We read with great interest the review article by Drs Stefanovic and Lossos on extranodal marginal zone lymphoma of the ocular adnexa (OAML). Although we agree on most of the issues covered and authors' viewpoints, we would like to add constructive comments on the topic of OAML to allow Blood readers to consider equally important critical issues complementary to those raised by the authors.The most relevant issues of this letter involve the relationship between Chlamydophila psittaci (Cp) infection and OAML. In this context, it is important to highlight that some recent studies have increased the level of evidence supporting this association. In a large cumulative series, the presence of Cp in OAML has been demonstrated by 3 different polymerase chain reaction techniques, immunohistochemistry, immunofluorescence technique, and electron microscopy. In addition, a prospective case-control study has confirmed both viability and infectivity of Cp by means of in vitro isolation and growth in OAML patients, fulfilling the second Koch postulate for this bacterium-lymphoma association. Together with Helicobacter pylori, Cp is presently the only bacterium with lymphomagenic potential isolated so far in in vitro cultures from lymphoma patients.
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