Conjunctival Stromal Tumor: Report of 4 Cases

• Published in: Ophthalmology (Rochester, Minn.) Vol. 119; no. 4; pp. 682 - 687
• Main Authors: Herwig, Martina C., MD, Wells, Jill R., MD, Grossniklaus, Hans E., MD, MBA
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2012; Elsevier
• Subjects: Actins - analysis; Adult; Antigens, CD - analysis; Antigens, CD34 - analysis; Antigens, Differentiation, Myelomonocytic - analysis; Biological and medical sciences; Biomarkers, Tumor - analysis; Conjunctival Neoplasms - chemistry; Conjunctival Neoplasms - pathology; Conjunctival Neoplasms - surgery; Female; Humans; Immunoenzyme Techniques; Male; Medical sciences; Mesenchymal Stromal Cells - chemistry; Mesenchymal Stromal Cells - pathology; Middle Aged; Miscellaneous; Neoplasm Proteins - analysis; Ophthalmology; Retrospective Studies; S100 Proteins - analysis; Solitary Fibrous Tumors - chemistry; Solitary Fibrous Tumors - pathology; Solitary Fibrous Tumors - surgery; Vimentin - analysis; Ophthalmology; Conjunctiva; Report; Stromal tumor
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2011.09.024

Purpose To describe the clinical, histopathologic, immunohistochemical, and ultrastructural features of a case series of benign stromal tumors in the bulbar conjunctiva. Design Observational case series. Participants Four patients with a conjunctival lesion that were classified histologically as low-grade stromal tumors consisting of spindle-shaped cells with occasional pseudonuclear inclusion and multinucleated cells in a partly myxoid matrix. Methods Four cases of low-grade conjunctival stromal tumors were retrospectively identified in an ophthalmic pathology laboratory database. Patients' records were analyzed for demographic data, clinical appearance, and the postoperative course. Formalin-fixed, paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin and periodic acid Schiff. Immunohistochemical stains for vimentin, S100, CD34, smooth muscle actin (SMA), CD68, and factor XIIIa were performed. Transmission electron microscopy (TEM) was performed on 3 of the cases. Main Outcome Measures Histopathologic evaluation (including immunostains and TEM) and clinical correlation. Results All 4 tumors occurred in the bulbar conjunctiva of patients between 41 to 53 years of age. None of the patients developed recurrence after excisional biopsy. Histologically, all tumors exhibited spindle-shaped cells with pseudonuclear inclusions and occasional multinuclear cells. Mitotic figures were not observed. The stroma seemed to be myxoid to collagenous. Immunohistochemical stains were positive for CD34, vimentin, and focally for CD68, but were negative for S100 and SMA. Conclusions We propose to classify these benign lesions, which share distinct histopathologic features, as “conjunctival stromal tumors.” A reactive/inflammatory component needs to be considered in the pathogenesis of this lesion. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.