Corneal myxoma following micro-pulse cyclophotocoagulation in a young female: A case report.

INTRODUCTION: Corneal myxoma is a rare benign tumor that can occur in the cornea where the exact cause remains unknown. However, it is thought to be a reactive process that can be caused by corneal infections, ectasia, ocular trauma, or surgery. PRESENTATION OF CASE: In this case report, we describe a 35-year-old-woman who presented with corneal myxoma after micro-pulse cyclophotocoagulation (MPCPC). The patient presented with decreased vision due to a large pedunculated white corneal mass after being treated with MPCPC as a non-surgical management of her pre-existing glaucoma. The corneal mass was localized to the sub-epithelial space and was excised successfully by a minimal invasive procedure without recurrence over a 1-year period. DISCUSSION: Corneal myxomas are unusual benign tumors typically seen in adults as whitish gelatinous lesion. Only a few individual cases and case series have been reported in the literature. The exact pathogenesis is yet to be known. The lesion is thought to be due to an inflammatory process. We are reporting a case of corneal myxoma that has occurred after MPCPC which is a non-surgical cyclodestructive procedure. The procedure has not been mentioned previously as a risk factor for corneal myxoma. Our case is the first corneal myxoma developing after MPCPC. CONCLUSION: We report a corneal myxoma noted in a young female after a non-surgical laser procedure. Though the lesion is rare, it should be considered in physicians' differential of a corneal mass especially in the presence of chronic ocular.

Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital.

BACKGROUND: Conjunctival lesions are common with a wide spectrum of benign, premalignant, and malignant lesions. Few histopathological studies have been conducted on conjunctival lesions with variable designs and results. Our aim in this study is to provide information on common conjunctival lesions seen in an ophthalmology tertiary care center in Saudi Arabia. METHODS: A retrospective, observational study of all consecutive conjunctival tissue specimens sent for histopathological assessment to the pathology department from 2015 to 2019 were analyzed. Clinical data were collected from medical records, and the histopathological slides were reviewed by a single pathologist. RESULTS: A total of 110 conjunctival specimens from 108 patients were included (mean age: 53 years, 67 males and 43 females). Bilateral involvement was mostly found in inflammatory lesions (40%). Most lesions were benign (91%), with a significantly longer duration of symptoms in malignant lesions (p = 0.036*). The clinical diagnosis matched the final histopathological diagnosis in 75.5% of the total specimens. The most frequent category of benign lesions was fibrodegenerative and proliferative lesions (53.6%), with a significantly higher prevalence among adult males (p < 0.001). Melanocytic lesions were more common in children (33.3%) than adults (9.8%), and the mean age of children was significantly lower (p = 0.013). The most frequent malignant lesion was ocular surface squamous neoplasia (50%), with equal prevalence among males and females. The overall outcome was favorable in 89.4% and unfavorable in 10.6%, mostly due to surgical complications, further progression of the lesion, or recurrence. CONCLUSION: This study shows variability in the frequency of conjunctival lesions based on gender, age, geographical, racial, and environmental factors. There has been a shift in the gender-based prevalence of ocular squamous neoplasia over the last three decades, probably due to a change in lifestyle.

A case of dyschromatosis symmetrica hereditaria with an associated eyelid hemangioma.

INTRODUCTION AND IMPORTANCE: Dyschromatosis symmetrica hereditaria (DSH) are rare autosomal dominant pigmentary genodermatosis characterized by reticular hyper- and hypopigmented skin macules on the dorsal aspect of the extremities and freckle-like spots on the face, sparing the palms and soles. Cutaneous hemangiomas were not reported in the literature with DSH. We describe for the first time to the best of our knowledge a case of DSH with histopathologically confirmed eyelid hemangioma. CASE PRESENTATION: A 25-year-old female was diagnosed with DSH in her childhood by a dermatologist then later developed cutaneous lupus erythematosus (CLE). Four years later she presented to our clinic with right lower eyelid painless mass. The histopathological examination showed inflamed epidermis overlying a mixed capillary and cavernous hemangioma. The patient had complete healing of the skin post-operatively with excellent cosmetic result. DISCUSSION: DSH is usually isolated, however, acral hypertrophy, psoriasis, dental anomalies, aortic valve sclerosis, dystonia and intracranial hemangiomas have been reported in association with the disease. The types of the hemangiomas reported were not specified with lack of tissue diagnosis. Our case is unique because of the late occurrence of this eyelid skin hemangioma, the concomitant CLE, the history of hyperthyroidism, and the positive family history of consanguinity. CONCLUSION: The pathogenesis of DSH is not well understood, however the previously reported intracranial hemangiomas and the currently reported skin vascular lesion would raise the role of inheritance and variable expression of such an association especially with concomitant CLE. This may warrant further studies on the etiology of DSH.

Orbital solitary fibrous tumors: a multi-centered histopathological and immunohistochemical analysis with radiological description.

BACKGROUND: Solitary fibrous tumors (SFT), formerly called hemangiopericytoma, are rare tumors derived from mesenchymal cells originally described in the pleura, but these tumors may affect extraserosal tissues including the lacrimal gland and orbit. OBJECTIVE: Conduct a multi-centered clinical, radiological and histopathological analysis of 17 orbital SFT cases. DESIGN: A retrospective case series. SETTING: Three eye centers in two countries. PATIENTS AND METHODS: The data collected from the charts of 17 adult patients presenting with tissue diagnosis of orbital hemangiopericytoma or SFT from January 2003 to December 2018 included demographics, clinical imaging and histopathological information including immunohistochemical (IHC) characteristics. MAIN OUTCOME MEASURES: The demographic characteristics, clinical presentation, and histopathological patterns or variants of SFT were analyzed. SAMPLE SIZE: 17 adult patients. RESULTS: Mean age was 45 years (range 23-80 years). Male to female ratio was 3:1. The right eye was affected in 12 (70.5%) patients. Commonest presentation was proptosis in 13/17 (76% of patients). Other symptoms were impaired motility (29%) and ptosis (11%). Lesions mostly affected the medial orbit (35%), then orbital apex in 11%. The histopathological classic pattern-less variant was the commonest. One case with aggressive behavior, multiple recurrences and atypical features was encountered. Immunohistochemical (IHC) markers used included CD34 expression in all cases, Bcl-2 expression in 10/11, CD99 in 9/9 and Vimentin in 4/4. STAT6 was used in 2 cases. CONCLUSIONS: SFTs are rare tumors affecting the orbit in both genders equally in their mid-forties, but showed male predominance in our analysis with a predominant classic histopathological pattern. Tissue diagnosis is essential and requires IHC studies for confirmation. LIMITATIONS: Sample size is relatively small owing to the rarity of this tumor in the orbit. CONFLICT OF INTEREST: None.

Primary extramedullary plasmacytoma of the eyelid conjunctiva - A case report and review of the literature.

Extramedullary plasmacytomas (EMPs) are uncommon plasma cell tumors that develop in soft tissue as isolated tumors without osseous involvement while secondary lesions are associated with systemic multiple myeloma (MM). Primary extramedullary lesions are most commonly found in upper respiratory tract, gastrointestinal tract and lymph nodes. They can be found either in patients with history of MM or preceding the manifestation of a systemic disease. Orbital manifestation of the lesion is rare but conjunctival involvement is very unusual. The reported cases in the English-written literature are only five cases. Herein, we report the sixth case of primary EMP in a middle-aged adult who presented with a lesion confined to the conjunctiva, unremarkable present and past medical history, and confirmed tissue diagnosis. In addition, a review and summary of the previously reported cases in the literature is presented. We aim to attract the attention of ophthalmic surgeons to consider plasmacytoma within the differential diagnosis of a conjunctival lesion.

Primary mesenchymal chondrosarcoma of the orbit: Histopathological report of 3 pediatric cases.

Mesenchymal chondrosarcoma (MCS) is an unusual tumor mainly found in the skeleton. Around third of the cases occur in extra-skeletal sites with the orbit being the third most common site in these cases. In previous reviews of the orbital cases, it has been concluded that orbital MCS tends to occur in women in the second or third decades of life. However, 8 cases of orbital MCS have been reported so far in the pediatric age group (age less than 18 years-old) one of which has been considered congenital MCS in a 5-days old newborn girl. We describe 3 additional pediatric cases with primary orbital MCS and they were all males. Our cases presented with proptosis and calcific orbital masses on imaging studies. Histopathological examination of the excised masses shared the typical presence of undifferentiated mesenchymal cells and immature areas of cartilage. The diagnosis of MCS was further confirmed by immunohistochemical staining. Brief review of the literature in relation to this diagnosis in the orbit is also presented.

Bilateral orbital isolated (solitary) neurofibroma in the absence of neurofibromatosis - A case report.

Isolated neurofibroma is a slowly progressive tumor rarely found in the orbit accounting for less than 1% of the space occupying lesions of the orbit. It usually presents in the 2nd to 5th decades of life with proptosis, swelling, visual changes, ptosis, diplopia or pain. Almost all cases reported are unilateral. We report a 23-year-old female with no systemic features or family history of neurofibromatosis who presented with right upper eyelid swelling. Radiological studies revealed bilateral identical masses in the superior orbits. The patient underwent surgical excision of the lesion on the right side and it was proved to be neurofibroma. She did not have a recurrence with a follow up period of 2 years but developed sensory deficit. This is the fifth reported case of bilateral isolated neurofibroma.