Atypical Fibroxanthoma Affecting the Ocular Surface and Adnexa: A Case Series.

Abstract

Purpose : To describe the clinical, histopathologic and immunohistochemical characteristics of atypical fibroxanthoma (AFX) affecting the ocular surface and adnexa.

Methods : A clinical pathological retrospective case series was conducted.This study was conducted with adherence to the tenets of the declaration of Helsinki and with approval of the University of Miami’s Institutional Review Board. All patients with a histopathologic diagnosis of atypical fibroxanthoma of the ocular surface and ocular adnexa between 2009 and 2017 were compiled from a search of the database of the Florida Lions Ocular Pathology laboratory records. All records of four patients with a diagnosis of AFX were reviewed. Pathologic diagnoses were confirmed by two pathologists.
All specimens underwent routine processing with paraffin embedding. Hematoxylin-eosin (H&E) staining was performed. Immunohistochemistry (IHC) for CD10 (Leica, 56C6), CD99 (Cell Marque, EPR3097Y), S-100 (Leica, polyclonal, 1:800), Cytokeratin (Leica, AE1/AE3), P63 (Biocare, 4A4), and SOX-10 (Cell Marque, polyclonal) were performed for this study.

Results : Four cases of atypical fibroxanthoma were identified. Mean age of the population was 62 ± 29 years; 75% (n = 3) were caucasian and 50% (n = 2) were female. One patient had two lesions originating on the ocular surface. Clinically, two lesions originated from the limbal conjunctiva, one originated from the inferior bulbar conjunctiva and one lesion originated from inferior eyelid. Before excision, two patients had a previous history of treatment for OSSN and one had a history of squamous cell carcinoma of the eyelid. The lesions were positive for CD-10 and CD-99 and negative for Cytokeratin, P-63, S-100 and SOX-10, which are consistent with a diagnosis of atypical fibroxanthoma. All lesions were rapidly growing and no evidence of malignant transformation was noted.

Conclusions : Patients with pedunculated ocular surface and adnexal neoplasias should be carefully assessed in order to rule out uncommon lesions including AFX.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1. Shows a inferior limbal conjunctival white, tan tumor that measures 11.0 x 11.0 x 17.0 mm.

 

Figure 2. H&E displays atypical pleomorphic cells located within the substantia propria which contain pleomorphic nuclei, brisk mitotic activity and variably prominent nucleoli.