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 Table of Contents  
CASE REPORT
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 15-16

Conjunctival fibroepithelial polyp – A rare case


1 Department of Ophthalmology, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
2 Department of Pathology, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India

Date of Submission27-Jul-2022
Date of Acceptance10-Nov-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Khalida Sayeed
Department of Ophthalmology, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1839_22

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  Abstract 


Fibroepithelial polyp, one of the most common benign cutaneous lesions, was seen as a conjunctival mass, which, to the best of our knowledge, is the second ever reported case of fibroepithelial polyp involving conjunctiva, although it can have atypical presentation and has been reported at sites like ureteropelvic junction, genitals, bronchi, tonsils, and outer ear canal. The common benign and malignant conjunctival lesions are pterygium, pingecuela, pannus, pyogenic granuloma, limbal dermoid, papilloma, squamous cell carcinoma, lymphoma, Kaposi sarcoma, and malignant melanoma. Therefore, the possibility of fibroepithelial polyp affecting uncommon sites cannot be negated.

Keywords: Conjunctiva, cutaneous, fibroepithelial polyp


How to cite this article:
Sayeed K, Iqbal J, Malhotra R. Conjunctival fibroepithelial polyp – A rare case. Indian J Ophthalmol Case Rep 2023;3:15-6

How to cite this URL:
Sayeed K, Iqbal J, Malhotra R. Conjunctival fibroepithelial polyp – A rare case. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:15-6. Available from: https://www.ijoreports.in/text.asp?2023/3/1/15/368181



Fibroepithelial polyps, also known as acrochordon or skin tag, are one of the benign nonepithelial tumors that arise from the mesodermal tissue.[1] They are usually seen in middle-aged and older individuals. No gender preponderance has been seen. The common sites involved are skin of neck, trunk, face, axilla, and groin. Infrequently, they can be seen in the ureteropelvic system, genitals, or bronchus. Majority of the cases are sporadic. Rarely, they can be seen with tumors of perifollicular mesenchyme involving the hair bulb. Fibroepithelial polyps are soft, flesh-colored, bag-like tumors, which are often attached to the surrounding skin by a slender stalk. Histologically, they consist of fibrovascular cores covered by benign squamous epithelium. Ischemic necrosis can occur in these lesions due to torsion, leading to pain. They are occasionally seen to be associated with trauma, diabetes, obesity, polycystic ovary syndrome, hormonal replacement therapy, acromegaly, and intestinal polyposis.[2],[3] Increase in number and size of these lesions may often take place during pregnancy, which may be due to hormonal stimulation.


  Case Report Top


A 68-year-old male, farmer by occupation, presented to us with a swelling in right eye (RE) of about the size of a pea for the last 1 year, which was gradually progressive and associated with redness, mild pain, foreign body sensation, and blurring of vision. There was past history of cataract surgery 3 years back and excision of similar swelling at the same site 3 years back in the same eye, records of which were not available. There was no history suggestive of any systemic illness.

On general examination, there was no significant preauricular, submandibular, or submental lymphadenopathy. Systemic examination showed no swelling elsewhere in the body.

Local examination of RE revealed an elevated pearly gray lesion of about 1 × 1 cm with tufts of vessels with ill-defined borders present at the superior bulbar conjunctiva and limbus extending from 11 o′ clock to 3 o′ clock, encroaching the superior cornea and covering half of the pupillary area. No pigmentation was seen, and it was fixed to the underlying tissue [Figure 1]a.
Figure 1: (a) Whitish lobulated mass present in superior conjunctiva with vascularization encroaching superior cornea covering half of the pupillary area. (b) Polypoid mass lined by squamous epithelium (H & E, 40×). (c) Hyperplastic squamous epithelium showing focal areas of dysplasia and goblet cells seen focally (H & E, 40×). H & E = hematoxylin and eosin

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Left eye anterior segment examination was within normal limits. Fundus examination of both eyes was within normal limits. Routine blood investigations were done.

No touch technique was used for complete excision of the mass with 4-mm safe surgical margin of excision with cauterization of base and conjunctival closure under local anesthesia. The excised mass was sent for biopsy. Topical antibiotic and steroid drops were prescribed. No complications and no recurrence were noted during follow-up.

On histopathologic examination, polypoid mass lined by hyperplastic squamous epithelium showing focal dysplasia was seen. Goblet cells were seen focally. Underlying stroma was fibromyxoid and edematous. Diagnosis of fibroepithelial polyp with focal dysplasia was made [Figure 1]b, [Figure 1]c.


  Discussion Top


Fibroepithelial polyps are one of the most common cutaneous lesions, but can have atypical presentation and have been reported at sites like ureteropelvic junction, genitals, bronchi, tonsils, and outer ear canal.[4],[5],[6],[7] The incidence of eyelid fibroepithelial polyp is found to be 8.6%.[8] In our case, the patient, being an elderly in her seventh decade, with history of recurrence of swelling at the same site and the clinical appearance of the lesion led us toward the provisional diagnosis of ocular surface squamous neoplasia. Other common conjunctival lesions are pterygium, pannus, pyogenic granuloma, limbal dermoid, papilloma, squamous cell carcinoma, lymphoma, Kaposi sarcoma, and malignant melanoma.[9]

To our surprise, the histopathologic examination of the excised mass suggested it to be a conjunctival fibroepithelial polyp with focal dysplasia. This is the second ever reported case of fibroepithelial polyp involving conjunctiva. The first one was reported by Vatansever et al.[1] in 2019 in a 57-year-old male, who presented with a swelling of the nasal conjunctiva. Not only the uncommon site of the conjunctival lesion, but also the previous two ocular surgeries in the same eye can be a risk factor for the occurrence of conjunctival fibroepithelial polyp.

Its pathophysiology includes mast cell recruitment due to trauma, which causes upregulation of tumor necrosis factor-alpha (TNF-α) and further leads to fibroblast proliferation and mitogenicity.[2] Hormonal growth factors also cause keratinocyte and fibroblast proliferation.[3] Human papillomavirus (HPV) is also seen to be involved in its pathogenesis.[10] Due to the possibility of involvement of multiple sites by the fibroepithelial polyp, it has to be looked for at other locations too to prevent any complication caused by it. Although rare, this lesion has the chance of malignant transformation, which should be actively searched for in a patient of fibroepithelial polyp at any of the sites.


  Conclusion Top


Ocular fibroepithelial polyp can involve conjunctiva apart from eyelid skin and simultaneous presence of such lesions at other organs can not be negated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vatansever M, Dinç E, Dursun Ö, Oktay ÖÖ, Arpaci R. Atypical presentation of fibroepithelial polyp: A report of two cases. Arq Bras Oftalmol 2019;82:239-41.  Back to cited text no. 1
    
2.
El Safoury OS, Fawzy MM, Hay RM, Hassan AS, El Maadawi ZM, Rashed LA. The possible role of trauma in skin tags through the release of mast cell mediators. Indian J Dermatol 2011;56:641-6.  Back to cited text no. 2
    
3.
Farag AG, Allah AM, El-Rebey HS, Ibraheem KI, Mohamed AS, Labeeb AZ, et al. Role of insulin-like growth factor-1 in skin tags: A clinical, genetic and immunohistochemical study in a sample of Egyptian patients. Clin Cosmet Investig Dermatol 2019;12:255-66.  Back to cited text no. 3
    
4.
Ludwig DJ, Buddingh KT, Kums JJ, Kropman RF, Roshani H, Hirdes WH. Treatment and outcome of fibroepithelial ureteral polyps: A systematic literature review. Can Urol Assoc J 2015;9:E361-7.  Back to cited text no. 4
    
5.
Raphael Avidime A, Usman H. Bilateral giant fibroepithelial labial mass: A case report. J Obstet Gynaecol Can 2017;39:564-6.  Back to cited text no. 5
    
6.
Melo RC, Ribeiro C, Sanches A, Oliveira A. A rare benign tumor of tracheobronchial tree: Endobronchial fibroepithelial polyp. Rev Port Pneumol 2015;21:221-2.  Back to cited text no. 6
    
7.
Thomas P, Rai P, Meena R. Fibroepithelial polyp of external auditory canal. Eur Ann Otorhinolaryngol Head Neck Dis 2017;134:141-2.  Back to cited text no. 7
    
8.
Paul S, Vo DT, Silkiss RZ. Malignant and benign eyelid lesions in San Francisco: Study of a diverse urban population. Am J Clin Med 2011;8:40-6.  Back to cited text no. 8
    
9.
Olivier JF. Common conjunctival lesions. Continuing Med Educ 2013;31:134-7.  Back to cited text no. 9
    
10.
Pezeshkpoor F, Jafarian AH, Ghazvini K, Yazdanpanah MJ, Sadeghian A, Esmaili H, et al. An association of human papillomaviruses low risk and high risk subtypes with skin tag. Iran J Basic Med Sci 2012;15:840-4.  Back to cited text no. 10
    


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