Successful Treatment of Peripheral T-cell Lymphoma Not Otherwise Specified in Bilateral Subconjunctiva: A Case Report.

Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) typically presents in lymph nodes with advanced-stage disease. Ocular adnexal involvement, particularly bilateral subconjunctival presentation, is exceptionally rare. We describe a 39-year-old woman who presented with progressive bilateral conjunctival masses despite one year of topical corticosteroid treatment. Examination revealed well-demarcated pink subconjunctival nodules in both eyes. Following surgical excision, histopathological and immunophenotypic analyses confirmed PTCL-NOS with CD3+/CD4+ T-cell infiltration. Molecular studies detected clonal T-cell receptor gene rearrangement in both tumor tissue and bone marrow, indicating stage II disease. The patient achieved complete remission with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy and remains disease-free after three years. To our knowledge, this represents the first reported case of primary bilateral subconjunctival PTCL-NOS successfully managed with systemic chemotherapy, highlighting the importance of comprehensive evaluation and aggressive treatment in this unusual presentation.