A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature
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 k...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S245199362200336X |
| _version_ | 1817998096008740864 |
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| author | Kushan Medagoda K.A. Salvin B.A.G. Gayana Mahendra |
| author_facet | Kushan Medagoda K.A. Salvin B.A.G. Gayana Mahendra |
| author_sort | Kushan Medagoda |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T02:48:11Z |
| format | Article |
| id | doaj.art-9d7efe6dbbb54b75b1fd91ae7e4fecb2 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-14T02:48:11Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-9d7efe6dbbb54b75b1fd91ae7e4fecb22022-12-22T02:16:26ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362022-09-0127101590A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literatureKushan Medagoda0K.A. Salvin1B.A.G. Gayana Mahendra2Department of Physiology, Faculty of Medicine, University of Kelaniya, Sri Lanka; Corresponding author.Department of Anatomy, Faculty of Medicine, University of Kelaniya, Sri LankaDepartment of Pathology, Faculty of Medicine, University of Kelaniya, Sri LankaPurpose: 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.http://www.sciencedirect.com/science/article/pii/S245199362200336XPhlyctenulosisConjunctival myxoid tumorsConjunctival myxoid stromal tumor (COMST)Cardiac myxomas |
| spellingShingle | Kushan Medagoda K.A. Salvin B.A.G. Gayana Mahendra A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature American Journal of Ophthalmology Case Reports Phlyctenulosis Conjunctival myxoid tumors Conjunctival myxoid stromal tumor (COMST) Cardiac myxomas |
| title | A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature |
| title_full | A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature |
| title_fullStr | A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature |
| title_full_unstemmed | A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature |
| title_short | A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature |
| title_sort | conjunctival myxoid stromal tumor comst mimicking phlyctenulosis a case report and brief review of the literature |
| topic | Phlyctenulosis Conjunctival myxoid tumors Conjunctival myxoid stromal tumor (COMST) Cardiac myxomas |
| url | http://www.sciencedirect.com/science/article/pii/S245199362200336X |
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