Nasreen A Syed MD FC Blodi Eye Pathology Laboratory University of Iowa Acknowledgements Francisca Zuazo Echinique MD Patricia Kirby MD Conjunctival Complex Choristoma 3 month old Caucasian female ID: 915585
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Conjunctival Complex Choristoma
Nasreen A. Syed, MD
F.C. Blodi Eye Pathology Laboratory University of Iowa
Slide2AcknowledgementsFrancisca Zuazo Echinique, MDPatricia Kirby, MD
Conjunctival Complex Choristoma
Slide33 month old Caucasian femalePedunculated mass in the left lateral canthusPresent since about 1 month of age
Medical history: unremarkableExam appropriate for age other than the mass
Conjunctival Complex ChoristomaClinical Presentation
Slide4Conjunctival Complex Choristoma
Clinical Presentation
Slide5Resection delayed until 6 months of age due to risks of general anesthesiaPatient returned at age 6 months, lesion slightly largerObservation recommendedExcisional biopsy performed at age 10 months
Conjunctival Complex Choristoma
Management
Slide6Conjunctival Complex ChoristomaGross Examination
Tan-white, solid, rubbery irregular piece of tissue4 mm x 3.5 mm x 3 mm
Slide7Conjunctival Complex Choristoma
Histopathology
Slide8Conjunctival Complex ChoristomaHistopathology
Slide9Conjunctival Complex ChoristomaHistopathology
Slide10Conjunctival Complex ChoristomaHistopathology
Slide11Conjunctival Complex Choristoma
Immunohistochemistry
EMA
SSTR2
S100PR
Slide12Conjunctival Complex ChoristomaImmunohistochemistry
AE1/3
p63
CD68
Slide13Conjunctival Complex ChoristomaDiagnosis
Conjunctival complex choristomaOsseous component
Meningothelial component
Slide14Conjunctival Complex ChoristomaDiscussion
Ocular surface choristomatous lesions are uncommonTypically present in childhood or as young adult
Can occasionally occur in older adultsUsually occur as a dermoid or lipodermoidOccasionally can have other tissues (complex choristoma)Smooth muscle, lacrimal gland, bone, cartilage, tooth, brain
Slide15Conjunctival Complex ChoristomaDiscussion
? Cutaneous choristomatous analog
Cutaneous meningioma3 categoriesType I – primary cutaneousType II – deep soft tissue ectopic meningiomas extending into skinType III – CNS meningiomas extending into the skin (not choristomatous)Also may be related to previous trauma with skull fracture
Slide16Conjunctival Complex ChoristomaDiscussion
Cutaneous meningiomaType 1 cases
Tend to occur on the scalp or paraspinal skinChildhood or early adulthoodTend to be of the meningothelial typeAlmost all have psammoma bodiesCan express vimentin, EMA, S100, p63Rarely associated with genetic syndromes such as NF1Postulated to be on a spectrum with rudimentary meningoceles
Slide17Conjunctival Complex ChoristomaDiscussion
No reports of ocular surface meningothelial choristomas in humans in literature identifiedIs this the first case?
Rare reports of type II cutaneous meningiomas in the eyelidType I cutaneous meningioma of eyelid has been reported in dogs
Slide18Conjunctival Complex ChoristomaDiscussion
Our case – we recommended imaging of head to exclude a deeper lesion or any anomalies of the CNS
MRI of head and orbits was normal