|Year : 2021 | Volume
| Issue : 2 | Page : 184-185
Cavernous hemangioma of the conjunctiva and its ultrasound biomicroscopic features
R Balamurugan1, Parul Chawla Gupta1, Raghulnadhan Ramanadhane1, Gude Geethanjali2, Pulkit Rastogi2, Jagat Ram1
1 Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||26-Jun-2020|
|Date of Acceptance||02-Oct-2020|
|Date of Web Publication||01-Apr-2021|
Dr. Jagat Ram
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Keywords: Cavernous hemangioma, conjunctiva, propranolol, ultrasound biomicroscopy, Valsalva manoeuvre
|How to cite this article:|
Balamurugan R, Gupta PC, Ramanadhane R, Geethanjali G, Rastogi P, Ram J. Cavernous hemangioma of the conjunctiva and its ultrasound biomicroscopic features. Indian J Ophthalmol Case Rep 2021;1:184-5
|How to cite this URL:|
Balamurugan R, Gupta PC, Ramanadhane R, Geethanjali G, Rastogi P, Ram J. Cavernous hemangioma of the conjunctiva and its ultrasound biomicroscopic features. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 29];1:184-5. Available from: https://www.ijoreports.in/text.asp?2021/1/2/184/312356
| Case Report|| |
A 47-year-old female presented with a reddish-purple elevated mass in the right eye for the past 2 years. The onset of the mass was insidious and gradually increasing in size. There was no history of any trauma or any previous ocular surgery. No evidence of mucosal or cutaneous mass lesion on systemic examination was present.
Her best-corrected visual acuity was 6/9 bilaterally. Slit-lamp examination of the right eye revealed a 6 mm × 5 mm partially mobile, cystic, bulbar conjunctival lesion in the nasal part of the conjunctiva with well-defined borders and overlying tortuous vessels as shown in [Figure 1]a. There were no visible pulsations or an increase in the size of the mass on performing the Valsalva manoeuvre. Rest of the ocular evaluation as well as examination of the other eye was within normal limits. Based on history and clinical examination, a diagnosis of benign vascular tumor was made.
|Figure 1: (a) It shows the cavernous hemangioma of the bulbar conjunctiva. (b) It shows the post excision photo of the lesion at 1-month follow-up|
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Ultrasound biomicroscopy (UBM) at 50 MHz frequency was carried out in supine position with the right eye looking laterally and the eye immersed in normal saline-filled watercap and the probe being kept parallel to the lesion. The scan [Figure 2]a and [Figure 2]b demonstrated multiple cystic spaces with moderate to high internal echogenicity with a visible horizontal level suggestive of blood-filled cystic cavity. The mass had well-defined margins with absence of invasion to the surrounding tissues of cornea and sclera.
|Figure 2: (a and b) They show the ultrasound biomicroscopic image with gain being kept at 100 dB with the probe being kept abutting the mass lesion parallel to it describing normal scleral texture and a well-circumscribed conjunctival mass with multiple intralesional cystic cavities filled with the moderate to high intensity echoes suggestive of blood-filled cyst|
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The mass was excised with amniotic membrane transplantation. Histopathology [Figure 3]a and [Figure 3]b revealed dilated vascular channels arranged back to back in the subepithelial conjunctival stroma. These vascular channels were thin walled and were lined by flattened endothelial cells confirming the diagnosis of cavernous hemangioma. The patient was followed up for 1 year and no recurrence was noted [Figure 1]b.
|Figure 3: (a) It shows surface conjunctival lining with large blood-filled cavernous spaces underneath (H and E, 4× magnification). (b) These blood-filled spaces are lined by a single layer of endothelial lining (H and E, 40× magnification)|
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| Discussion|| |
Hemangioma is an example of a hamartoma. It consists of irregular thick and thin-walled sinusoidal vascular channels., Cavernous hemangiomas usually present as benign intraorbital tumors in adults; however, the conjunctival types are very rare., Based on the retrospective case series by Shields et al. on clinical features of vascular tumors of the conjunctiva done among 140 patients, the incidence of cavernous hemangioma was found to be 0.2%. It is seen mostly in adults between the fourth and fifth decades of life with higher female preponderance. A prospective study by Buchwald et al. to compare the value of UBM and anterior segment optical coherence tomography (AS-OCT) in the diagnosis of conjunctival lesions revealed that AS-OCT shows very small cystic structures, while UBM is better for better assessment of tumor margin assessment. There have been isolated case reports of resolution of these lesions with timolol eye drops, similar to the treatment of cutaneous capillary hemangioma in infants with propranolol. However, most patients do well with excisional biopsy and do not require further therapy.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]