Asian Biomedicine Vol. 9 No. 6 December 2015; 817 - 819 DOI: 10.5372/1905-7415.0906.457 Clinical vignette

A rare presentation of myxoma, pediculated and originating from the fornix of the conjunctiva

Deniz Turgut Cobana, Seda Gunb, Muhammet Kazim Erola aDepartment of Ophthalmology, Antalya Education and Research Hospital, Antalya 07400, TurkeybDepartment of Medical Pathology, Gazi State Hospital, Samsun 61420, Turkey

Background: Myxoma is a rare benign tumor of the connective tissue. It is the most common type of benign heart tumor, but may occur elsewhere. Objectives: To report a case of ocular fornix conjunctiva with involvement of myxoma. Methods: A 50-year-old male patient was admitted to our clinic with the complaint of a growing ovoid mass in his left lower eyelid fornix conjunctiva for over a year. The mass contained a hemorrhagic ulcer and was solid, painless, purple-red, and clinging to the inferior fornix by thin pedicle tissue. Examination of both eyes found that they were otherwise normal. Results: The mass was diagnosed as myxoma on the basis of histopathology including vimentin and CD34, but not S100 immunoreactivity, and fusiform-stellar-shaped cells in loose myxoid stroma stained with Alcian blue. Conclusions: Myxoma should be considered in the differential diagnosis of ocular tissue masses and that it can mimic other types of tumors.

Keywords: Fornix of conjunctiva, myxoma, pediculated

Myxoma is a rare benign tumor of the connective The mass was solid, painless, purple-red, and tissue. It is the most common type of benign heart ovoid, and clinging to the inferior fornix by a thin tumor, but it can occur in various parts of the body pedicle tissue. A hemorrhagic ulcer was located on it. [1]. It is observed mostly alone, but sometimes it may Detailed examination of both eyes showed they were be associated with Carney complex or multisystem normal except for the mass. diseases such as Zollinger–Ellison syndrome. Myxoma The mass was considered as a reactive lymphoid rarely originates from ocular tissues, but usually hyperplasia or pyogenic granuloma in preoperative originates from the bulbar conjunctiva if there is ocular differential diagnosis. The total mass was excised involvement [2, 3]. under local anesthesia. It is difficult to distinguish this rarely seen Macroscopically, the mass was pale pink-yellow tumor by macroscopic view. It can be misdiagnosed, polypoid material covered with skin, and 15 × 10 × 10 especially if the mass originates from an unusual mm in size. Tissue sectioning revealed a regular, well- region. We sought to report a case with ocular fornix circumscribed, pale pink-yellow, semitranslucent, conjunctiva involvement of myxoma to emphasize gelatinous (myxoid) mass. the consideration of ocular myxoma in differential Histopathology of the tissue sample surrounded diagnosis of ocular tissue masses. with multilayered acanthotic squamous epithelium revealed a recent widespread hemorrhage under the Case report epithelium and well-demarcated hypocellular lesion A 50-year-old male patient was admitted to our consisting of scattered fusiform-stellar-shaped cells clinic with the complaint of a growing mass in the left in a loose myxoid stroma (Figure 2A). There were lower eyelid fornix conjunctiva for over a year. When scattered cytoplasmic projections, intranuclear his eyelid was not supported, his left lower eyelid vacuoles, and mild pleomorphism in cells (Figure 2B). remained at eversion by the effect of the mass as Small numbers of vascular structures and indicated by the arrowhead in Figure 1. scattered mast cells were observed in the stroma. Immunohistochemical staining revealed cellular Correspondence to: Deniz Turgut Coban, Antalya Education and Research Hospital, Department of Ophthalmology, Antalya expression of vimentin and CD34, but not S100 07400, Turkey. E-mail: [email protected] immunoreactivity (Figure 3). 818 Deniz Turgut Coban, et al.

Figure 1. Mass in the left lower eyelid fornix conjunctiva (arrowhead)

Figure 2. A. Loose myxoid stroma surrounded by a squamous epithelium (hematoxylin and eosin staining ×400; bar = 250 μm), B. Cytoplasmic projections in fusiform-stellar-shaped cells (hematoxylin and eosin staining ×400; bar = 50 μm).

Figure 3. A. Vimentin-immunoreactivity in cells (3-amino-9-ethylcarbazole chromogen ×400, bar = 50 μm), B: CD34-imunoreactivity in cells (3-amino-9-ethylcarbazole chromogen ×400, bar = 50 μm). Vol. 9 No. 6 Myxoma from the fornix of the conjunctiva 819 December 2015

Stroma was stained positively by Alcian blue pink, and gelatinous, unlike in our case. In our case, (Figure 4). The case was diagnosed as myxoma on the reason for the purple-red appearance of the mass the basis of histopathology. The patient was consulted was the result of bleeding underneath the capsule that by the relevant departments for associated pathology, was shown in histopathology [6]. To our knowledge, but there was not any additional pathology except there is only one other case with a red color reported for sinusitis and nasal polyps. The patient refused in the literature [2]. treatment of polyps. Ectropion was not seen following Almost all publications report that myxoma the mass excision. Recurrence was not observed is adherent to conjunctival structures. In our case, during a 12 month followup period. polypoid myxoma was pediculated with conjunctiva by only about 3 mm tissue. To our knowledge, the present case is only the second reported in the literature that originates from the fornix of the conjunctiva [2, 3]. We should consider that myxoma can also occur in eye tissues and can mimic other types of tumors.

Conflict of interest statement The authors have no conflicts of interest to declare.

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