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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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Medagoda K, Salvin K, Mahendra BG. A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature. Am J Ophthalmol Case Rep 2022; 27:101590. [PMID: 35722057 PMCID: PMC9200994 DOI: 10.1016/j.ajoc.2022.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose This is a case report of a patient with a conjunctival myxoid stromal tumor (COMST), mimicking a phlyctenulosis. Tumors of the conjunctiva and cornea occupy a large spectrum ranging from benign lesions of myxoma to aggressive, life-threatening malignancies. Phlyctenulosis and phlyctenular keratoconjunctivitis are hypersensitivity reactions to a foreign antigen. Observations A 64-year-old male presented with six-month history of non-painful lump in the conjunctiva of the left eye. It was a mobile, non-tender, non-ulcerated, non-hemorrhagic, non-pigmented lesion and was non-adherent to the sclera. The differential diagnosis of phlyctenulosis or a soft tissue tumor was considered. The lesion was completely excised. The microscopy showed an ill-defined hypocellular myxoid lesion composed of stellate and spindle-shaped cells with eosinophilic cytoplasm, containing round-ovoid and spindle-shaped nuclei with a vesicular chromatic pattern. The tumor cells were diffusely and strongly positive for vimentin and CD 34 and were negative for S100. The immunomorphological features were compatible with a conjunctival myxoid stromal tumor. Complete systemic evaluation excluded the possible association with systemic myxomas. Conclusions and importance Myxoid tumors of the conjunctiva are benign tumors, however, they can mimic other benign conditions like phlyctenulosis or more sinister lesions like malignant tumors. Therefore, it is important to do an excisional biopsy to ascertain the definitive pathology of an indeterminate conjunctival lesion. COMST may be the index presentation for the detection of previously undiagnosed myxoma syndromes. One such association is with cardiac myxomas, which can result in vascular embolic events. Therefore, it is important to do cardiac screening in all patients diagnosed with a COMST.
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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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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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Qin XY, Jin ZH, Wang YP, Zhang ZD. Conjunctival myxoid stromal tumour: a distinctive clinicopathological and immunohistochemical study. Br J Ophthalmol 2018; 103:1259-1265. [PMID: 30381388 DOI: 10.1136/bjophthalmol-2018-312747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To describe the clinicopathological and immunohistochemical characteristics of 10 patients representing a new entity of benign conjunctival myxoid stromal tumours. METHODS Retrospective review of clinical findings, histopathological and immunohistochemical studies identified 10 cases of low-grade conjunctival myxoid stromal tumours. Specimens were routinely processed and stained with H&E. Immunohistochemical stains for CD34, CD68, vimentin, S100, smooth muscle actin (SMA), myosin, desmin, actin, Bcl-2 and Ki-67 were performed. Specific stains for Alcian-blue periodic acid-Schiff (AB-PAS) and aldehyde fuchsin stains were also performed. RESULTS Ten patients with an average age of 45.6±11.1 years had a tender white or faint yellow to red mass on the bulbar conjunctiva. All the lesions were completely removed, and none of the patients relapsed. Histologically, all neoplasms consisted of spindle-shaped cells that showed signs of pseudonuclear inclusions, multinuclear cells and had no atypia. The stroma consisted of a large amount of mucus and was infiltrated with delicate to ropey collagens, a few mast cells and new vessels. Immunohistochemical stains were positive for CD34, vimentin and Bcl-2; partial positive for CD68; very low for Ki-67; and negative for S100, SMA, myosin, desmin and actin. AB-PAS suggested that the stroma was mucinous. CONCLUSIONS These rare benign mesenchymal conjunctival tumours are mostly unilateral and occur in the bulbar conjunctiva. Complete resection is the radical treatment. These lesions are characterised by multiple spindle cells, a large amount of mucus, and sharing similar basic histopathological features with conjunctival myxoma and conjunctival stromal tumour. We suggest naming these lesions 'conjunctival myxoid stromal tumours'.
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Affiliation(s)
- Xiao-Yi Qin
- Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhe-Hao Jin
- Eye Hospital of Wenzhou Medical University, Wenzhou, China
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Ríos Y Valles-Valles D, Hernández-Ayuso I, Rodríguez-Martínez HA, Medina-Cruz A, Salcedo-Casillas G, Rodríguez-Reyes AA. Primary conjunctival myxoma: case series and review of the literature. Histopathology 2017; 71:635-640. [PMID: 28570006 DOI: 10.1111/his.13274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Dolores Ríos Y Valles-Valles
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital 'Dr Luis Sánchez Bulnes', Mexico City, Mexico
| | - Ivette Hernández-Ayuso
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital 'Dr Luis Sánchez Bulnes', Mexico City, Mexico
| | | | - Armando Medina-Cruz
- Pathology Service, Facultad de Medicina, UNAM y Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico
| | - Guillermo Salcedo-Casillas
- Oculoplastics and Orbit Surgery Service, Asociación para Evitar la Ceguera en México, IAP, Hospital 'Dr Luis Sánchez Bulnes', Mexico City, Mexico
| | - Abelardo A Rodríguez-Reyes
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital 'Dr Luis Sánchez Bulnes', Mexico City, Mexico
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Barsotti G, Rocchigiani G, Millanta F. Conjunctival myxoma in a dog: clinical and histopathological features. Aust Vet J 2016; 94:223-226. [DOI: 10.1111/avj.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/23/2015] [Accepted: 10/01/2015] [Indexed: 11/27/2022]
Affiliation(s)
- G Barsotti
- Department of Veterinary Sciences; University of Pisa; via Livornese lato monte, 56122 San Piero a Grado Pisa Italy
| | - G Rocchigiani
- Department of Veterinary Sciences; University of Pisa; via Livornese lato monte, 56122 San Piero a Grado Pisa Italy
| | - F Millanta
- Department of Veterinary Sciences; University of Pisa; via Livornese lato monte, 56122 San Piero a Grado Pisa Italy
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Sharma N, O'Hagan S, Phillips G. Conjunctival myxoma - atypical presentation of a rare tumour: case report and review of literature. BMC Ophthalmol 2016; 16:54. [PMID: 27177589 PMCID: PMC4866281 DOI: 10.1186/s12886-016-0233-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/07/2016] [Indexed: 11/12/2022] Open
Abstract
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).
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Affiliation(s)
- Neharika Sharma
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland, Australia.
| | - Stephen O'Hagan
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland, Australia.,(Ophthalmology), James Cook University, Queensland, Australia
| | - Gael Phillips
- Pathology Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
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Abstract
Conjunctival myxoma is an exceptionally rare, slow-growing, benign neoplasm of primitive mesenchyme origin. Forty-one cases of conjunctival myxoma from a literature review, including the authors' case, are listed. The usual clinical history is a painless mass appearing during months to years. Grossly, the tumor is a well-circumscribed, cystlike, gelatinous, yellow-to-pink, translucent-to-solid mass. Microscopically, the hypocellular tumor contains stellate- and spindle-shaped cells in a mucoid stroma with abundant hyaluronic acid mucopolysaccharides. Vimentin and α-smooth muscle actin highlight the spindle and stellate cells. S100 protein and desmin are negative for the tumor cells. Treatment is complete surgical excision, with no recurrence reported in the follow-up period. Notably, conjunctival myxoma may be associated with Carney complex, an autosomal-dominant disorder associated with skin pigmentation, endocrine abnormalities, and myxoma of the heart and eye. Physicians should appreciate this unique ocular tumor because of its potential association with Carney complex.
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Affiliation(s)
- Meng-Jun Xiong
- Department of Pathology, University of Missouri, Kansas City, School of Medicine, Kansas City
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