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Case Reports
. 2024 Oct 9;16(10):e71130.
doi: 10.7759/cureus.71130. eCollection 2024 Oct.

A Huge Conjunctival Atypical Fibroxanthoma

Estefania Ramirez Marquez  1 , José J López-Fontanet  1 , Gerardo Torres  2 , Jean Lafontaine  3 , Maria Correa  3 , Armando L Oliver  1 , Joseph Campbell  4
Affiliations
Case Reports

A Huge Conjunctival Atypical Fibroxanthoma

Estefania Ramirez Marquez et al. Cureus. .

Abstract

We report the case of a Hispanic male whose conjunctival atypical fibroxanthoma (AFX) grew very large, with intraocular as well as extraocular muscle extensions, and was treated with exenteration. A 50-year-old male presented with a one-month history of foreign-body sensation in his left eye. The initial examination revealed an erythematous, vascularized, pedunculated lesion arising from the left eye conjunctiva. A tissue biopsy from the lesion confirmed the diagnosis of an AFX with a small component of squamous cell carcinoma. The patient was intermittently lost to follow-up until, one-and-a-half years after his initial visit, he underwent an exenteration of the left eye as the tumor had intraocular and extraocular muscle extensions. Subsequently, he was scheduled for ongoing monitoring.

Keywords: atypical fibroxanthoma; conjunctiva; cornea; exenteration; tumor.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Photographs of the progression of the patient’s left-eye atypical fibroxanthoma.
External photographs of the patient upon initial evaluation reveal (A) a hemorrhagic and pedunculated lesion prolapsing from the conjunctiva and (B) a vascular pedunculated mass extending from the bulbar conjunctiva with prominent feeder vessels and distal ulceration. Photographs three months later show a (C) front and (D) lateral view of a hemorrhagic mass with a purple hue obscuring the view of the ocular surface and distal ulcerative changes. After 10 months, photographs reveal (E) a large pedunculated mass with distal ulcerated and necrotic changes originating from the bulbar conjunctiva and cornea. Photograph 16 months after the initial encounter during (F) preoperative evaluation reveals a large pedunculated mass with superior hemorrhagic and purulent tissue.
Figure 2
Figure 2. Axial orbital computed tomography scans.
(A) Pre-contrast and (B) post-contrast scans reveal an exophytic-enhancing conjunctival lesion around the inferior aspect of the anterior left globe measuring approximately 1.1 cm (anterior-posterior) × 2.1 cm (transverse) × 1.7 cm (craniocaudal). There was no involvement of the eyelid, lacrimal gland, extraocular muscles, or left lens.
Figure 3
Figure 3. Histopathological images.
(A) Pleomorphic cells with hyperchromatic nuclei and abundant eosinophilic cytoplasm and numerous mitotic figures (hematoxylin and eosin (H&E), 40×). (B) Higher magnification showing pleomorphism, hyperchromasia, prominent nucleoli, and bizarre multinucleated giant cells (H&E, 60×). (C) Squamous cell component. (D) CD10, strong and diffuse immunoreaction (20×). (E) CD68 positivity (20×). (F) p40 positivity (40×).
See this image and copyright information in PMC

References

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