CORNEAL PYOGENIC GRANULOMA –

A RARE CASE WITH REVIEW OF LITREATURE

SURYA KANT NIRALA,PUNAM PRASAD BHADANI,SATISH KUMAR, IFFAT JAMAL ,SHUCHISMITA

DEPARTMENT OF PATHOLOGY ,AIIMS PATNA.

INTRODUCTION DISCUSSION GROSS AND MICROSCOPY

Figure 3 Microscopy

Figure 1. CT

SCAN.

ABSTRACT

CASE REPORT

CONCLUSIONS

REFERENCES

Pyogenic granuloma is an

exuberant vasculoproliferative,

inflammatory lesion composed of

excessive granulation tissue.

Conjuctival pyogenic granulomas

are common. But corneal

involvement is very rare because

of the avascular nature of cornea.

This report presents a case of a

62 year old male patient (whose

tissue was sent to department of

Pathology, AIIMS Patna). He had

come with complaint of loss of

vision & pain to department of

opthalmology . Slit lamp

examination showed vascularised

central corneal mass with

surrounding stromal infiltrate. On

histopathological examination

corneal pyogenic granuloma was

confirmed.is confirmed.

Gross finding: Specimen received as irregular

greyish white, soft tissue bits, measuring 1x1x0.4

cm. (Figure 2)

Microscopy: Section from the received corneal

button shows (Figure 3):

Stratified squamous lining epithelium with an area

of ulceration along with collarette formation.

Sub epithelial area as well as beneath the

ulcerated area show proliferated capillaries, dense

chronic inflammatory infiltrate and presence of

granulation tissue respectively.

Histopathologic Diagnosis - Pyogenic granuloma.

.

Pyogenic granuloma is a relatively common

skin growth. The term pyogenic granuloma were

described by Poncet and dor 18974.

The term pyogenic granuloma is actually a

misnomer since it contains neither the

inflammatory (purulent) exudate nor the typical

granulomatous epitheloid giant cell reaction.

It is also known as eruptive hemangioma or

lobular capillary hemangioma or pregnancy

tumour.

The common site of involvement is face,

hands, finger, lips and eyelids.

Ocular involvement is mostly located on

external surface of eyelid or palpebral

conjunctiva.

The diagnosis may be challenging if

diagnosed especially at the limbus or cornea.

Might be misdiagnosed as conjuctival

squamous cell carcinoma & ended up with

enucleation.

The age of onset , history of prior trauma,

infections & clinical features will often point to

the correct diagnosis.

Histopathological diagnosis will confirm the

entity.

A 62 year old male was admitted to AIIMS

Patna ophthalmology department with complaint

of loss of vision and pain in right eye.

10 days before presentation patient’s wife

noticed a small fleshy pinkish growth at centre of

the left eye.

The mass increases on size with pain, redness

of eyes and photophobia. The pain & redness

had started four weeks before the appearance of

mass & photophobia.

History of trauma present in the same eye,

one month back by small stone.

Local examination reveal swollen eyelids,

with mucopurulent discharge and infected

conjunctiva. Over the cornea, a pink fleshy

vascularised mass of 0.5x0.5 cm at the centre.

Evisceration done & sent for HPE.

CT Scan: Left globe was seen to be deformed,

morphology distorted, vitreous hyperdense with

soft tissue around the globe and leukoaraiosis

grade 3. (Figure 1)

Corneal pyogenic granuloma is a rare

complication of minor trauma1, surgery and

infection.

Therefore it should be considered as

differential diagnosis in corneal mass especially

after infection or trauma.

Pyogenic granuloma are vasculoproliferative,

inflammatory and exuberant proliferation of

granulation tissue which occurs most often on

face and extremities.

Ocular pyogenic granuloma are mostly

located on external surface of eyelid or the

palpebral conjunctiva2.

The involvement of cornea by pyogenic

granuloma is very rare and reported rarely in

English literature.

The avascularity of cornea could be a

probable reason for this rarity3 and hence, it

could be misdiagnosed as ocular malignant

pathology which could end up in extensive

surgery like enucleation.

1.Ferry AP (1989) Pyogenic granulomas of the eye and ocular

adnexa: a study of 100 cases. sTrans Am Ophthalmol Soc

87:327-347

2.Friedman AH, Henkind P (1971) Granuloma pyogenicum of

the palpebral conjunctiva. Am J Ophthalmol 71:868-872

3.Mietz H, Arnold G, Kirchhof B, Krieglstein GK. Pyogenic

granuloma of the cornea: report of a case and review of the

literature. Graefes Arch Clin Exp Op-hthalmol 1996; 23 (4):

131-136.

4.Ferry AP, Zimmermann LE (1965) Granuloma pyogenicum

of limbus simulating recurrent squamous cell carcinoma. Arch

Ophthalmol 74:229-230

5.Ekaterini C, Joseph H, Ralph C. Pyogenic Granuloma of the

Cornea in an Infant With Unilateral Microphthalmia. Arch

Ophthalmol 2003;121 (8): 1197-1200

6.Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma

of cornea: A case report. Indian J Ophthalmol 1996;44:39-40

: Corneal pyogenic granuloma is a rare complication of minor trauma1, surgery and infection. Therefore it should be considered as di. a. ma.

•Ekaterini C, Joseph H, Ralph C. Pyogenic Granuloma of the Cornea in an Infant With Unilateral Microphthalmia. Arch Ophthalmol 2003;121

Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40

Srinivasan S, Prajna N V, Srinivasan M. Pyogenic granuloma of cornea: A case report. Indian J Ophthalmol 1996;44:39-40

Figure 2. Gross picture of specimen .