Case of atypical fibroxanthoma in the palpebral conjunctiva

Abstract

We report a case of atypical fibroxanthoma that developed in the palpebral conjunctiva. A 94-year-old woman had a hemorrhagic tumor in the right lower palpebral conjunctiva that was resected, and adjunctive cryotherapy was applied to the surgical bed. The tumor was bleeding and appeared as a pale red, elastic but firm nodule approximately 15x16x8 mm in size. It was composed mainly of fibroblast-like cells and pleomorphic histiocyte-like cells. A storiform pattern was observed in the fibroblast-like cells. The tumor stained positive for vimentin, CD68, and CD10, weakly for CD74 and CD99, and was negative for keratin (wide), KL-1, alpha-fetoprotein, myoglobin, S-100, alpha-smooth muscle actin, desmin, leukocyte common antigen, and glial fibrillary acidic protein immunohistochemically. The MIB-1 index was about 10%. From these findings, we diagnosed the tumor as an atypical fibroxanthoma. There has been no recurrence in the 2 years since the resection. An atypical fibroxanthoma in the palpebral conjunctiva is very rare. The clinical presentation and histological and immunohistochemical studies are helpful in distinguishing between an atypical fibroxanthoma and a malignant fibrous histiocytoma.