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Vincenzo Isola,1 Danilo Mazzacane,1 Noemi Defelice,1 Antonio D’Amico,1 Laura Dezza,2 Antonio Marti,3 Alfredo Pece,1,41Department of Ophthalmology, Melegnano Hospital, 2Oncology Service, 3Department of Radiology, 4Fondazione Retina 3000, Milan, ItalyAbstract: This report documents a case of T cell lymphoma manifesting only with a conjunctival mass. A 67-year-old man underwent a diagnostic punch biopsy, histopathological examination, and immunohistochemical study for a pink-yellow colored mass infiltrating the bulbar conjunctiva in the lower fornix of the eyelid. A biopsy specimen of the conjunctival mass was found histopathologically to be a malignant T cell lymphoma. Systemic involvement was diagnosed within four weeks after the initial diagnosis by computed tomography, showing evidence of extension at the level of the ethmoidal cells, optic nerve, periorbital tissue, and pancreas. T cell lymphoma of the conjunctiva as a primary manifestation of systemic cancer is an uncommon entity. Punch biopsy may be the first diagnostic pathway useful to initiate a search for systemic involvement of a malignant lymphoid tumor of T cell lineage.Keywords: conjunctiva, cancer, T cell lymphoma, biopsy