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   Table of Contents      
ARTICLE
Year : 1960  |  Volume : 8  |  Issue : 3  |  Page : 72-74

Amyloid tumour of conjunctiva


Departments of Ophthalmology and Pathology, Medical College, Nagpur, India

Date of Web Publication5-May-2008

Correspondence Address:
Ishwarchandra
Departments of Ophthalmology and Pathology, Medical College, Nagpur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Ishwarchandra, Sharma K D. Amyloid tumour of conjunctiva. Indian J Ophthalmol 1960;8:72-4

How to cite this URL:
Ishwarchandra, Sharma K D. Amyloid tumour of conjunctiva. Indian J Ophthalmol [serial online] 1960 [cited 2019 Oct 19];8:72-4. Available from: http://www.ijo.in/text.asp?1960/8/3/72/40682

Involvement of conjunctiva in pri­mary or secondary amyloidosis is in­frequent. Brief mention of the disease has been made in literature by various observers. Amongst Indian observers, Redi (1948), Srinivasan (1949), Wahi et al (1954) and Shrivastav and Agarwal (1954) have reported cases,the last observers reporting on the pathological aspect of a previous case observed in this Ophthalmology De­partment.

The second case of a tumour form­ing amyloidosis is being recorded in the literature because of its compara­tive rarity.


  Case Report Top


Mrs. M. 24 years MI. F. was admit­ted to Ophthalmic Department, Medical College Hospital, Nagpur on 15th October, 1959 for a painless growth inside the right eye, progress­ively increasing in size for the last six months and inability to open the right eye for the last 3 months.

In the left eye she was complaining of lacrymation for the last 3 months.

Family History

Married lady with 3 healthy children.

Past History

She had fever with rigor three months back for which she was treated by a Hakim.

No history of any venereal disease, tuberculosis, malaria, and chronic sup­purative lesion or chronic avitaminosis could be elicited.

General examination

Systemic examination did not reveal anything abnormal.

Local Examination:

In both the eyes there was trachoma Stage II, with a well defined pannus.

In the left eye there was mucocele of the left sac.

In the right eye there was a swel­ling of the tipper lid with mechanical drooping and a marked narrowing of palpebral aperture. The upper lid could not be averted.

On lifting the lid a polypoid growth could be seen arising from the bulbar conjunctiva occupying mainly the inn­er and outer angles and extending under the fornices. The medial end of the growth extended and involved the palpebral conjunctiva right up to the lid margin. The mass was pink in colour, and moderately hard to feel.

Movements of the eye ball were res­tricted in all directions.

Nothing abnormal was detected in the right eyeball and the fundus was normal.

Visual acuity was reduced to 6/36.

The growth from the median angle was excised. The growth was sub­conjunctival, free from the sclera. It did not bleed much and was friable. With the previous experience of one of us (Ishwarchandra) having seen a similar case, only a few years back, the possibility of localized amyloidosis was kept in mind during clinical exa­mination, which was subsequently confirmed on microscopy.

The following pathological and radiological examinations were done:­Blood for K.T.: Negative.

E.S.R.: 23 m.m. at the end of 1st hour (corrected Westergreen).

R.B.C.: 3.5 mil. per c.mm.

Haemoglobin: 1%

Total W.B.C.: 6300 per c.mm. Differential count :

Polymorphs : 76%.

Lymphocytes: 20%.

Eosinophils : 3%.

Mononuclears : 1%

Screening of chest was non-contribu­tary.

The left lacrymal sac was excised and was sent. for histologic study and showed only changes met with in chronic dacryocystitis.

Biopsy report of tumour mass sent

The excised biopsy specimen con­sisted of a soft pink grey piece of tis­sue 1.5 c.m. in its longest dimension. One surface appeared to be smooth and the other rough and ragged.

Histological section showed stretch­ed, thinned out conjunctiva. The sub­conjunctival tissue was replaced by homogenous nonfibrillar; acidophilic hyaline material [Figure - 1]. On staining with haematoxylin and eosin stain this was diagnosed as amyloid deposit which %, as confirmed by Congo-red and meta-chromatic stains. Similara myloid deposit was also observed in the walls of blood vessels [Figure - 2]. A reaction, on the part of tissue to the amyloid was characterised by the pre­sence of lymphocytes, plasma cells and foreignbody giant cells.


  Discussion Top


Amyloidosis is uncommon in India. In a recent communication Bhende and Patel (1959) have reviewed the published cases of amyloidosis in Indians. One is struck with the paucity of reported cases in literature. They could collect only 35 cases of which 14 were discovered and studied at au­topsy, 20 cases were recognised by liver or renal biopsy and one by the study of a surgically removed speci­men, the latter being the only example of localized amyloidosis in eye lids, reported by Agarwal and Shrivastav (1958). Obviously this review does not include the cases reported by Redi(1958), Srinivasan (1949) and Wahi et al (1954). Out of the 12 cases of amyloidosis, recently added in litera­ture by Bhende and Patel (1959) none of these cases occurred as a localized tumour.

Reimann et al (1935) have recog­nized four varieties of amyloidosis and referred to as (1) secondary, (2) pri­mary, (3) localized amyloid tumour and (4) ainyloiciosis associated with multiple myeloma. Of these secondary amyloidosis is the most common form and is associated with long continual infective, tissue destructive processes such as tuberculosis, leprosy, osteo­myetitis, etc. The organs most often involved are the spleen, kidneys, liver and adrenals. Primary amyloido­sis, which occurs in the absence of any known preceding predisposing disease, to-ids to involve the mesodermal tissues such as smooth and skeletal muscles, cardio-vascular system and skin. This type of amyloidosis is also known to show variability in the staining charac­teristics. However most authorities have now accepted the contention that primary and secondary amyloi­dosis are closely related. No clear cut distinction can be made between the two on the grounds of (1) morphology of deposits, including the staining characters, (2) distribution of de­posits, (3) pathogenesis and (4) che­mistry. According to Symmers (1956) the only criterion for labelling the form as primary amyloidosis is the ab­sence of recognized predisposing cause.

Localized amyloidosis forming tu­mour-like nodules has been described in many areas, including the respira­tory tract, tongue, conjunctiva, pharnyx, thyroid, etc. The etiology of such localized amyloid deposits in the ocular tissue is obscure. Very often these are associated with some local causes like chronic conjunctivitis or trachoma, the latter in 6o-7o per cent of these cases. The presence of ob­vious predisposing causes like tracho­ma and chronic dacryocystitis, the uniform staining reaction for amyloid and the tissue response around amy­loid deposits by lymphocytes and plasma cells, are points in favour of the present case being classified as that of secondary amyloidosis.[8]

 
  References Top

1.
Agarwal, S., and Shrivastav, J. B. (1956), Brit. J. Ophthal. 42, 433-436.  Back to cited text no. 1
    
2.
Bhende, Y. M., and Patel, S. M., (1959), Ind. J. Of Path. and Bact. 2, 286­292.  Back to cited text no. 2
    
3.
Handousa, A,(1951),Brit J. Ophthal. 38, 510.  Back to cited text no. 3
    
4.
Redi, F. (1948), Cior. Ital. Optical.1, 2,27, 263, quoted in Ophthalmic litera­ture 1948.  Back to cited text no. 4
    
5.
Reirnann, H. A., Koucky, R. and Ekhird, C.M. (1935), Amer. J. Path. 11 , 977.  Back to cited text no. 5
    
6.
Srinivasan, E. C., (1949) Proc. All India Ophthal. Soc., 10, 39.  Back to cited text no. 6
    
7.
Symmers W. St. (1956) J. ClinPath. 9, 187-211.  Back to cited text no. 7
    
8.
Wahi, Pashpati, N, Wahi, P.N. and Mathur K. N., (1954), J. All-India Ophthal­Soc. 2, 1954.  Back to cited text no. 8
    


    Figures

  [Figure - 1], [Figure - 2]



 

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