Tissue Necrosis in Epstein-Barr Virus-Negative Orbital Diffuse Large B-Cell Lymphoma.

An 82-year-old man presented with a history of diplopia for 5 months and painful swelling of the left eyelids for 3 months. Imaging studies revealed a lesion involving the left extraocular muscles, orbital fat, and optic nerve. Laboratory investigations were negative for Epstein-Barr virus antiviral capsid antigens-immunoglobulin M. Initial biopsy of the lesion was performed and histopathologic examination revealed only necrosis with positivity of cluster of differentiation 20. This prompted a second biopsy of the involved left extraocular muscles and the orbital fat. The results of histopathological and immunohistochemical tests corresponded to Epstein-Barr virus-negative diffuse large B-cell lymphoma, germinal center B-cell type.