Bilateral synchronous conjunctival myxoma and review of the literature.

PURPOSE: The purpose of this study was to report the clinicopathological features and management of the first case of bilateral synchronous conjunctival myxoma. METHODS: This study was a case report and literature review. RESULTS: A 66-year-old Chinese male with past ocular history of uncomplicated bilateral phacoemulsification and intraocular lens (IOLs) 3 years ago prior to presentation presented with bilateral red and swollen conjunctiva for over a year. On examination his corrected distance visual acuity (CDVA) was 25/20 in the right eye 20/20 in the left eye. Slit lamp examination revealed swollen temporal conjunctiva bilaterally which appeared as painless, well-circumscribed, salmon-pink, fleshy patches. The lesion in the right eye was subsequently excised, followed by excision of the lesion in the left eye at 3-week interval. Microscopically, histopathological examination of both excised specimens revealed hypocellular conjunctival mucosa covered by non-dysplastic epithelium, with presence of myxoid degeneration in the subepithelial stroma and immunostaining findings consistent with conjunctival myxoma. At his latest follow-up at 24 months, there were no recurrences of the conjunctival masses and the CDVA was the same as preoperatively.

Rare presentations of primary amyloidosis as ptosis: a case report.

BACKGROUND: Amyloidosis is a rare, progressive and variable group of diseases characterized by extracellular deposits of amyloid protein in different tissues and organs. It is a protein-misfolding disease in which small proteins of about 10 to 15 kDa acquire an alternative and relatively misfolded state at minimum energy and subsequently aggregate into oligomers and polymers. It mimics other eyelid diseases, such as involutional ptosis, eyelid granulomatous or cancerous lesions. Misdiagnosis of eyelid amyloidosis is usual when the lesion grows slowly and insidiously. Definite diagnosis depends on clinical suspicion and tissue-proven biopsy. CASE PRESENTATION: A 50-year-old female had painless progressive ptosis in both eyes for 6 months. She presented with limited upward gaze due to swelling of the upper eyelids OU. She complained of mild foreign body sensation. Upon examination, we observed an infiltrated irregular yellowish mass on the surface of her upper palpebral conjunctiva in both eyes. The mass was non-movable without tenderness. We performed excisional biopsy for the masses and subsequent histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. Unfortunately, her ptosis and upward gaze restriction was not improved after the operation. However, the masses did not enlarge in the following 3 months. CONCLUSIONS: The varied presentations of ocular adnexal and orbital amyloidosis often lead to a significant delay between first symptoms and diagnosis. Immediate confirmatory biopsy and subsequent systemic workup should be performed whenever amyloidosis is highly suspected.

Giant Papilla Prolapse from the Upper Tarsal Conjunctiva in a 3-year-old Child: A Case Presentation and a Brief Literature Review.

Giant papillae (1.0 mm or greater in diameter) on the upper tarsal conjunctiva are one of the most common findings in cases of vernal keratoconjunctivitis (VKC). Presently described is the case of a 3-year-old female with a unilateral giant papilla formation prolabing from the medial side of the upper tarsal conjunctiva toward the ocular surface in the left eye. A brief review of the recent literature concerning the etiology, associated risk factors, surgical options, and management of patients with giant papillae is also discussed. A significant reduction in the size of the papilla was observed after a week of medical treatment with a topical steroid and antiallergic eye drops. To the best of our knowledge, this case demonstrates the first time that a giant papilla appeared in the form of a prolapsed mass extending from the tarsal conjunctiva in a child with VKC. Ophthalmologists should keep in mind that a giant papilla can look like another form of conjunctival mass, and should not rush to excise or biopsy, as it may respond to medical treatment.

Inflammatory myofibroblastic tumour of the conjunctiva masquerading as ocular surface squamous neoplasia.

A 63-year-male had painless, progressive, yellowish-pink, immobile conjunctival mass with prominent feeder vessels in the right eye of 1-year duration. The rest of the ophthalmic examination was unremarkable. MRI showed no extension into orbit or extraocular muscles. An excision biopsy with the amniotic membrane patch was performed. Histopathology confirmed inflammatory myofibroblastic tumour (IMT) with SMA and calponin positivity on immunohistochemistry. Complete surgical excision, amniotic membrane, and oral steroids provided long-term relief from recurrence. The conjunctiva is a rare site for IMT, and IMT should be kept in the differentials for atypical cases of ocular surface neoplasia.

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.

Primary conjunctival myxoma: case series and review of the literature.

AIMS: Myxomas are benign soft tissue tumours resembling primitive mesenchyme. They rarely involve ocular structures, and have been recognized in the conjunctiva, eyelids, cornea, and orbit. The aim of this study was to investigate the clinicopathological features of seven patients with primary conjunctival myxoma seen at Dr Luis Sánchez Bulnes Hospital, an ophthalmological referral centre in Mexico City. METHODS AND RESULTS: We reviewed the clinical, histochemical and immunohistochemical studies of patients with documented myxoma of the conjunctiva diagnosed in our hospital. Seven conjunctival myxomas were retrieved from 5923 conjunctival biopsies (0.1%). The mean age of patients was 40 years, with a range of 27-51 years. Females were more frequently affected, and none of our patients had systemic disease. The left eye was involved in five cases, and most of the lesions were located in the bulbar conjunctiva. Histopathological examination revealed a benign tumour composed of spindle-shaped and stellate-shaped cells immersed within an abundant mucinous matrix with sparse vessels and reticulin fibres. Immunohistochemistry demonstrated positivity for vimentin and negativity for smooth muscle actin, SOX10 and GLUT1 in myxoma cells of all cases. S100 was found to be positive in four cases, and muscle-specific-actin in three cases. CONCLUSIONS: Conjunctival myxomas are uncommon tumours. For accurate diagnosis, histopathological examination is mandatory. The treatment of choice is surgical removal, and the prognosis is excellent.

Conjunctival granuloma with necrosis associated with exposed suture in upper double lid masquerading as ocular surface squamous neoplasia: a case report.

BACKGROUND: This study reports two cases of conjunctival granuloma with necrosis caused by an exposed suture in the upper palpebral conjunctiva masquerading as ocular surface squamous neoplasia. CASE PRESENTATION: Two patients presented with chronic conjunctival ulcerative and granulomatous lesions on the superior bulbar conjunctiva that repeatedly recurred after the mass was removed. The pathologic findings revealed the absence of malignant cells and presence of many lymphocytes, plasma cells, and histiocytes. There was no evidence of acid-fast bacilli or fungal organisms. When a past history of blepharoplasty was established, microscopic examination revealed occult exposed suture tips. After the sutures were removed, the granuloma with necrosis was resolved within a month. CONCLUSION: For all conjunctival lesions in the superior bulbar conjunctiva, a thorough examination of the ocular adnexae which includes eyelid eversion should be performed. There should be a suspicion of foreign body or exposed suture material especially when there is a non-healing ulcer.

Epibulbar osseous choristoma: A case report.

PURPOSE: To present the case of a 12-year-old female with an epibulbar osseous choristoma. OBSERVATIONS: The patient presented with right-sided conjunctival mass, which caused her discomfort. Slit lamp examination revealed a 5×5-mm, firm nodule in the superotemporal quadrant of the bulbar conjunctiva. The nodule had feeder vessels, adhered firmly to the sclera, and lacked signs of malignancy. The patient underwent excisional biopsy under general anesthesia. During this procedure, great care was taken to avoid perforation of the globe. The pathologic sections were significant for well-circumscribed osseous tissue without atypia. CONCLUSIONS AND IMPORTANCE: We describe diagnosis and successful surgical management of osseous choristoma the rarest subtype of ocular choristoma. With only 65 cases reported since mid-19th century, the condition remains poorly described. This report provides additional information on diagnosis and treatment of this rare condition.

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.

Conjunctival myxoma - atypical presentation of a rare tumour: case report and review of literature.

BACKGROUND: Conjunctival myxomas are rare, benign, connective tissue tumours that classically present as slow-growing, painless, well-circumscribed masses (Arch Ophthalmol 124:735-8, 2006; Case Rep Ophthalmol 3:145-50, 2012). There have been 29 cases reported in the literature (Arch Ophthalmol 124:735-8, 2006; Malays J Med Sci 20(1):92-4, 2013; Case Rep Ophthalmol 3:145-50, 2012; Middle East Afr J Ophthalmol 19(3):353-3, 2012). We present a case with atypical features, and emphasize the importance of excisional biopsies for diagnosing indeterminate conjunctival lesions. CASE PRESENTATION: A 32 year old Korean woman presented with a 5 mm × 7 mm × 3 mm pedunculated firm cystic lesion on the inferior palpebral conjunctiva of her right lower eyelid. The lesion had rapidly enlarged over the course of a week. She gave a history of uncomplicated bilateral epiblepharon correction performed in Korea three months prior. There were no systemic features, or family history of genetic conditions. The lesion was excised under local anaesthesia and reported to be a conjunctival myxoma. The clinical and histopathological features of this lesion were consistent with previous reports on conjunctival myxoma (Arch Ophthalmol 124:735-8, 2006; Arch Ophthalmol 101:1416-20, 1983; Case Rep Ophthalmol 3:145-50, 2012; Am J Ophthalmol 102(1):80-84, 1986). The unusual features of this case were, the rapid growth of the lesion - with the previously documented mean time before presentation being 34 months (range 3 months - 24 years) (Arch Ophthalmol 124:735-8, 2006; Case Rep Ophthalmol 3:145-50, 2012); the location of the lesion in the inferior palpebral conjunctiva - 93 % of previously reported cases had occurred in the bulbar conjunctiva (Arch Ophthalmol 124:735-8, 2006; Case Rep Ophthalmol 3:145-50, 2012); and its occurrence in association with recent eyelid surgery - which has never been reported. CONCLUSION: This case of conjunctival myxoma adds to the small number of documented cases, by demonstrating an atypical presentation. Conjunctival myxomas can occur in association with the Carney Complex, which is an autosomal dominant syndrome associated with benign tumours, spotty mucocutaneous pigmentation, and endocrine overactivity (Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008). Ophthalmic manifestations of the Carney Complex have been found to precede vascular embolic events secondary to cardiac myxoma, thus early diagnosis of conjunctival myxoma can prevent potentially devastating consequences (Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008). The different presentations of this rare tumour emphasise the importance of excisional biopsies in diagnosing indeterminate conjunctival lesions; and its association with cardiac myxoma, highlights the need for cardiac investigations in all patients who present with conjunctival myxoma (J Ophthalmol (1);1-5, 2014; Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008).

Pediatric conjunctival lymphoma associated with oral carbamazepine use.

PURPOSE: To report a case of a pediatric patient diagnosed with conjunctival lymphoma associated with oral carbamazepine use. OBSERVATION: An 11-year-old boy who presented with 5-month history of a small nasal conjunctival mass in the left eye that failed therapy with topical corticosteroids. Upon excision and molecular analysis, diagnosis of Follicular Lymphoma was favored. The patient was healthy and did not have any known risk factors except for a history of epilepsy treated with systemic carbamazepine. CONCLUSION AND IMPORTANCE: We report a case of a rare childhood conjunctival lymphoma. Conjunctival lymphomas may masquerade as chronic conjunctivitis, or scleritis that fail therapy with topical corticosteroids. Furthermore, our patient did not have any known risk factors such as old age, systemic lymphoma or immunosuppression. The patient did have a history long-term use of systemic carbamazepine. This is to our knowledge the first case conjunctival lymphoma that may be associated to the use of carbamazepine.

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.

Conjunctival Mass as an Initial Presentation of Iatrogenic Orbital Encephalocele.

A 46-year-old woman presented with a symptomatic conjunctival mass of the right eye, appearing 2 months after undergoing right frontal craniotomy to excise a meningioma. MRI of the brain revealed a new iatrogenic encephalocele extending into the right temporal orbit. Our opinion is that the conjunctival mass resulted directly from this encephalocele. To date this has been conservatively managed, and we believe this to be the first report of an iatrogenic encephalocele presenting in this manner.

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.