Case Report of Nodular Fasciitis in the Conjunctiva

PURPOSE: We report a case of nodular fasciitis of the conjunctiva that has not been previously reported in the Republic of Korea.CASE SUMMARY: A 18-year-old female patient presented with a left conjunctival mass, which had been enlarging for 1 month. The tumor was located at the corner of the conjunctiva of the left eye. The size of the tumor was 1 mm in width and 1.5 mm in height, and tenderness and redness were not observed. There was no history of trauma, but bilateral upper lid blepharoplasty was performed 2 months prior to her visit. Excision of a conjunctival mass was performed and there was no evidence of involvement of the sclera or peripheral conjunctiva around the mass. We performed immunohistochemistry and PCR for human herpes virus 8 (HHV8). Immunohistochemistry was positive for S-100 and negative for smooth muscle actin and HHV8. The mass was myofibroblastic in nature and the histopathological features and clinical findings of this case were diagnosed as nodular fasciitis with the features as described above. There was no recurrence for 4 months after removal of the mass.CONCLUSIONS: Because the treatments and prognoses of malignant tumors or other inflammatory diseases such as nodular scleritis and nodular fasciitis are quite different, differentiation from these diseases is considered an important factor in the diagnosis of nodular fasciitis.

Clinical pathological analysis of 422 primary conjunctival masses / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To improve accuracy of the diagnosis of primary conjunctival masses(PCM) through analyze the clinicopathological characteristics and pathogenic causes of 422 cases of PCM.METHODS:Clinical manifestations, histological characteristics and immunopheno types were reviewed.Relevant literatures were reviewed.RESULTS:Benign conjunctival masses were 403 cases (95.5%).Those included masses from squamous cell papilloma (71 cases, 17.6%), conjunctival cyst (68 cases, 16.9%), inflammatory masses (62 cases, 15.4%), pigmented nevus (60 cases, 14.9%), lipoma (58 cases, 14.4%).Malignant conjunctival neoplasms were 19 cases (4.5%).Those included tumors from B Cell Lymphoma (6 cases,31.6%), melanoma (6 cases,31.6%), and squamous cell carcinoma (5 cases, 26.3%).Different types of primary conjunctival masses were induced by the same cause.CONCLUSION:The pathological types of primary conjunctival masses are various and the majority of which is benign.For the diagnosis of primary conjunctival masses, morphological analysis, immunohistochemical examination shoud be combined to increase the diagnostic accuracy and decrease misdiagnosis rate.

A Case of Primary Conjunctival Giant Cell Tumor

PURPOSE: To report a case of primary conjunctival giant cell tumor (GCT). CASE SUMMARY: A 67-year-old female visited our clinic with the chief complaint of a 10-year-history of conjunctival mass in the left eye. The patient had no marked changes in the mass size, and her visual acuity and intraocular pressure were within the normal range. The protruding conjunctival mass invaded the limbal area at the 8 o’clock direction in the left eye and was 5 × 4 × 2 mm in size. Moreover, the pink-colored mass had a lobulated shape with a well-defined margin. In the adjacent mass region, concurrent presence of the conjunctival injection was observed. However, the patient did not exhibit pain or tenderness. We performed wide excision of the conjunctival mass concomitantly with amniotic membrane transplantation. Then, histopathological examinations and immunohistochemical staining of the surgical site were performed. On histopathology, the patient had findings suggestive of GCT. Additionally, immunohistochemistry was positive for CD68 and vimentin. leading to the final diagnosis of GCT. CONCLUSIONS: To our knowledge, this is the first case of GCT of the conjunctiva, which has not been described in the literature. Our case highlights the importance of differential diagnosis from other protuberant conjunctival tumors. A complete removal of GCT of the conjunctiva and a recovery of aesthetic outcomes can be achieved by surgical excision of the mass.

Clinical Manifestations of Extruded Conjunctival Melanocytic Mass

PURPOSE: To investigate the clinical manifestations and characteristics of extruded conjunctival melanocytic mass. METHODS: A total of 33 patients who had extruded conjunctival melanocytic mass and who underwent excisional biopsy were retrospectively reviewed. RESULTS: Based on the excisional biopsy results, 13 patients (40%) were diagnosed with compound nevus, nine patients (27%) with subepithelial nevus, eight patients (24%) with primary acquired melanosis without atypia, and three patients (9%) with malignant melanoma. Compound nevus was located on the temporal side of the cornea in 54% of affected cases, bulbar conjunctival in 77%, and was partially pigmented (brown) in 61%. The average size of the melanocytic mass was 24 mm when histological analysis showed melanin nevus cells in the conjunctival epithelial layer and subepithelial stromal layer. Subepithelial nevus was located on the temporal side of the cornea (56%) and in the bulbar conjunctival (78%) and had a brown color (78%). The average size of the melanocytic mass was 28 mm when histological analysis showed melanin nevus cells located only in the subepithelial stromal layer and forming nest shapes. Primary acquired melanosis without atypia was located on the temporal side of the cornea (62.5%) and bulbar conjunctival (75%) and had brown color (75%). The average size of melanin nevus cells located only in the basement membrane of the epithelial layer was 30 mm. Three of these masses were malignant melanoma, and all cases were located on the superior side of the cornea and palpebral conjunctiva. All cases were black and had an average size of 53 mm, with malignant cells observed in all layers of the conjunctiva and connective tissue. CONCLUSIONS: A conjunctival melanocytic mass located on the palpebral conjunctiva, extruding onto the surface, and large in size should be suspected as malignant melanoma. In such cases, early biopsy and aggressive resection are required.

A Case of Conjunctival Mass with Infectious Mononucleosis by EBV

PURPOSE: To report a case of conjunctival mass with infectious mononucleosis by Epstein-Barr virus (EBV) confirmed with Epstein-Barr encoding region (EBER) in situ hybridization. CASE SUMMARY: A 8 year-old male without underlying disease was referred with counjunctival mass on the right eye starting 3 days ago. In ophthalmologic evaluation, there was injected, nontender, and "salmon patch" appearance conjunctival lesion on right superior bulbar conjunctiva. The patient was admitted to pediatrics with sore throat and fever. The tonsil were enlarged and white blood cell count was 14960/uL. EBV polymerase chain reaction (PCR) test and Viral capsid antigen Immunoglobulin M (VAC IgM) test were positive, the diagnose of infectious mononucleosis by EBV was made. After 5 days steroid eyedrop therapy, biopsy was performed because the lesion was not improved. There were lymphocyte infiltration, chronic inflammation and positive in EBER in situ hybridization. CONCLUSIONS: Elevated and pinkish lesion on conjunctiva, EBV lesion should be considered as differential diagnosis.

A Case of Conjunctival Myxoma Invading the Caruncle

PURPOSE: To report a rare case of conjunctival myxoma invading the caruncle. CASE SUMMARY: A 46-year-old man presented with a medical canthal conjunctival mass in his left eye. The mass was a semi-transparent, yellowish, movable mass 10 mm x 6 mm in size in the subconjunctival space. There was no pain and no tenderness. Excisional biopsy of the mass was performed. Histopathologic examination revealed findings suggestive of myxoma. CONCLUSIONS: Relatively transparent, movable, yellowish to pinkish conjunctival masses at medial canthal area without pain or tenderness can be diagnosed as myxoma on biopsy and myxoma can be seen at caruncle.

A Case of Rosai-Dorfman Disease Affecting the Palpebral Conjunctiva

PURPOSE: To report a single case of Rosai-Dorfman disease of the palpebral conjunctiva with a review of the relevant literature. CASE SUMMARY: A 39-years-old woman presented with a palpebral conjunctival mass 3 weeks in duration on both eyes. The patient had a history of excisional biopsy of lymphadenitis and wanted to remove the mass for cosmetic reasons. An excisional biopsy was performed to obtain a diagnosis for proper management. The histopathologic examination of the lesion showed an intensive proliferation of monotonous and histiocytoid cells beneath the epidermis. Immunohistochemical staining for the S-100 protein was positive and anti-CD1A antibody was negative. Five months after mass excision, there was no evidence of recurrence.

Seborrheic Keratosis of the Conjunctiva: A Case Report

Seborrheic keratosis is a benign epithelial neoplasia that occurs mainly in the skin of the eyelids and face. We describe a case of seborrheic keratosis of the conjunctiva confirmed by histopathology. A 72-year-old man presented with a recurrent conjunctival mass involving the nasal side of his right eye. Clinically, a diagnosis of conjunctival papilloma was made, and a mass excision was performed. The histopathological analysis evidenced a conjunctival-covering epithelium with papillomatous changes and irregular acanthosis, at the expense of a proliferation of basaloid cells. In addition, the lesion exhibited multiple pseudohorn cysts containing keratin. With the above findings, a diagnosis of conjunctival seborrheic keratosis was established. The occurrence of seborrheic keratosis on the conjunctiva is rare. In this case, seborrheic keratosis was confirmed by pathologic report despite its similar appearance with papilloma. Seborrheic keratosis should be considered in the differential diagnosis of conjunctival lesions.

Isolated Langerhans Cell Histiocytosis in the Palpebral Conjunctiva of an Adult Patient

PURPOSE: To report a case of isolated Langerhans cell histiocytosis (LCH) in the palpebral conjunctiva of an adult patient. METHODS: A 39-year-old male presented with a mass of one month's duration on the palpebral conjunctiva of his left upper lid. The lesion had gradually progressed. The mass was non-tender, relatively well circumscribed, yellowish white, flat, firm, and 5 mm x 8 mm in size. Otherwise, the ophthalmic examination was completely normal, including the anterior and posterior segments. Based on the clinical picture, an infiltrative/neoplastic lesion was suspected. Incision biopsy was performed to obtain a diagnosis for proper management. RESULTS: The histopathologic examination of the lesion showed an intensive proliferation of monotonous and histiocytoid cells beneath the epidermis. Immunohistochemical study revealed that the tumor cells were positively stained in the cytoplasm with anti CD1A antibody and anti S-100 antibody. The patient was then referred to the Oncology Department for evaluation. A detailed systemic examination, and the laboratory and radiologic investigations ruled out systemic involvement. The diagnosis of isolated LCH was finally made. Three months later, the lesion underwent remission without any treatment. CONCLUSIONS: This rare disorder may also present as a solitary lesion on the palpebral conjunctiva in adults, and so it should be kept in mind during the differential diagnosis of a conjunctival mass in an adult.

A Case of Granulocytic Sarcoma Involving the Forniceal Conjunctiva

PURPOSE: We report a case of the granulocytic sarcoma located at the conjunctival fornix in a 10-year-old girl with acute myeloid leukemia, who was in complete remission after bone marrow transplantation. METHODS: A 10-year-old girl had a 1-week history of firm, dark brown conjunctival mass at lower fornix and mild lid swelling of the right eye. Several months previously she had had some chalazions at lower lid and a history of acute myeloid leukemia that was currently in complete remission after bone marrow transplantation. Other ocular manifestations were not specific. Excision of the conjunctival mass and a biopsy for diagnostic and therapeutic purposes were performed. RESULTS: The 12 x 6 x 5 mm-sized mass was totally excised. The pathologic examination was consistent with granulocytic sarcoma. Three weeks after the biopsy, the patient had a relapse of acute myeloid leukemia. She died 2 months later while undergoing intensive therapy. CONCLUSIONS: This condition should be considered in the diagnosis of granulocytic sarcoma in patients with a history of acute myeloid leukemia.