: corneal pyogenic granuloma is a rare complication of...
TRANSCRIPT
CORNEAL PYOGENIC GRANULOMA –
A RARE CASE WITH REVIEW OF LITREATURE
SURYA KANT NIRALA,PUNAM PRASAD BHADANI,SATISH KUMAR, IFFAT JAMAL ,SHUCHISMITA
DEPARTMENT OF PATHOLOGY ,AIIMS PATNA.
INTRODUCTION DISCUSSION GROSS AND MICROSCOPY
Figure 3 Microscopy
Figure 1. CT
SCAN.
ABSTRACT
CASE REPORT
CONCLUSIONS
REFERENCES
Pyogenic granuloma is an
exuberant vasculoproliferative,
inflammatory lesion composed of
excessive granulation tissue.
Conjuctival pyogenic granulomas
are common. But corneal
involvement is very rare because
of the avascular nature of cornea.
This report presents a case of a
62 year old male patient (whose
tissue was sent to department of
Pathology, AIIMS Patna). He had
come with complaint of loss of
vision & pain to department of
opthalmology . Slit lamp
examination showed vascularised
central corneal mass with
surrounding stromal infiltrate. On
histopathological examination
corneal pyogenic granuloma was
confirmed.is confirmed.
Gross finding: Specimen received as irregular
greyish white, soft tissue bits, measuring 1x1x0.4
cm. (Figure 2)
Microscopy: Section from the received corneal
button shows (Figure 3):
Stratified squamous lining epithelium with an area
of ulceration along with collarette formation.
Sub epithelial area as well as beneath the
ulcerated area show proliferated capillaries, dense
chronic inflammatory infiltrate and presence of
granulation tissue respectively.
Histopathologic Diagnosis - Pyogenic granuloma.
.
Pyogenic granuloma is a relatively common
skin growth. The term pyogenic granuloma were
described by Poncet and dor 18974.
The term pyogenic granuloma is actually a
misnomer since it contains neither the
inflammatory (purulent) exudate nor the typical
granulomatous epitheloid giant cell reaction.
It is also known as eruptive hemangioma or
lobular capillary hemangioma or pregnancy
tumour.
The common site of involvement is face,
hands, finger, lips and eyelids.
Ocular involvement is mostly located on
external surface of eyelid or palpebral
conjunctiva.
The diagnosis may be challenging if
diagnosed especially at the limbus or cornea.
Might be misdiagnosed as conjuctival
squamous cell carcinoma & ended up with
enucleation.
The age of onset , history of prior trauma,
infections & clinical features will often point to
the correct diagnosis.
Histopathological diagnosis will confirm the
entity.
A 62 year old male was admitted to AIIMS
Patna ophthalmology department with complaint
of loss of vision and pain in right eye.
10 days before presentation patient’s wife
noticed a small fleshy pinkish growth at centre of
the left eye.
The mass increases on size with pain, redness
of eyes and photophobia. The pain & redness
had started four weeks before the appearance of
mass & photophobia.
History of trauma present in the same eye,
one month back by small stone.
Local examination reveal swollen eyelids,
with mucopurulent discharge and infected
conjunctiva. Over the cornea, a pink fleshy
vascularised mass of 0.5x0.5 cm at the centre.
Evisceration done & sent for HPE.
CT Scan: Left globe was seen to be deformed,
morphology distorted, vitreous hyperdense with
soft tissue around the globe and leukoaraiosis
grade 3. (Figure 1)
Corneal pyogenic granuloma is a rare
complication of minor trauma1, surgery and
infection.
Therefore it should be considered as
differential diagnosis in corneal mass especially
after infection or trauma.
Pyogenic granuloma are vasculoproliferative,
inflammatory and exuberant proliferation of
granulation tissue which occurs most often on
face and extremities.
Ocular pyogenic granuloma are mostly
located on external surface of eyelid or the
palpebral conjunctiva2.
The involvement of cornea by pyogenic
granuloma is very rare and reported rarely in
English literature.
The avascularity of cornea could be a
probable reason for this rarity3 and hence, it
could be misdiagnosed as ocular malignant
pathology which could end up in extensive
surgery like enucleation.
1.Ferry AP (1989) Pyogenic granulomas of the eye and ocular
adnexa: a study of 100 cases. sTrans Am Ophthalmol Soc
87:327-347
2.Friedman AH, Henkind P (1971) Granuloma pyogenicum of
the palpebral conjunctiva. Am J Ophthalmol 71:868-872
3.Mietz H, Arnold G, Kirchhof B, Krieglstein GK. Pyogenic
granuloma of the cornea: report of a case and review of the
literature. Graefes Arch Clin Exp Op-hthalmol 1996; 23 (4):
131-136.
4.Ferry AP, Zimmermann LE (1965) Granuloma pyogenicum
of limbus simulating recurrent squamous cell carcinoma. Arch
Ophthalmol 74:229-230
5.Ekaterini C, Joseph H, Ralph C. Pyogenic Granuloma of the
Cornea in an Infant With Unilateral Microphthalmia. Arch
Ophthalmol 2003;121 (8): 1197-1200
6.Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma
of cornea: A case report. Indian J Ophthalmol 1996;44:39-40
: Corneal pyogenic granuloma is a rare complication of minor trauma1, surgery and infection. Therefore it should be considered as di. a. ma.
•Ekaterini C, Joseph H, Ralph C. Pyogenic Granuloma of the Cornea in an Infant With Unilateral Microphthalmia. Arch Ophthalmol 2003;121
Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40
Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40
Figure 2. Gross picture of specimen .