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Year : 2020  |  Volume : 63  |  Issue : 4  |  Page : 654-655
Pleomorphic lipoma of conjunctiva - An unusual tumor at unusual site


1 Ophtalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, Telangana, India
2 Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
3 Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

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Date of Submission19-Jun-2019
Date of Decision07-Jan-2020
Date of Acceptance16-Jan-2020
Date of Web Publication28-Oct-2020
 

How to cite this article:
Mishra DK, Jakati S, Bothra N, Agrawal M. Pleomorphic lipoma of conjunctiva - An unusual tumor at unusual site. Indian J Pathol Microbiol 2020;63:654-5

How to cite this URL:
Mishra DK, Jakati S, Bothra N, Agrawal M. Pleomorphic lipoma of conjunctiva - An unusual tumor at unusual site. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Nov 24];63:654-5. Available from: https://www.ijpmonline.org/text.asp?2020/63/4/654/299310




Pleomorphic lipoma is a rare benign lipomatous tumor and rarely occurs in the bulbar conjunctiva, subjunctiva, and orbit.[1],[2]

Herein, we described a rare case of pleomorphic lipoma at an unusual site of bulbar conjunctiva in a middle-aged female.

A 39-year-old woman presented to an oculoplasty clinic with a 2-year history of asymptomatic slow-growing mass over the temporal side of the right eye. On examination, her best-corrected visual acuity was 20/20 in both eyes without any aid. The right eye on the temporal side showed a fleshy pink mass with a yellowish tinge and measured 7 mm × 5 mm × 3 mm with increased vascularity [Figure 1]a. The anterior and posterior segment examination of the right and left eye were unremarkable. There were no systemic abnormalities or lymphadenopathy found. The excision biopsy of the mass was performed. Intraoperatively it was noted that the bulbar conjunctival mass had no communication with the orbital fat. The excised conjunctival tissue was sent for the histopathological examination to Ophthalmic Pathology Laboratory.
Figure 1: (a) Clinical photograph shows a fleshy pink mass with yellow tinged in temporal region of the conjunctiva and the lesion has prominent blood vessels. (b) Photomicrograph shows loosely arranged spindle cells with floret like giant cells, (Hematoxylin and Eosin stain, 10× ).Inset). Inset: 40× magnification. (c). Photomicrograph shows low proliferation Index, Ki-67 (Immune stain, 10 ×) (d). Photomicrograph shows CD34 positive floret like giant cells, (Immune stain, 10 ×)

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Gross examination of excision biopsy revealed a greyish-yellow soft tissue mass measuring 7 mm × 5 mm × 3 mm. Cut surface was solid, grey-white to yellow, firm, and slippery. Microscopic examination showed a hypocellular lesion with loose clusters of spindle cells admixed with multinucleated giant cells having floret shaped nuclei [Figure 1]b. Immunohistochemistry showed strong expression for vimentin. Proliferative index ki-67 was very low [Figure 1]c. S-100 and smooth muscle actin were not expressed in tumor cells. CD34 was expressed by floret-shaped giant cells and spindle cells [Figure 1]d. Based on histomorphology and immunohistochemistry, the diagnosis of pleomorphic lipoma was made. Postoperative period was uneventful, and at last follow up-period, 3 weeks later, there was no recurrence noted.

Pleomorphic lipoma was first described by Shmookler and Enzinger in 1981.[3] It is four times more common in males with the age range of 50–70 years. Emily Li and colleagues reported a case of pleomorphic lipoma in a 55-year-old woman who presented with a painless, pink mass of the right eye bulbar conjunctiva similar to our case.[4]

The review of literature shows that cases diagnosed as prolapsed orbital fat, were actually pleomorphic lipomas of the orbit, containing adipocytic cells that are distinct from normal orbital adipocytes.[5] There have been reports of pleomorphic lipoma occurring in extraorbital tissues, which are devoid of fat or have low fat density.[6],[7] In our case, pleomorphic lipoma arose from the bulbar conjunctiva, which does not contain fat normally.

To conclude, the pleomorphic lipoma of conjunctiva is an extremely rare entity. Clinically it can be misdiagnosed and intraoperative careful examination must be done to rule out communication with orbital fat. The histopathological examination of excised tissue is also essential for the confirmation of pleomorphic lipoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Schmack I, Patel RM, Folpe AL, Wojno T, Zaldivar RA, Balzer B, et al. Subconjunctival herniated orbital fat: A benign adipocytic lesion that may mimic pleomorphic lipoma and atypical lipomatoustumor. Am J SurgPathol 2007;31:193-8.  Back to cited text no. 1
    
2.
Daniel CS, Beaconsfield M, Rose GE, LuthertPJ, Heathcote JG, Clark BJ. Pleomorphic lipoma of the orbit: A case series and review of literature. Ophthalmology 2003;110:101-5.  Back to cited text no. 2
    
3.
Shmookler BM, Enzinger FM. Pleomorphic lipoma: A benign tumor simulating liposarcoma. A clinicopathologic analysis of 48 cases. Cancer 1981;47:126-33.  Back to cited text no. 3
    
4.
Li E, Silbert J, Sinard J. Pleomorphic lipoma of the bulbar conjunctiva. BMJ Case Rep 2018;11:e226548.  Back to cited text no. 4
    
5.
Daniel CS, Beaconsfield M, Rose GE, LuthertPJ, Heathcote JG, Clark BJ, et al. Pleomorphic lipoma of the orbit: A case series and review of literature. Ophthalmology 2003;110:101-5.  Back to cited text no. 5
    
6.
Ranganathan K, Mathew SA, Sreena NS, Lavanya N. Fat free pleomorphic lipoma of oral cavity: A rare entity. J ClinDiagn Res 2017;11:ZD01-3.  Back to cited text no. 6
    
7.
Sachdeva MP, Goldblum JR, Rubin BP, Billings SD. Low-fat and fat-free pleomorphic lipomas: A diagnostic challenge. Am J Dermatopathol 2009;31:423-6.  Back to cited text no. 7
    

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Correspondence Address:
Dilip K Mishra
Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Road No.02, Banjara Hills, KAR Campus, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_480_19

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