Purpose
To report 10 cases of an unusual conjunctival lesion that has been termed acquired sessile hemangioma .
Design
Retrospective, interventional case series.
Methods
A chart review was conducted on patients coded as having a conjunctival vascular tumor at the Ocular Oncology Service at Wills Eye Institute, Thomas Jefferson University. A cohort of these patients was identified as having a lesion comprising a complex sessile arrangement of conjunctival blood vessels that were remarkably similar to one another, but were distinctly different from other known conjunctival vascular tumors and malformations. These lesions were called acquired sessile hemangioma of the conjunctiva. Each case was evaluated for patient age, gender, race, laterality, and follow-up. Each tumor was assessed for anatomic location in the conjunctiva, quadrant of involvement, diameter, thickness, margin (sharp or ill-defined), and presence of feeder blood vessels.
Results
Ten cases were identified. The median age at the time of diagnosis was 58 years (mean, 58 years; range, 31–83 years). There were 8 women and 3 men, and all patients were white. Only 1 patient was referred specifically for the vascular lesion. In the other 9 cases, it was a coincidental finding by the authors on referral for unrelated problems. There were no related systemic or ocular findings that seemed to be related to acquired sessile hemangioma. In each case, acquired sessile hemangioma was characterized by a flat array of intertwining, mildly dilated blood vessels, usually on the bulbar conjunctiva. Fluorescein angiography, performed in 1 case, demonstrated a feeding artery, draining vein, and leakage of dye from the deeper blood vessels in the lesion and minimal or no leakage of dye from the more superficial blood vessels. Histopathologic analysis, obtained in 1 case, disclosed that the lesion comprised 2 to 3 layers of dilated congested blood vessels that were otherwise of normal appearance. A literature review failed to detect any previous reports on this lesion.
Conclusions
Acquired sessile hemangioma is an unusual conjunctival vascular lesion of adults that has characteristic clinical features. It should be differentiated from other conjunctival vascular lesions. There are no systemic associations. The best management is observation only, since most remain stable and have no known complications.
True vascular tumors of the conjunctiva are uncommon. The better-known ones include lymphangioma, capillary hemangioma, cavernous hemangioma, varix, racemose hemangioma, pyogenic granuloma, glomangioma, Kaposi’s sarcoma, and hemangiopericytoma. In a recent review of 140 conjunctival vascular tumors, the authors discovered 10 cases of another vascular lesion that differs clinically from the aforementioned conditions. Ten cases of this unusual vascular tumor are reported herein that are termed acquired sessile hemangioma of the conjunctiva .
Methods
Using the diagnostic database of the Oncology Service at Wills Eye Institute, all cases meeting the diagnostic criteria for acquired sessile hemangioma were collected. Patient age at diagnosis, race, gender, referral diagnosis, associated systemic and ocular disease, affected eye(s), and associated ocular findings were determined. Specific tumor features included diameter, thickness, conjunctival quadrant, anatomic conjunctival location, natural course, and histopathologic results.
Results
Ten cases of acquired sessile hemangioma were identified. The most important data are shown in the Table . The median patient age at the time of diagnosis was 58 years (mean, 58 years; range, 31 to 83 years). All patients were white, and there were 8 women and 2 men. The patient was referred specifically for the vascular lesion in only 1 case. In the other 9 cases, it was a coincidental finding by the authors on referral for other unrelated problems, including choroidal nevus, choroidal melanoma, iris nevus, iris cyst, and primary acquired melanosis of the conjunctiva. There were no systemic or ocular problems that seemed to be related to the acquired sessile hemangioma lesion. Acquired sessile hemangioma affected the right eye in 7 cases and left eye in 3 cases, and none were bilateral. The lesions were remarkably similar to one another and were characterized by a sessile mass of curvilinear, sometimes intertwining, blood vessels ( Figure 1 , Top left, Top right, Middle left, Middle right, Bottom left). The arteries and veins often ran parallel to one another and formed irregular loops. There were no distinct margins to the lesions. The acquired sessile hemangiomas ranged from 1 to 2 mm in diameter and were estimated to be 1 mm or less in thickness. Most lesions were located in the temporal or inferotemporal aspects of the bulbar conjunctiva (Table). With manipulation of the overlying conjunctiva, the lesions remained relatively stationary, suggesting that they were in the superficial stroma deep to the epithelium. Each had a slightly dilated, minimally tortuous, feeding artery and draining vein. It often was difficult to differentiate the artery from the vein, because they looked quite similar. Two of the lesions were found to undergo spontaneous regression after 7 months and 12 months, respectively ( Figure 1 , Bottom left and right).
| Patient No. | Age (yrs) | Race | Sex | Systemic Findings | Ocular Findings (Affected Eye) | Largest Diameter (mm) | Thickness (mm) | Quadrant | Anatomic Location (Conjunctiva) | Regression |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 54 | White | F | Skin hemangiomas | Choroidal nevus | 2 | <1 | T | Bulbar | No |
| 2 | 66 | White | M | Asthma | Choroidal nevus, sessile papilloma of caruncular epithelium | 3 | <1 | IT | Bulbar | Excised |
| 3 | 71 | White | F | None | Choroidal nevus, iris nevus | 1.5 | <1 | IN | Bulbar | No |
| 4 | 34 | White | F | None | Conjunctival lymphangiectasis | 2 | <1 | IT | Palpebral | No |
| 5 | 58 | White | F | Hypercholesterolemia | Choroidal nevus | 2 | <1 | T | Bulbar | Yes |
| 6 | 31 | White | F | None | IPE cyst | 2 | <1 | N | Bulbar | No |
| 7 | 58 | White | F | DM | PAM | 2.5 | <1 | IT | Bulbar | Yes |
| 8 | 83 | White | F | DM + HTN | Retinal vein congestion | 2 | <1 | T | Bulbar | No |
| 9 | 65 | White | F | Hypercholesterolemia | None | 3 | <1 | N | Bulbar | No |
| 10 | 57 | White | M | None | None | 2 | <1 | T | Bulbar | No |
