Bilateral synchronous conjunctival myxoma and review of the literature

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.

Conjunctival myxoma: A case report and review of a rare tumor

“…[17] No malignant transformation of a conjunctival myxoma has been reported, although some cardiac myxomas proceed to malignancy. [20,24] At presentation, our patient had no systemic comorbidity except for dyslipidemia; however, it is important to note that some myxomas may be a component of the Carney complex [11] or may be associated with Zollinger-Ellison syndrome or an abnormal atrial septum thickness. [25] Carney complex is an autosomal dominant syndrome that meets at least 2 of the following criteria: myxoma (cardiac, cutaneous, or mammary), spotty mucocutaneous pigmentation (of the face, trunk, lips, eyelid, or conjunctiva), endocrine overactivity (including Cushing syndrome), pituitary adenoma (associated with acromegaly or gigantism) and/or psammomatous melanotic schwannoma.…”

“…The differential diagnosis of conjunctival myxoma includes amelanotic nevus, amelanotic melanoma, fibrous histiocytoma, cyst, myxoid neurofibroma, lymphangioma, spindle cell lipoma, rhabdomyosarcoma and myxoid liposarcoma. [ 7 , 9 , 17 , 20 ] Conjunctival amelanotic nevi and melanomas are both characterized by prominent intrinsic vascularity or pigmentation; myxomas lack such features. [ 9 , 14 , 20 ] Fibrous histiocytomas are distinguished from myxomas by the vascularity and significant nuclear pleomorphism.…”

“…[ 7 , 9 , 17 , 20 ] Conjunctival amelanotic nevi and melanomas are both characterized by prominent intrinsic vascularity or pigmentation; myxomas lack such features. [ 9 , 14 , 20 ] Fibrous histiocytomas are distinguished from myxomas by the vascularity and significant nuclear pleomorphism. [ 9 ] Conjunctival cysts are lined with layers of non-keratinized epithelium and connective tissue, that are filled with clear serous fluid, whereas myxomas do not exhibit these layers.…”

“…[ 17 ] Spindle cell lipomas tends to be more yellowish and they contain mature fat cells and signet ring cells compared to myxoma. [ 20 , 22 ] Rhabdomyosarcomas typically occurs in childhood or adolescence, presenting as small, round cells mixed with stellate cells that exhibit mitotic activities; myxomas lack these cells. [ 23 ] In contrast to liposarcomas, myxomas lack pleomorphic multivacuolated lipoblasts and signet ring cells.…”

“…[ 23 ] In contrast to liposarcomas, myxomas lack pleomorphic multivacuolated lipoblasts and signet ring cells. [ 20 ]…”