Tumor-like corneal limbal lesions
K.V. Sereda, Cand Sc (Med); G.I. Drozhzhina, Dr Sc (Med), Prof.; T.B. Gaidamaka, Dr Sc (Med); V.L. Ostashevskii, Cand Sc (Med); V.V. Vit, Dr Sc (Med), Prof
Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine; Odesa (Ukraine)
TO CITE THIS ARTICLE: Sereda KV, Drozhzhina GI, Gaidamaka TB, Ostashevskii VL, Vit VV. Tumor-like corneal limbal lesions. J.ophthalmol.(Ukraine).2020;2:17-23. http://doi.org/10.31288/oftalmolzh202021723
Background: Primary tumors of the cornea and sclera are extremely rare. Most tumors of this region are secondary neoplasms arising from adjacent ocular structures. Benign tumors, namely, conjunctival and/or corneal dermoid tumors and lipodermoids are most common.
Purpose: To analyze three cases of tumor-like corneal limbal lesions and to assess treatment outcomes.
Material and Methods: Three cases of tumor-like corneal limbal lesions were under our observation. All these were given a preliminarily diagnosis of a dermoid cyst or lipodermoid. Two patients underwent corneal lesion removal and subsequent keratoscleral plasty. In the third case, amniotic membrane was applied to the cornea after corneal lesion removal.
Results: The intrasurgically removed tissue was sent for histological examination. The diagnosis of dermoid or lipodermoid was not confirmed in any case. In these three cases, histology showed thickened loose connective tissue composed of crossed bundles of collagen fibers and covered by stratified squamous epithelium with a non-uniform thickness profile, with evidence of mild acanthosis. Loose connective tissue comprised blood vessels and was mildly infiltrated with lymphocytes in one case.
Conclusion: Limbal tumor-like lesions require thorough diagnostic evaluation including impression cytology is a must to differentiate benign from malignant epithelial lesions. In addition, the tissue removed during the surgical procedure must be sent to the pathological laboratory for histological verification of diagnosis.
Keywords: tumor-like lesions, corneal limbal area, dermoid cyst, lipodermoid, keratoscleral plasty, amniotic membrane
1.Vit VV. [Pathology of the eye, ocular adnexa and orbit]. Vol. 1. Odesa:Astroprint; 2019. Russian.
2.Saakyan SV, Tatskov RA, Ivanova OA, Tsygankov AY, Maybogin AM. [Surgical Treatment of Epibulbar Malformations]. Ophthalmology in Russia. 2019;16(3):289-95. Russian.
3.Elsas FJ, Green WR. Epibulbar tumors in childhood. Am J Ophthalmol. 1975 Jun;79(6):1001–7.
4.Boynton JR, Searl SS, Ferry AP, Kaltreider SA, Rodenhouse TG. Primary nonkeratinized epithelial (‘conjunctival’) orbital cysts. Arch Ophthalmol. 1992; 110:1238–42.
5.Sathananthan N, Moseley IF, Rose GE, Wright JE. The frequency and clinical significance of bone involvement in outer canthus dermoid cysts. Br J Ophthalmol. 1993 Dec;77(12):789-94.
6.Karatza EC, Shields CL, Shields JA, Eagle JRC. Calcified orbital cyst simulating a malignant lacrimal gland tumor in an adult. Ophthal Plast Reconstr Surg. 2004 Sep;20(5):397–9.
7.Rajabi MT, Ramezani K. Lipodermoid Cyst: A Report of a Rare Caruncular Case. Middle East Afr J Ophthalmol. 2015 Oct-Dec;22(4):528-30.
8.Fasina O, Ogun OG. Giant deep orbital dermoid cyst presenting early in infancy in a Nigerian child: a case report and review of the literature. J Med Case Rep. 2012;6:320.
9.Robb RM. Astigmatic refractive errors associated with limbal dermoids. J Pediatr Ophthalmol Strabismus. 1996 Jul-Aug;33(4):241-3.
10.Scott JA, Tan DT. Therapeutic lamellar keratoplasty for limbal dermoids. Ophthalmology. 2001 Oct;108(10):1858-67.
11.Watts P, Michaeli-Cohen A, Abdolell M, Rootman D. Outcome of lamellar keratoplasty for limbal dermoids in children. J AAPOS. 2002 Aug;6(4): 209–15.
12.Villalón ML, Leal MLÁ, Chavez JR, et al. Recurrent epibulbar dermoid cyst treated with amniotic membrane implant a case report. BMC Surg. 2018 Nov 14;18(1):98.
13.Kruse FE, Joussen AM, Rohrschneider K, You L, Sinn B, Baumann J, et al. Cryopreserved human amniotic membrane for ocular surface reconstruction. Graefes Arch Clin Exp Ophthalmol. 2000 Jan;238(1):68–75.
14.Malhotra C, Jain AK. Human amniotic membrane transplantation: Different modalities of its use in ophthalmology. World J Transpl. 2014 Jun 24;4(2):111-21.
15.Gheorghe A, Pop M, Burcea M, Serban M. New clinical application of amniotic membrane transplant for ocular surface disease. J MedLife. 2016 Apr-Jun;9(2):177-9.
16.Li DQ, Tseng SC. Three patterns of cytokine expression potentially involved in epithelial-fibroblast interactions of human ocular surface. J Cell Physiol. 1995 Apr;163(1):61-79.
17.Hao Y, Ma DH, Hwang DG, Kim WS, Zhang F. Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea. 2000 May;19(3):348-52.
18.Zhang S, Zhu YT, Chen SY, He H, Tseng SC. Constitutive expression of pentraxin 3 (PTX3) protein by human amniotic membrane cells leads to formation of the heavy chain (HC)-hyaluron an (HA)-PTX3 complex. J Biol Chem. 2014 May 9;289(19):13531-42.
19.Watts P, Michaeli-Cohen A, Abdolell M, et al. Outcome of lamellar keratoplasty for limbal dermoids in children. J AAPOS. 2002 Aug;6(4):209-15.
20.Zhong J, Deng Y, Zhang P, et al. New Grading System for Limbal Dermoid: A Retrospective Analysis of 261 Cases Over a 10-Year Period. Cornea. 2018 Jan;37(1):66-71.
The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.