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Feng PW, Galor A, Tang V, Khzam RA, Herskowitz WR, Dubovy SR, Karp CL. Characteristics of conjunctival myxomas on anterior segment optical coherence tomography. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00180-7. [PMID: 39097290 DOI: 10.1016/j.jcjo.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/23/2024] [Accepted: 06/11/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Paula W Feng
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida; Miami Veterans Administration Medical Center, Miami, Florida
| | - Vincent Tang
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - William R Herskowitz
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
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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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3
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Kim S, Kim N. Conjunctival Myxoid Stromal Tumor Involving Eyelid Margin: A Case Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:80-81. [PMID: 38104592 PMCID: PMC10869430 DOI: 10.3341/kjo.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Seongmi Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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4
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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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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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Al-Qahtani BS, Alkatan HM, Khandekar R, Al-Salem A, Al-Swailem SA. Clinical features and histopathological analysis of corneal myxoma. Sci Rep 2022; 12:11207. [PMID: 35778593 PMCID: PMC9249855 DOI: 10.1038/s41598-022-15475-1] [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: 03/07/2022] [Accepted: 06/24/2022] [Indexed: 11/09/2022] Open
Abstract
To describe the presentation, histopathological characteristics, and management outcomes for corneal myxoma. This one-armed cohort study evaluated histologically confirmed consecutive cases of corneal myxoma. Data were evaluated on demographics, clinical presentation, management, histopathological and immunohistochemical features, and outcomes; visual acuity and corneal clarity. The study sample was comprised of 10 eyes (10 patients). The median age at presentation was 10.5 years. Five eyes had high intraocular pressure, four eyes had decreased distance visual acuity and one eye became discolored. Surgical management included penetrating keratoplasty (8 eyes), phototherapeutic keratectomy (1 eye), and evisceration because of a blind painful eye (1 eye). Postoperative best-corrected distance vision ranged from 20/20 to 20/60 (1 eye), < 20/60 to 20/200 (2 eyes), < 20/200 to 20/400 (1 eye), < 20/200 to light perception (4 eyes) and no light perception (1 eye). The histopathology of these lesions showed typical subepithelial proliferating spindle-shaped cells of mesenchymal origin within a myxoid stroma rich in glycosaminoglycan. The median duration of follow-up was 5 years. Recurrence was observed in an eye that underwent local excision. Corneal myxoma is a rare lesion that is presumably isolated, secondary, and reactive in nature. Surgically management yields reasonably favorable outcomes.
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Affiliation(s)
- Bader S Al-Qahtani
- Research Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia.,Ophthalmolmology Department, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia
| | - Ahmed Al-Salem
- Research Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia
| | - Samar A Al-Swailem
- Research Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia.
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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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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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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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13
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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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14
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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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15
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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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16
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Khan H, Chaubey S, Uzzaman MM, Iqbal Y, Khan F, Butt S, Deshpande R, Desai J. Clinical presentation of atrial myxomas does it differ in left or right sided tumor? Int J Health Sci (Qassim) 2018; 12:59-63. [PMID: 29623019 PMCID: PMC5870304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This paper reports a 20 years' experience in the management of atrial myxomas at our institution. Apart from presenting our experience of their clinical presentation, surgical management, post-operative complication, and long-term follow-up we investigated any correlation between left and right sided tumor with their symptom of presentation. MATERIALS AND METHODS The data were retrospectively collected for patients between the period 1995 and 2015 from the hospital database. The follow-up was conducted by questionnaire received from the patients describing their current status. RESULTS Fifty four consecutive patients underwent surgical resection for atrial myxomas. The mean age was 62 years (standard deviation [SD]: ±14 years) with a larger number of female (55.5%) patients. The most common location for the tumor was the left atrium (70.3%) with the atrial septum being the most common (63%) site of attachment. The tumors presented in a variety of ways, namely, as shortness of breath (37.03%), transient ischemic attack (24.07%), and chest pains (22.2%) being the more common modes of presentation. Left heart tumors presented 6 years earlier with more severe shortness of breath as compared to right-sided tumors. Post-operative atrial fibrillation occurred in 22.2% of patients. Concomitant surgical procedures were required in 26% of patient. The median length of post-operative hospital stay was 6 days (IQR: 5; 9). There were 2 (3.7%) in-hospital mortalities and 4 (7.4%) later deaths at 2, 3, 7, and 15 years, respectively. Long-term follow-up actuarial Kaplan-Meire survival for the whole group was 92.6 ± 3.6% at 20 years with a significant reduction in the severity of shortness of breath. CONCLUSION Cardiac myxoma is the most common form of the cardiac tumor with a slight female preponderance. Left-sided tumors present earlier than right-sided tumors with more severe shortness of breath. Excellent long-term results can be achieved with surgical intervention for cardiac myxomas, including any concomitant interventions. In particular, a sustained reduction in shortness of breath is observed.
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Affiliation(s)
- Habib Khan
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK,Address for correspondence: Habib Khan, Department of Cardiothoracic Surgery, Kings College Hospital, London SE5 9RS, UK. Tel./Fax: 00442032993433. E-mail:
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Mohammed Mohsin Uzzaman
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Yasir Iqbal
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Fareeda Khan
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Salman Butt
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Jatin Desai
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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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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