|Year : 1960 | Volume
| Issue : 3 | Page : 72-74
Amyloid tumour of conjunctiva
Ishwarchandra, KD Sharma
Departments of Ophthalmology and Pathology, Medical College, Nagpur, India
|Date of Web Publication||5-May-2008|
Departments of Ophthalmology and Pathology, Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ishwarchandra, Sharma K D. Amyloid tumour of conjunctiva. Indian J Ophthalmol 1960;8:72-4
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|| |
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.
Married lady with 3 healthy children.
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.
Systemic examination did not reveal anything abnormal.
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.
Total W.B.C.: 6300 per c.mm. Differential count :
Polymorphs : 76%.
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|| |
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.
| References|| |
Agarwal, S., and Shrivastav, J. B. (1956), Brit. J. Ophthal. 42, 433-436.
Bhende, Y. M., and Patel, S. M., (1959), Ind. J. Of Path. and Bact. 2, 286292.
Handousa, A,(1951),Brit J. Ophthal. 38, 510.
Redi, F. (1948), Cior. Ital. Optical.1, 2,27, 263, quoted in Ophthalmic literature 1948.
Reirnann, H. A., Koucky, R. and Ekhird, C.M. (1935), Amer. J. Path. 11 ,
Srinivasan, E. C., (1949) Proc. All India Ophthal. Soc., 10, 39.
Symmers W. St. (1956) J. ClinPath. 9, 187-211.
Wahi, Pashpati, N, Wahi, P.N. and Mathur K. N., (1954), J. All-India OphthalSoc. 2, 1954.
[Figure - 1], [Figure - 2]