|Year : 1996 | Volume
| Issue : 1 | Page : 39-40
Pyogenic granuloma of cornea: A case report
Sathish Srinivasan, N Venkatesh Prajna, M Srinivasan
Aravind Eye Hospital & P.G. Institute of Ophthalmology, Madurai, India
N Venkatesh Prajna
Aravind Eye Hospital, 1, Anna Nagar, Madurai 625020
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40
Pyogenic granulomas are vasoproliferative inflammatory lesions composed of granulation tissue, and commonly occur on the cutaneous or mucosal surfaces. They usually follow trauma or infection. Though these lesions have been often reported on the lids and conjunctiva, corneal involvement has been acknowledged to be rare. We report a case of pyogenic granuloma of the cornea, which presented 18 years following trauma.
| Case report|| |
A 55 year old man presented to our out patient department with a history of a growth in his left eye of one month duration. He had sustained a thorn injury to the left eye, 18 years back resulting in a central corneal opacity and loss of vision. Examination of the left eye revealed a slight drooping of the upper eyelid and circumcorneal congestion of the conjunctiva. The cornea showed a dense central leucoma and a smooth surfaced mass of about 3 mm x 3 mm in size arising from the central corneal leucoma. It protruded for about 1 mm with a stalk attached to its basal attachment with the leucoma [Figure - 1]. There was no regional lymph node involvement. The mass precluded the detailed examination of the other intra ocular structures. The fellow eye was normal except for a mild nasal pterygium. The best corrected visual acuity was hand movements in the left eye and 6/6 in the right eye. The mass was excised intoto and was subjected to histopathological examination which revealed multiple endothelial lined vascular channels (proliferating capillary buds) along with an infiltrate of mononuclear cells, characteristic of pyogenic granuloma [Figure - 2].
| Discussion|| |
Pyogenic granulomas were originally described by Poncet and Dor in 1897. The term is a misnomer since it contains neither the inflammatory (purulent) exudate nor the typical epitheloid giant cell reaction characteristic of granulomatous inflammation. They are lesions composed of granulation tissue similar to that seen in wound healing. Granulation tissue consists of proliferating connective tissue (fibroblasts and fibrocytes) and newly formed capillary channels. Acute and chronic inflammatory cells are often interspersed between the fibrovascular elements.
The common site of occurence is on the skin of the face and extremities and usually follows trivial trauma or infection, although spontaneous occurence has been reported. They may also occur on the mucosal regions such as gingiva, hard palate, cheek, tongue, and the nasal fossa. In the eye, it has been reported to arise from the upper lid, lower lid, medial canthus, lateral canthus, upper and lower palpebral conjunctiva and in part of an exenterated socket. This condition may also occur in the limbus and may mimic a squamous cell carcinoma. [3,4] The involvement of the cornea is acknowledged to be extremely rare and was first reported by Minckler. He reported a case of pyogenic granuloma involving the cornea which simulated a recurrent squamous cell carcinoma clinically and was initially misdiagnosed as invasive squamous cell carcinoma on biopsy.
Apple et al, while acknowledging the rarity of this clinical entity arising from the cornea, reported three cases of pyogenic granuloma of cornea. All these cases developed this condition following chemical trauma to the eye. The duration between the trauma and the development of this granuloma was variable - two cases developed within two months, while one case developed eight years after initial trauma. Our patient developed this condition 18 years following the initial trauma. To the best of our knowledge, this is the first report from our country of a pyogenic granuloma arising from the cornea and the ophthalmologists may well entertain this clinical entity as a differential diagnosis when suspecting a malignant lesion.
| References|| |
Sen DK. Granuloma pyogenicum of limbus. Ind J Ophthalmol 31:31-32, 1983.
Panda A, Bhatia IM, Pattnaik NK. Granuloma pyogenicum. Ind J Ophthalmol 30:103-106, 1982.
Ferry AP, Zimmerman LE. Granuloma pyogenicum of limbus. Arch Ophthalmol 74:229-230, 1965.
Boockvar W, Wessely Z, Ballen P. Recurrent granuloma pyogeni cum of limbus. Arch Ophthalmol 91:42-44, 1974.
Minckler D. Pyogenic granuloma of the cornea simulating squamous cell carcinoma. Arch Ophthalmol 97:516-517, 1979.
Apple DJ, Boniuk MM. Pyogenic granuloma of the cornea. Surv Ophthalmol 29:188-192, 1984.
[Figure - 1], [Figure - 2]