Discussion :
Ocular adnexal lymphoma (OAL) is a rare manifestation of non-Hodgkin’s lymphoma (NHL). It represents 1%–2% of all NHL and 5%–10% of all extranodal lymphomas [2]. About 25%–30% of OALs involve the conjunctiva [2]. Conjunctival lymphomas are most commonly extranodal marginal zone lymphoma [previously termed mucosal associated lymphoid tissue (MALT)] (68%), follicular lymphoma (16%), mantle cell lymphoma (7%), and diffuse large B-cell lymphoma (5%). Whereas the T-cell and T/natural killer-cell lymphoma type are rare and very aggressive; this subtype presents only 1% to 3% of all lymphomas in these sites [3]. Up to 80% of T-cell NHL in the conjunctiva appear as secondary lymphomas [4].
Few cases of primary orbital peripheral T-cell lymphoma were reported in literature [5–9] (Table 1). Clinical features of conjunctival lymphoma are non-specific and the lesions can look nearly identical to other more benign processes. Biopsies and further studies are fundamental to make the diagnosis. Our case was an unusual site of T cell lymphoma; thus, the diagnosis was totally unexpected. As well as the patient did not have the widespread and systemic disease symptoms frequently associated withthis type of lymphoma. There by careful histopathological examinationis very important for prompt confirmation of the diagnosis and early commencement of treatment. However, patients should have a complete medical check and an extented evaluation of the systemic disease. There is no consensus on the treatment of these lymphomas. The management of conjunctival lymphoma relay on location, extent of periocular involvement, systemic staging of the disease, and general health of the patient [10]. The Modalities include complete surgical resection if possible; external beam radiotherapy and specifc systemic chemotherapy protocols. We opted for the last strategy in our case because the data is scarce. He was treated by CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone). T-cell lymphoma is considered extremely rare in conjunctiva with poor prognosis. Approximately, half of patients progress or relapse during the first year after diagnostic [7].  Our case illustrates the unfavorable evolution and the aggressiveness of the disease with meningeal relapse during the treatment. The patient died within 4,3 months of diagnosis.