Marsupialized Fungal Mycetoma Masquerading as Conjunctival Melanoma

Sayyad, Fouad E.; Karp, Carol L.; Wong, James R.; Weiss, Matthew J.; Bermudez-Magner, Jose Antonio; Dubovy, Sander R.

doi:10.1097/ico.0000000000000146

Cited by 5 publications

(4 citation statements)

References 19 publications

(21 reference statements)

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“…These cases showed bulbar conjunctival nodular involvement, and mycosis was not the first diagnosis. The patients were initially misdiagnosed and treated for scleritis (similar to our case), inflamed pterygium, or conjunctival tumours 3 6 7…”

Section: Discussionmentioning

confidence: 62%

“…The patient was a contact lens wearer who underwent scleral buckle surgery 2 years ago. A fungal infection from Scytalidium sp was confirmed after removing the mass 7…”

Section: Discussionmentioning

confidence: 96%

“…Finally, melanoma and amelanotic melanoma might also mimic this presentation; however, the lack of feeder vessels and the presence of transillumination rule them out. Moreover, AS-OCT would have shown its characteristic features, such as hyper-reflective subepithelial lesion with normal thickness and the appearance of a basal epithelium or an epithelial cleavage, indicating atypical melanocytes 7–9…”

Section: Differential Diagnosismentioning

confidence: 99%

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Anterior segment optical coherence tomography and ultrasound biomicroscopy in the diagnosis of subconjunctival mycosis mimicking nodular scleritis

et al. 2023

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A female patient in her 20s presented with a bulbar conjunctival mass lesion that was diagnosed as nodular scleritis. It was treated with topical and oral steroids in another hospital. Imaging was done using anterior segment optical coherence tomography and ultrasound biomicroscopy, which helped to rule out scleritis and subconjunctival cysticercosis. Histopathology of the excision biopsy specimen revealed fungal filaments. Topical antifungals were started, and the condition resolved without recurrence after therapy. Although rare, infections should be considered in the differential diagnosis of conjunctival mass lesions. Imaging can help to rule out other entities and guide towards appropriate management.

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Section: Discussionmentioning

confidence: 62%

“…The patient was a contact lens wearer who underwent scleral buckle surgery 2 years ago. A fungal infection from Scytalidium sp was confirmed after removing the mass 7…”

Section: Discussionmentioning

confidence: 96%

Section: Differential Diagnosismentioning

confidence: 99%

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Anterior segment optical coherence tomography and ultrasound biomicroscopy in the diagnosis of subconjunctival mycosis mimicking nodular scleritis

et al. 2023

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“…These include infections, foreign bodies, and chronic inflammation. Mycosis has been reported to mimic clinically conjunctival melanoma in a number of cases of dematiaceous fungi due to the presence of melanin in the wall of the fungal elements [ 11 ]. Foreign bodies have also been reported to clinically simulate conjunctival melanoma, including aluminium silicate material, mascara deposits, graphite from injury with a pencil, adrenochrome deposits from adrenalin analogues, and suture reactions [ 12 – 15 ].…”

Section: Discussionmentioning

confidence: 99%

Traumatic iridial extrusion mimicking a conjunctival melanocytic neoplasm

Zoroquiaín¹,

Ganimi²,

Alghamdi³

et al. 2016

ecancer

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Conjunctival melanoma is a rare malignant tumour of the eye. Its diagnosis represents a challenge for general pathologists due to low exposure to ocular biopsies and a broad differential diagnosis. In addition, conjunctival samples are often small and are associated with a high frequency of artefacts due to their processing. Here, we present the first case to date of a traumatic iridial extrusion masquerading as a conjunctival melanocytic neoplasm. An 83-year-old Asian man presented with a conjunctival-pigmented nodule surrounded by an area of diffuse pigmentation. Histopathology revealed in the nodule a well-demarcated lesion composed of spindle shaped melanocytes with thick-walled blood vessels. At higher magnification, the blood vessels were composed of thick walls with collagen fibres in an onion-skin-like arrangement. The histological findings were consistent with extruded iridial tissue. The map biopsies of the flat, pigmented lesion showed melanocytic cell proliferation with dendritic processes restricted to the lamina propria without any epithelial involvement, consistent with ocular melanocytosis. The diagnosis of conjunctival melanocytic lesions is challenging, and non-neoplastic conditions should always be included in the differential diagnosis. Pathologists should correlate clinicopathological findings and be familiar with the normal histology in order to achieve the correct diagnosis.

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