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Lee SE, Lee SB, Kim K, Sung JY. Conjunctival myxoma: A case report and review of a rare tumor. Medicine (Baltimore) 2024; 103:e37342. [PMID: 38457580 PMCID: PMC10919476 DOI: 10.1097/md.0000000000037342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Conjunctival myxoma is a rare benign tumor, which can mimic more common conjunctival lesions such as a cyst, lymphangioma, amelanotic nevus, neurofibroma, amelanotic melanoma, or lipoma. We describe a patient with the conjunctival myxoma, who was initially misdiagnosed as a conjunctival cyst. This case report includes intraoperative photographs and various immunohistochemical staining images. PATIENTS CONCERNS A 55-year-old woman presented with a painless mass in the superotemporal conjunctiva of the left eye, which she had noticed 1 month ago. The patient had no previous history of trauma or eye surgery. Slit-lamp examination revealed a well-circumscribed, freely movable, pinkish, semi-translucent mass on the temporal bulbar conjunctiva, suggestive of a conjunctival cyst. DIAGNOSES Histopathological analysis showed stellate- and spindle-shaped cells within the loose myxoid stroma, confirming a diagnosis of conjunctival myxoma. INTERVENTIONS The conjunctival lesion was completely excised under local anesthesia. OUTCOMES After 4 months of follow-up, the patient remained in good health without recurrence of the conjunctival lesion and no evidence of any systemic abnormality. LESSONS Myxoma is an extremely uncommon benign tumor derived from primitive mesenchyme. Considering the rarity of the tumor and its similarity to other conjunctival tumors, diagnosis can be challenging. Ophthalmologists should consider myxoma as a possible differential diagnosis when encountering conjunctival lesions. Surgical excision is essential to confirm the diagnosis and careful systemic evaluation is required to prevent potentially life-threatening underlying systemic conditions.
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Affiliation(s)
- Seong Eun Lee
- Department of Ophthalmology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyunghee Kim
- Department of Pathology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jae Yun Sung
- Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
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Lin TPH, Wan KH, Cheuk W, Leung E, Yuen HKL, Lam DSC. Bilateral synchronous conjunctival myxoma and review of the literature. Eur J Ophthalmol 2023; 33:NP130-NP136. [PMID: 36083167 DOI: 10.1177/11206721221124665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kelvin H Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
| | - Enne Leung
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Hunter K L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Dennis S C Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
- C-MER (Beijing) Dennis Lam Eye Hospital, Beijing, China
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Matsuo T, Tanaka T. Resection of Orbital Myxoma With Magnetic Resonance Imaging Evidence of Ethmoid Sinus Origin: Case Report and Review of 20 Patients in the Literature. J Investig Med High Impact Case Rep 2023; 11:23247096231201013. [PMID: 37737575 PMCID: PMC10517617 DOI: 10.1177/23247096231201013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023] Open
Abstract
A 41-year-old woman showed a palpable mass at the superonasal orbital edge on the right side. Magnetic resonance imaging demonstrated a lobulated fluid-containing tubular mass which extended anteriorly to posteriorly along the medial orbital wall, nasal to the eyeball. She was followed once a year for 8 years until the age of 49 years when she decided to undergo surgical resection because of the enlarged mass. The lobulated large mass was resected and the pathology showed sparsely distributed spindle cells, positive for CD34, in alcian blue-positive mucous substances, indicative of myxoma. Postoperative magnetic resonance imaging showed residual lobulated tubular mass along the optic nerve on the medial side and superior to the eyeball. The residual orbital mass showed stable structure with more evident connection with the ethmoid sinus lesion, suggestive of the ethmoid origin, in 12 years until the age of 61 years. In the review of 20 patients with orbital myxomas in the literature, in addition to this case, roughly classified locations in the orbit were retrobulbar in 8 patients, on the lateral side of the orbit in 4, on the superior side in 6, on the medial side in 1 (this patient), and in the orbit with no specific description in 2. In pathological examinations, immunohistochemistry was not done in 8 patients, done but all negative in 2, and positive in 11 patients: nerve sheath myxoma was diagnosed in 3 patients based on positive S100 staining. Orbital myxoma is rare but considered in differential diagnosis of orbital masses.
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Alkharashi M, Alkatan HM, Alhumidi AA, Otaif W. Conjunctival myxoma masquerading as conjunctival lymphoma: A case report. Int J Surg Case Rep 2022; 97:107441. [PMID: 35872550 PMCID: PMC9403289 DOI: 10.1016/j.ijscr.2022.107441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ocular myxomas are very rare and can involve the orbit, eyelids, and conjunctiva. Conjunctival myxoma can be misdiagnosed as amelanotic nevus, conjunctival cyst, or ocular surface squamous neoplasia, among others. They can appear as an isolated lesion or can be associated with systemic manifestations as part of the Carney complex or Zollinger-Ellison syndrome. CASE PRESENTATION We describe a 64-year-old healthy male who presented with a right eye painless peri-limbal salmon-colored patch lesion in the infero-temporal bulbar conjunctiva over a period of 2 years. There was no of ocular trauma or surgery and no effect on vision. The mass was not tender, raised, and mobile with fine intrinsic vascularity. Excisional biopsy with the presumed diagnosis of lymphoma revealed a typical sub-conjunctival myxoma. DISCUSSION The recognition of ocular myxoma necessitates systemic evaluation to rule out possible associated cardiac myxoma in Carney complex, thus can prevent life-threatening events. The excised mass in our patient showed an area of pseudo-elastotic degeneration, which has further complicated the clinical appearance of the lesion, however, the color, and consistency of the mass were highly suspicious of lymphoma. The diagnosis of myxoma by histopathology was helpful especially in presence of atypical appearance such as in our case. CONCLUSION The histopathological characteristics of conjunctival myxoma can aid in the diagnosis. The lesion in our case was associated with focal severe pseudo-elastotic degeneration and prominent salmon-patch appearing area thus was initially misdiagnosed clinically as a conjunctival lymphoma.
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Affiliation(s)
- Majed Alkharashi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M. Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Corresponding author at: Department of Ophthalmology, Department of Pathology & Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmed A. Alhumidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Otaif
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Conjunctival Myxoma: High-Resolution Optical Coherence Tomography Findings of a Rare Tumor. Cornea 2021; 41:1049-1052. [PMID: 34743106 DOI: 10.1097/ico.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe 2 cases of biopsy-proven conjunctival myxomas and present their optical signs on high-resolution optical coherence tomography (HR-OCT) with clinical and histopathological correlations. METHODS Two middle-aged female patients with a clinical diagnosis of conjunctival cysts were referred for surgical treatment. Clinical assessment, photographs, ultrasound biomicroscopy, and HR-OCT images were obtained. Excisional biopsies were performed, and specimens were sent for histopathological and immunohistochemical analyses. RESULTS Clinically, these patients presented with a well-circumscribed, semitranslucent, yellow-pinkish mass. Ultrasound biomicroscopy showed a dome-shaped epibulbar mass with medium-to-high internal reflectivity. No compromise of the underlying sclera was noted. HR-OCT showed a normal conjunctival epithelium, a subepithelial nonhomogeneous mass with hyperreflective and hyporeflective areas lined by a highly hyperreflective band, and mild posterior shadowing. Histopathological findings and immunoreactivity for CD34 and vimentin confirmed the diagnosis of conjunctival myxoma. CONCLUSIONS The HR-OCT optical signs found in our 2 cases strongly correlated with the microscopic findings. Disclosing the optical signs observed on HR-OCT can help clinicians diagnose and differentiate this lesion, guiding its management. However, more studies with a larger number of patients comparing conjunctival myxoma and other ocular surface tumors are needed to enlighten readers about the unique pattern observed by HR-OCT.
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Park ES, Kim MS, Jun I, Kim TI, Seo KY. A Rare Case of Conjunctival Myxoma Initially Misdiagnosed as a Conjunctival Inclusion Cyst. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:419-420. [PMID: 34488253 PMCID: PMC8521326 DOI: 10.3341/kjo.2021.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ella SeoYeon Park
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Sun Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Im Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Alvarado-Villacorta R, Torres Zavala NM, Marroquín Loayza L, Rodríguez-Reyes AA. Conjunctival myxoma: A systematic review of a rare tumor. Surv Ophthalmol 2021; 67:729-740. [PMID: 34461119 DOI: 10.1016/j.survophthal.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022]
Abstract
Conjunctival myxoma is an uncommon benign tumor that may develop as a localized disease or as part of the Carney complex, in which case it can cause significant morbidity and mortality. Conjunctival myxomas can mimic other pure or mixed tumors and are often overlooked in clinical practice. Histopathological studies are essential for diagnosis; however, controversy regarding their pathological and immunohistochemical features makes the diagnostic process more difficult. Because of the importance of correctly classifying these conjunctival tumors, as well as recognizing when a systematic screening is required owing to the possible association with life-threatening diseases, we comprehensively evaluate the literature on this rare entity based on a systematic approach.
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Affiliation(s)
- Rosa Alvarado-Villacorta
- Cornea and Refractive Surgery Department, Asociación para Evitar la Ceguera en México IAP., Mexico City, Mexico; Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Latin American Network for Research in Eye Diseases-LANRED, Mexico City, Mexico.
| | | | - Lelia Marroquín Loayza
- Ocular Pathology Laboratory "Dr. José Antonio Avendaño Valdez," Instituto Nacional de Oftalmología "Dr. Francisco Contreras Campos," Lima, Peru
| | - Abelardo A Rodríguez-Reyes
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, I.A.P., Mexico City, Mexico
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Isolated Superficial Myxoma Above the Eyebrow. J Craniofac Surg 2020; 32:e447-e449. [PMID: 33252525 DOI: 10.1097/scs.0000000000007278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT A 59-year-old man with a palpable mass above the left eyebrow that had appeared over a 1-year period presented to our clinic. He previously had been administered antiglaucoma eyedrops for pseudophakic glaucoma of the left eye and had undergone Ahmed glaucoma valve implant surgery. The palpable mass above the left eyebrow was soft, nontender, and large. On slit lamp examination, the Ahmed valve was positioned in the superotemporal quadrant of the limbal conjunctiva, and there was no other abnormal finding. Computerized tomography (CT) imaging showed a dense, soft tissue lesion in the left upper lateral periorbital area. The patient underwent tumor excision with biopsy under general anesthesia, and the histopathologic result was myxoma. To rule out Carney complex, dermatological and cardiac evaluation were performed, and the results were normal. Finally, the tumor was diagnosed as isolated myxoma. Isolated myxoma around the upper eyelid is very rare, and complete surgical excision is needed because it has a high recurrence rate.
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Kim HK, Jang SK, Choi KU, Lee JS. A Conjunctival Myxoid Stromal Tumor. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.8.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Hung KH, Yeh LK. Clinical appearance and pathological findings of conjunctival myxoma: Case report and literature review. Am J Ophthalmol Case Rep 2020; 19:100860. [PMID: 32803020 PMCID: PMC7419321 DOI: 10.1016/j.ajoc.2020.100860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To describe a case with a growing erythematous conjunctival mass in the left eye, diagnosed as conjunctival myxoma. Observations A 31-year-old lady had corrected visual acuity of 6/7.5 and normal intraocular pressure in both eyes. Congested left bulbar conjunctiva with one slightly elevated nodule at nasal area was noted for one year. Excisional biopsy was performed after failed treatment with topical eye drops. Pathology showed conjunctival myxoma with spindle- and stellate-shaped cells, which was a rare ocular surface neoplasia. There was no combined systemic disease found. Conclusions and importance We described the clinical and pathological features of conjunctival myxoma. Systemic evaluation should be considered before and after surgical excision.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taiwan.,Chang Gung University, College of Medicine, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taiwan.,Chang Gung University, College of Medicine, Taiwan
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Lam J, Ang A, Vermeulen T, Ardakani NM. Conjunctival Stromal Tumor: Report of 2 New Cases and Review of the Literature. Int J Surg Pathol 2020; 29:337-342. [PMID: 32723103 DOI: 10.1177/1066896920945783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Conjunctival stromal tumor (COST) is an emerging entity with only a limited number of cases reported in the literature. In this report, we describe 2 additional cases, review the accumulative clinical and histopathological features and expand on the immunophenotypic property of this entity. COST appears to have a sporadic presentation, affecting both sexes and patients of variable ethnicity and age group and predominantly occurring on the bulbar conjunctiva as a slow-growing asymptomatic or slightly tender mass-like lesion. Histopathologically, COST is characterized by singly dispersed spindle to round cells, often with some degree of degenerative nuclear atypia, within a myxomatous to collagenous stroma. Lesional cells are characteristically positive for CD34 and vimentin, negative for S100, SOX10 and STAT6 and show a normal pattern of staining with RB1 by immunohistochemistry. The reported cases to date have shown an indolent biological behavior, reliably treated by a complete surgical excision.
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Affiliation(s)
- Jonathan Lam
- 226920University of Western Australia, Perth, Western Australia, Australia.,3432Fremantle Hospital, Perth, Western Australia, Australia
| | - Andrea Ang
- 226920University of Western Australia, Perth, Western Australia, Australia.,6508Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tersia Vermeulen
- 56375PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Nima Mesbah Ardakani
- 226920University of Western Australia, Perth, Western Australia, Australia.,56375PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.,5673Murdoch University, Perth, Western Australia, Australia
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Das J, Basak SK, Das N. Conjunctival stromal tumour (COST): anterior-segment OCT findings. BMJ Case Rep 2019; 12:12/11/e230348. [PMID: 31753821 DOI: 10.1136/bcr-2019-230348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Conjunctival stromal tumour (COST) is a recently described rare conjunctival tumour of mesenchymal origin with only four publications describing a handful of cases thus far. In this report, we describe the anterior-segment optical coherence tomography (AS-OCT) characteristics in a case of COST for the first time, in addition to the clinical and histopathological characteristics. The AS-OCT showed an elevated, dome-shaped hyporeflective homogenous lesion in the conjunctival stroma lined by hyperreflective outer layer with mild posterior shadowing, consistent with histological description of a paucicellular tumour with large myxoid collagenous material inside. Immunohistochemistry showed positive CD34 and vimentin but negative S100 and smooth muscle actin, thereby differentiating it from conjunctival myxoma.
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Affiliation(s)
- Joyeeta Das
- Oculoplasty, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Samar K Basak
- Cornea and External Disease, Disha Eye Hospital, Kolkata, West Bengal, India
| | - Nibedita Das
- Cornea and External Disease, Disha Eye Hospital, Kolkata, West Bengal, India
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Small Benign Storiform Fibrous Tumor (Fibrous Histiocytoma) of the Conjunctival Substantia Propria in a Child: Review and Clarification of Biologic Behavior. Ophthalmic Plast Reconstr Surg 2019; 35:495-502. [DOI: 10.1097/iop.0000000000001355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Milman T, Salomao DR, Ida CM, Capiz Correa DR, Grossniklaus HE, Zhang Q, Hamershock RA, Shields C, Shields JA, Raber I, Rapuano CJ, Patel R, Eagle RC. Conjunctival Myxoid Lesions: Clinical-Pathologic Multiparametric Analysis, Including Molecular Genetics (An American Ophthalmological Society Thesis). Am J Ophthalmol 2019; 205:115-131. [PMID: 31078543 DOI: 10.1016/j.ajo.2019.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the clinical and pathologic characteristics of conjunctival myxoid lesions, with specific focus on PRKAR1A studies, in order to distinguish neoplastic conjunctival myxoma from other myxoid conjunctival lesions. METHODS A retrospective, interventional, multicenter study of all patients with conjunctival myxoma, conjunctival stromal tumor, or reactive fibromyxoid proliferation diagnosed during 1988-2018. Patient and family medical histories and clinical and pathologic characteristics of excised lesions were assessed. RESULTS There were 28 patients with conjunctival myxoid lesions diagnosed as myxoma (16/28), conjunctival stromal tumor (10/28), or reactive fibromyxoid proliferation (2/28). The patients with abundant myxoid matrix lesions (14/28, 50%) were younger (mean 49 [range 23-68] years) than those with scant-to-moderate myxoid matrix lesions (14/28, mean 61 [range 18-82] years; P = .04). Abundant myxoid matrix lesions more likely contained predominantly stellate cells (6/14 [43%] vs 0/14 [0%]; P = .05) and fibrillar collagen (13/14 [93%] vs 2/14 [14%]; P < .0001), conforming to the standard morphologic definition of myxoma. Absence of PRKAR1A protein expression was found in 2 lesions with morphologic features of myxoma (2/14, 14%), 1 of which demonstrated a pathogenic mutation in the PRKAR1A gene. There was no difference between the lesions with respect to other clinical and pathologic parameters. CONCLUSIONS PRKAR1A plays a role in the development of a subset of conjunctival myxomas, particularly in tumors fulfilling stringent morphologic criteria for myxoma. With the exception of PRKAR1A studies, current immunohistochemical panels cannot reliably distinguish between neoplastic conjunctival myxomas and other myxoid lesions, underscoring the importance of morphology in establishing accurate diagnosis.
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Affiliation(s)
- Tatyana Milman
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Pathology, Wills Eye Hospital, Philadelphia, PA, USA.
| | - Diva R Salomao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Hans E Grossniklaus
- Department of Ophthalmology, Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Qiang Zhang
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Rose A Hamershock
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Carol Shields
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Jerry A Shields
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Irving Raber
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Christopher J Rapuano
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ravi Patel
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ralph C Eagle
- Department of Ophthalmology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Pathology, Wills Eye Hospital, Philadelphia, PA, USA
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Jain P, Finger PT, Iacob CE. Conjunctival myxoma: A case report with unique high frequency ultrasound (UBM) findings. Indian J Ophthalmol 2018; 66:1629-1631. [PMID: 30355886 PMCID: PMC6213696 DOI: 10.4103/ijo.ijo_518_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 39-year-old female presented with a painless yellow-pink tumor on her right eye. High-frequency ultrasound imaging revealed an epibulbar lesion with homogenous low internal reflectivity and no evidence of intraocular invasion. The patient underwent excisional biopsy leading to a pathology diagnosis of myxoma. Additional surgical margins as well as adjuvant cryotherapy margins were followed by extensive conjunctival repair. Herein, we report on a conjunctival myxoma with unique ultrasonographic findings.
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Affiliation(s)
- Puneet Jain
- The New York Eye Cancer Center, New York, NY, USA
| | | | - Codrin E Iacob
- Department of Pathology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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