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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 3  |  Page : 244-246

Lipoma conjunctivae


1 Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
2 Department of Opthalmology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria

Date of Web Publication28-Mar-2014

Correspondence Address:
Almustapha Aliyu Liman
Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.129578

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  Abstract 

Lipoma conjunctivae represents a very rare but known pathological condition. Here we report a case of a 23-year-old woman presented with an insidious, painless mass of the left conjunctiva first noticed 4 years prior to presentation. There was no visual impairment. Examination revealed a circumscribed, elevated, freely mobile, non-pigmented, yellowish growth in the infero-temporal region of the bulbar conjunctiva. The mass was easily compressible and does not significantly increase in size on pressing the eyeball. Visual acuity was 6/5 bilaterally. Excisional biopsy was done and histological examination revealed conjunctival lipoma. We presented this curious tumor in a young woman for its rarity, peculiar anatomic location and its mimic of conventional lipomatous morphology.

Keywords: Benign tumors, dermolipoma, lipoma conjunctivae, pleomorphic lipoma


How to cite this article:
Liman AA, Chinda D, Raheem N, Garba F. Lipoma conjunctivae. Arch Int Surg 2013;3:244-6

How to cite this URL:
Liman AA, Chinda D, Raheem N, Garba F. Lipoma conjunctivae. Arch Int Surg [serial online] 2013 [cited 2019 Aug 24];3:244-6. Available from: http://www.archintsurg.org/text.asp?2013/3/3/244/129578


  Introduction Top


Although lipomas, benign tumors of mature adipose tissue cells represent by far, the most common mesenchymal neoplasms, conjunctival lipomas are a very rare occurrence. [1] Most lipomas reported at this anatomic location have been of the pleomorphic lipoma types or dermolipoma. [2] It may exist as a hereditary condition and as a congenital anomaly. [3],[4] This unusual case of benign lipomatous neoplasm is reported for its rarity and clinical interest.


  Case Report Top


The present case report is about a 23-year-old woman presented to the ophthalmology clinic of our hospital, with an insidious, painless mass of the left conjunctiva. This was first noticed 4 years prior to presentation. There was no history of trauma, surgical procedure to the eye and no increase in size of the eyeball or visual impairment. It does not itch or cause any extra-cosmetic problem. No family history of similar condition was elicited or of other pre-morbid condition.

Ocular examination revealed a visual acuity of 6/5 bilaterally. There was no proptosis and the eye lids were normal with good lid closure. Physical examination also revealed a localized, circumscribed, elevated, freely mobile, non-pigmented, yellowish growth in the infero-temporal region of the bulbar conjunctiva. The mass was easily compressible and does not significantly increase in size on pressing the eyeball. Other structures were essentially normal. Systemic examination was unremarkable. A diagnosis of conjunctival lipoma was made.

Hemogram and routine biochemical tests were within normal limits. Patient was thus offered an excision biopsy after counseling. Gross examination of the resected lesion showed a faintly lobulated yellowish soft-tissue mass that measured 2 cm × 1 cm with a greasy cut surface. A hematoxylin and eosin stained paraffin embedded tissue sections made from it showed a fairly well delineated lesion comprising lobules of mature adipocytes with a delicate fibrovascular connective tissue stroma [Figure 1].
Figure 1: Photomicrograph of the tumor showing lobules of mature adipocytes with a delicate fibrovascular connective tissue stroma a characteristic morphology of lipoma (H and E, ×40)

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On this basis, a diagnosis of lipoma conjunctivae of the conventional type was confirmed. The patient was placed on topical steroid and antibiotics and duly followed-up in the clinic and has done well at 2 years follow-up.


  Discussion Top


Cutaneous lipomas are very commonly encountered, but lipomas of the eyeball are very rare. [2],[3],[4] Lipoma, in the main, is rare in the first two decades of life and usually makes its appearance when fat begins to accumulate in inactive and often obese individuals. [1],[5] Most cases are seen in patients between the ages of 40 and 60 years. [1],[6] No high peak age has been established for lipoma conjunctivae. This may be accounted for by its comparative rarity. Its presence at birth, in a 14-year-old boy who exhibited several developmental anomalies has, however, been documented. [4] It may, similarly occur as hereditary anomaly as reported in three filial generations. [3]

In our patient the mass was solitary and freely mobile. The differential diagnoses include dermoid cyst, vaso-formative and melanocytic lesions and both benign and malignant forms of epithelial and mesenchymal conjunctival tumors such as neurofibroma, dermatofibroma and a narrow range of carcinomata. Clinical diagnosis was achieved in our patient which was confirmed by histological examination. Another important differential diagnosis; itself a rare, often bilateral, clinical condition and a cause of orbital mass lesion but occurring mainly in obese elderly is prolapsed subconjunctival intraconal orbital fat which usually simulates pleomorphic lipoma and atypical lipomatous tumor (well differentiated liposarcoma) in some of its clinicopathologic characteristics. [7] This non neoplastic lesion, unlike the neoplasm being reported here, has predominantly been localized in the superotemporal quadrant and exhibits cytological elements such as lipoblasts, lockhern cells (adipocytes with intranuclear vacuoles), floret cells (multinucleated giant cells with wreath like configuration of normochromatic nuclei) and varying numbers of histiocytes, lymphoplasma cells and mast cells which are usually all lacking in conventional lipoma. [7]

Benign and malignant fatty tumors as well as normal mature adipocytes stain positively for vimentin and variably so for S-100 protein but the diagnostic utility of these stains in the histopathological evaluation of conventional lipoma is of little value and could have been exploited if we had a frozen section. [1]

Little is known about the etiopathogenesis of this tumor. Its gross and histological features nevertheless are similar to those of lipomas found in other anatomic sites. Most reported cases of conjunctival lipomas, though, were of the pleomorphic type with large lipid vacuoles surrounded by stellate, spindled and multinucleated cells. [2],[8] Clinically, the tumor in our patient grew insidiously and caused few problems or complications except for the benign cosmetic concerns. Such tumors may affect any part of the conjunctiva and have significant clinical differentials. Histologically, however, lipoma conjunctivae present little diagnostic difficulty. They may recur locally following local excision but the recurrence rate for all lipomas is low. [1]


  Conclusion Top


The clinical diagnosis of conjunctival lipoma may be shrouded by several differential diagnoses. Following diagnosis it can be safely and completely excised and histological examination would confirm the diagnosis. It is a thoroughly benign condition and surgical resection is the curative treatment modality.

 
  References Top

1.Weiss SW, Goldblum JR, editors. Enzinger and Weiss's Soft Tissue Tumours. Atlanta: 2001. p. 571-639.  Back to cited text no. 1
    
2.Bryant J. Pleomorphic lipoma of the bulbar conjunctiva. Ann Ophthalmol 1987;19:148-9.  Back to cited text no. 2
[PUBMED]    
3.SaebØ J. Lipoma conjunctivae in three generations. Acta Opthalmol 1948;26:447-50.  Back to cited text no. 3
    
4.Available from: http://www.images.wellcome.ac.uk/indexplus/image/<0061849.html. [Last accessed on 2013 Dec 15].  Back to cited text no. 4
    
5.Vinton RA Jr, Cawley EP, Wheeler CE. Lipoma of the eyeball. A report of two cases of bilateral, symmetrical, subconjunctival lipomas. Arch Dermatol 1961;84:941-2.  Back to cited text no. 5
[PUBMED]    
6.Fletcher CD, Unni KK, Mertens F, editors. World Health Organisation Classification of Tumours. Pathology and Genetics of Tumours of the Soft Tissues and Bone. Lyon: IARC Press: 2002. p. 19-46.  Back to cited text no. 6
    
7.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 lipomatous tumor. Am J Surg Pathol 2007;31:193-8.  Back to cited text no. 7
    
8.Shields JA, editor. Lipomatous and myxomatous tumours. In: Diagnosis and Management of Orbital Tumours. Philadelphia: W B Saunders; 1989. p. 236-8.  Back to cited text no. 8
    


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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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