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A Conjunctival Leiomyoma
Suzanne O. Brannan, FRCOphth,
David Cheung, FRCOphtha,
Simon Trotter, FRCPath, Alan J. Tyler, FBOA,
and Tristan Q. Reuser, FRCOphth
To report a conjunctival leiomyoma.
Observational case report.
A 35-year-old man was referred to us for
evaluation of a lesion in his left eye. The lesion had been
present for 1 year but had recently caused irritation.
Ophthalmologic examination revealed an elevated mass
in the episclera. There was no associated conjunctival/
episcleral injection. Ocular examination was otherwise
entirely normal. An excisional biopsy was performed.
The histopathologic and immunohistochemistry
examinations established the diagnosis of a conjunctival
This case represents the ﬁrst report, known
to date, describing the occurrence of a conjunctival
leiomyoma. (Am J Ophthalmol 2003;136:749 –750.
© 2003 by Elsevier Inc. All rights reserved.)
EIOMYOMAS ARE BENIGN SMOOTH MUSCLE TUMORS
that mainly develop in the female genital tract. They
uncommonly develop in the uveal tract
and must be
considered in the differential diagnosis of an amelanotic
Histopathologically they may resemble any
uveal “spindle cell” tumor, and immunohistochemistry is
necessary to establish the diagnosis. This case is the ﬁrst to
report the presence of a leiomyoma arising in the conjunc-
A 35-year-old Cameroonian male was seen for evalua-
tion of a lesion on his left eye. He ﬁrst noted the lesion 1
year earlier. The left eye had recently developed intermit-
tent irritation. On examination, corrected visual acuity
was 20/20 in both eyes. Slit-lamp examination revealed an
elevated mass in the conjunctiva (Figure 1) with no
associated injection of the episcleral and deep scleral plexi.
The lesion was not adherent to the sclera. Indirect oph-
thalmoscopy and gonioscopy were unremarkable. The
patient’s general health was good.
An excisional biopsy was performed. The scleral surface
deep to the lesion was inspected intraoperatively and was
noted to be free from pathology and with normal vascula-
ture. The biopsy consisted ofa4mmϫ 3 mm fragment of
conjunctival tissue containing a well-circumscribed nod-
ule. Microscopy revealed compactly arranged eosinophilic
fascicles of spindle cells within vascularized subepithelial
tissue (Figure 2, top). There were no mitotic ﬁgures or
junctional activity. Immunocytochemical analysis showed
extensive positive staining with the smooth muscle actin
marker (Dako Ltd, Ely, Cambridgeshire, England) (Figure
2, bottom). Negative staining was demonstrated for
HMB-45 and S-100. These features were consistent with a
diagnosis of a conjunctival leiomyoma.
Leiomyoma is a benign smooth muscle tumor that can
develop in any part of the body but which has a predilec-
tion for the female genital tract in more than 95% of
They are uncommon intraocular tumors that have
been reported to arise from the uveal tract.
There are no
previous reports of primary leiomyoma originating from
conjunctiva. Transscleral leiomyoma presenting as an
epibulbar lesion has been described.
assisted in excluding a uveal tumor with transscleral
spread: the tumor was mobile over sclera, and gonioscopy
and indirect ophthalmoscopy with indentation were unre-
markable. However, Shields and coworkers reported
leiomyomas originating in the supraciliary space with
possible full-thickness erosion of the sclera but sparing of
the underlying uveal.
In their observations on seven
intraocular cases, Shields and coworkers noted that
leiomyomas tend to affect the ciliary body and peripheral
choroid rather than posterior choroid.
cally, the differential diagnosis of ocular spindle cell lesions
Accepted for publication March 21, 2003.
From the The Princess Alexandra Eye Pavilion, Edinburgh, Scotland.
Inquiries to Suzanne O. Brannan, FRCOphth, Princess Alexandra Eye
Pavilion, Chalmers Street, Edinburgh EH3 9HA, Scotland; fax: (ϩ44)
0131-536-3897; e-mail: Suzanne@brannan43.fsnet.co.uk
FIGURE 1. Slit-lamp examination of the patient’s left eye
showed an elevated mass in the conjunctiva.