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First Author: D.Mpakas GREECE
Co Author(s): E. Tziastoudi F. Akritidou V. Antoniou M. Karafyloglou D. Bosvelis D. Karamanis
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A case report of a conjunctival myxoma and a review of the literature.
A 37 years old woman without a history of ocular trauma presented with painless swelling in the temporal bulbar conjunctiva of her left eye, which was perceived 12 months ago. The patient did not report any other health problems. In the ophthalmologic examination her visual acuity was 10/10 without correction bilaterally and the intraocular pressure was 14 mmHg in the right eye and 16 mmHg in the left. Biomicroscopy of the right eye was normal without any findings, while in the left eye a whitish, translucent, soft lesion, 9 x 5 mm in size, was found. The lesion was well defined and freely movable over the sclera. The rest of the ocular examination was normal.
The lesion was originally diagnosed as inflammatory conjunctival cyst and was treated conservatively with ointment tobramycin 0.1% / dexamethasone 0.3% three times daily for 10 days. Since there was no regression or decrease in the size, a surgical removal was performed and closure of the conjunctiva with thermocoagulation.
Histopathological examination revealed that the lesion consisted of loose connective tissue with focal myxomatodous texture and a few scattered blood vessels and bleeding impregnations. The overall histological picture was indicative of conjuctival myxoma.
The myxomas are benign slowly growing tumors of mesenchymal origin that occur in the heart and other organs, but very rarely in the eye. The conjunctival myxomas are extremely rare and can clinically be construed as other lesions. The incidence of conjunctival myxoma is 0.001 to 0.002% between the lesions of conjunctiva. The average age of reported cases is 50 years (range 18-80 years), with no preference of gender. This neoplasm presents as a soft, slowly growing, yellowish-pink, translucent, cystic and / or solid well-circumscribed fleshy lesion. The majority of reported cases have occurred in temporal conjuctiva. The differential diagnosis of conjunctival myxoma includes benign conditions such as amelanotic nevus, lymphangioma, lymphoma, myxoid neurofibroma, conjuctival cyst, or malignant conditions such as amelanotic melanoma, fibrous histocytoma, rhabdomyosarcoma, myxoid liposarcoma. The standard treatment for conjunctival myxoma is complete surgical excision. No cases of recurrence after complete excision or malignant transformation have been reported.