers and lymphoma cell invasion in the endomysium. A high-power view of the outlined area showed endomysial fibrosis with no evident necrotic or regenerating muscle fibers (inset) (H&E staining). (D) The extraocular muscles of the left eye showing non-atrophic fibers without extravascular invasion of lymphoma cells in the endomysium (H&E staining). (E) The right orbital adipose tissue showing lymphoma cell invasion (H&E staining). (F) The left orbital adipose tissue without extravascular invasion of lymphoma cells (H&E staining). Bars = (A-F) 100 μm; (inset in C) 50 μm.

Figure 3. Histopathologic findings of the small nodule in the left adrenal gland.
(A) Large lymphoma cells with irregular nuclei and scant cytoplasm proliferated inside the sinusoidal capillaries in the small nodule in the left adrenal gland (H&E staining). Immunohistochemical staining showed the lymphoma cells positive for CD3 (B), CD56 (C), and Epstein-Barr virus-encoded RNA 1 (EBER-1) (D). Bars = 50 μm.