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Simultaneous Occurence of a Low-malignant Leiomyosarcoma and a Basal Cell Carcinoma of the Conjunctiva

1Breidenbach K., 1Bialasiewicz A., 2Nirmala V., 2Date A.,
1Dept. of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University Hospital, University of Oman (Muscat)
2Dept. of Pathology, Sultan Qaboos University Hospital, University of Oman (Muscat)

Purpose: Leiomyomas of the conjunctiva are extremely rare. They have been reported at the caruncle, iris, ciliary body, and choroid.
Case report: A 60 year old patient suffered from an 2.5mm prominent conjunctival nasally localized tumor (7x5mm) since 6 months, which had been documented but not excised.
Results: Routine staining showed epithelial parakeratoses, basal cell proliferation and nukleare atypies with a loss of polarity and occasional mitoses involving the basal layers impressing as a solar elastosis. The subepithelial collagen showed marked basophilic degeneration. At one focus the epithelium is markedly thinned out with downward extensions of basaloid cells in strands and groups with peripheral palisading of nuclei, interspersed with horn cysts, and the stroma showed a mucoid degeneration impressing as a basal cell carcinoma. In the trichrome stain an unencapsulated nodular lesion with indistinct margins was present, composed of fascicles of spindle cells with oval nuclei, and typical cytoplasmic fibrils without necroses impressing as a leiomyoma. Moderate nuclear atypies, occasional giant cells and 4-6/10 mitoses/hpf could be observed. These cells showed a strong expression of smooth muscle actin and were negative for melanocytic and epithelial markers (S-100, HMB45, cytokeratins).
Conclusions: Leiomyosarkomas are mainly tumors of low malignancy. In the iris 4/21 leiomyomas were reported as malignant (Ashton et al, 1966). The reported part of leiomyosarcoma showed only few hyprchromatic cells and slightly increased rate of mitoses, but a decresed demarcation. The tumor cells were not found in the lumina of the vessels. Conjunctival tumors should be evaluated histologically in order to provide an exact diagnosis, the resp. Treatment, and schedule regular follow-ups.