Giant Orbital MALT Lymphoma in a 72-Year-Old Woman: A Case Report

<title>Abstract</title> <p>Orbital mucosa-associated lymphoid tissue (MALT) marginal zone lymphoma is the most common subtype of ocular adnexal lymphoma. In elderly patients, it typically presents as a slowly enlarging, painless mass. Giant lesions (&gt; 5 cm) are extremely rare. This article reports a rare case of giant orbital MALT lymphoma in a 72-year-old woman and reviews similar cases in the literature. The patient was a 72-year-old Asian woman with a left orbital mass that had been slowly enlarging for 6 years and a 4-year history of hypertension. Ophthalmic examination revealed a large, soft, dark-red mass in the left orbit protruding beyond the orbital rim, accompanied by vascular dilatation and congestion of the eyelid skin, complete ptosis, difficulty opening the eye, severe conjunctival chemosis, extensive corneal neovascularization, and sluggish pupillary light reflex. MRI demonstrated a mass measuring 7.4 cm × 6.2 cm × 4.9 cm involving the orbital apex. The patient underwent resection of the left orbital lesion. Postoperative pathology confirmed MALT lymphoma with CD20(+), CD79α(+), Bcl-2(+), and Ki-67 ≈ 20%. The surgical wound healed well. At 3-month follow-up, the patient declined adjuvant radiotherapy and has remained recurrence-free on regular monitoring. This case demonstrates that combined imaging and histopathological evaluation is essential for the definitive diagnosis of giant orbital MALT lymphoma. The patient’s delayed presentation led to significant disease progression, highlighting the need to strengthen health education, promote early diagnosis and treatment in elderly patients, and prevent diagnostic delays.</p>