Compound Nevus and Papilloma of the lacrimal caruncle: A Case Report and Literature Review
Author: Siriphat Daocharoenporn
Base Hospital / Institution: Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
ePoster presentation
Abstract ID: 25-188
Purpose
To describe clinicopathological features and management of a patient with a concurrent compound nevus and papilloma of the caruncle and to review the previous literature on the combination of benign caruncular tumors.
Methods
Interventional case report and literature review.
Results
A 63-year-old female with a history of chronic progressive visual loss in her right eye reported a non-progressive painless pigmented mass without a history of associated contact bleeding on her left caruncle. Ophthalmic examination revealed a large pigmented choroidal mass on her right eye and a papilliform pinkish lesion over a well-defined, homogeneous, pigmented mass on her left caruncle. Orbital magnetic resonance imaging scans indicated a choroidal melanoma in her right eye. The metastatic work-up was unremarkable. The patient was treated with a right globe enucleation with complete tumor removal of the left caruncular mass based on the presence of intratumorally dilated vessels with a feeding vessel to the papilliform lesion suggesting malignant transformation using the no-touch technique, followed by double freeze-thaw cryotherapy. Histopathological examination is consistent with a choroidal melanoma on the right eye and a compound caruncular nevus with an overlying conjunctival papilloma on the left eye. The patient completely recovered without evidence of recurrence at 6 months of follow-up.
Conclusion
The coexistence of benign caruncular tumors is extremely rare. We report the first case of a compound nevus combined with a papilloma at the caruncle. We postulate that a papilloma may develop on a caruncular nevus due to environmental exposure, allowing HPV-contaminated finger contact during eye rubbing. Mechanical trauma to the protruding lesion may also contribute to dysplastic or neoplastic changes. The management with complete tumor resection using the no-touch technique followed by double freeze-thaw cryotherapy is recommended to prevent tumor cells from seeding into a new region and postoperative recurrences.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Siriphat | Daocharoenporn | Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
| Weerawan | Chokthaweesak | Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
| Chawawat | Kangwanwongpaisan | Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
| Siroratt | Narkcham | Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
| Bunyada | Putthirangsiwong | Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
