Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 57802

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : ER04 - ER06 Full Version

Conjunctival Myxoma: Series of Three Cases of a Rare Ocular Tumour

Published: March 1, 2022 | DOI:
Yasmeen Khatib, Vinita Pandey, Yogita Sable, Rahul Pandey, Prajakta Gupte

1. Additional Professor, Department of Pathology, HBT Medical College and Dr. R N Cooper Hospital, Mumbai, Maharashtra, India. 2. Consultant Pathologist, Department of Pathology, Accura Healthcare and Diagnostics, Mumbai, Maharashtra, India. 3. Assistant Professor, Department of Pathology, HBT Medical College and Dr. R N Cooper Hospital, Mumbai, Maharashtra, India. 4. Consultant Pathologist, Department of Pathology, Accura Healthcare and Diagnostics, Mumbai, Maharashtra, India. 5. Assistant Professor, Department of Pathology, HBT Medical College and Dr. R N Cooper Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Prajakta Gupte,
202, Sea Breeze CHS, JP Road, Seven Bungalows, Andheri West,
Mumbai, Maharashtra, India.


Conjunctival myxomas are very rare benign tumours of mesenchymal origin which pose a diagnostic challenge clinically and radiologically. They usually present as asymptomatic slowly growing cystic lesions involving the bulbar conjunctiva. Two cases were with usual presentation while one was with unusual presentation. Two cases of conjunctival myxoma (59-year-old female patient and 65-year-old male patient) involving the bulbar conjunctiva and one (56-year-old female patient) in the palpebral conjunctiva are reported. Anterior segment examination and fundoscopy were within normal limits. A clinical diagnosis of conjunctival cyst, pinguecula and pyogenic granuloma was made in the three cases, respectively. Excision was done in all the cases and a diagnosis of myxoma was made based on the characteristic histological and immunohistochemical features. No systemic involvement was seen. The authors hereby report the present cases because of their rarity and to emphasise that, histopathology is required to distinguish it from other conjunctival lesions.


Bulbar, Cyst, Palpebral, Pinguecula, Pyogenic granuloma

Myxomas are benign connective tissue neoplasms most commonly seen in the heart. They can rarely involve the ocular structures like conjunctiva, eyelid, cornea and orbit (1). Conjunctival myxomas classically present as slow growing, painless, well circumscribed yellowish to pink cystic lesions (2),(3). It is important to differentiate them from other clinical mimics like conjunctival cyst, lymphangioma, myxoid neurofibroma amelanotic naevus, amelanotic melanoma and myxoid liposarcoma. Histopathology is needed to confirm their diagnosis. Microscopically, the hypocellular tumour contains spindle and stellate cells in a mucoid stroma. They are vimentin positive and S100 negative on Immunohistochemistry (IHC). They can have a localised presentation or be a part of Carneys syndrome which comprises of cardiac and extra-cardiac myxomas, spotty mucocutaneous pigmentation and endocrine overactivity (3). Hence cardiac involvement has to be ruled out in all cases of myxoma for prompt treatment. We present three cases of conjuncival myxomas involving the bulbar and palpebral conjunctiva.

Case Report

Case 1

A 59-year-old female patient presented to the Ophthalmology Department with complains of a gradually increasing swelling in the right eye that was present for six months. On examination, a well-defined yellowish-white cystic mass was seen in the temporal aspect of the right bulbar conjunctiva (Table/Fig 1)a. Routine investigations, visual acuity, intraocular pressure, anterior segment examination and fundoscopy were normal. Clinically, a diagnosis of conjunctival cyst was made and it was excised. On gross examination, a yellowish-white, soft, partly translucent nodule was seen measuring 5×4 mm {(Table/Fig 1)a-inset}. Cut section of the nodule was partly cystic and gelatinous in appearance. On microscopy, a fairly circumscribed partly cystic paucicellular tumour was seen (Table/Fig 1)b, having abundant myxoid matrix with ropy collagen bundles, scattered spindle and stellate cells, presence of mast cells, and very few blood vessels (Table/Fig 1)c. Some cells showed mild pleomorphism with hyperchromatic nuclei {(Table/Fig 1)c-inset}. However, no mitotic activity was seen. Presence of intracytoplasmic and intranuclear vacuoles was seen {(Table/Fig 1)c-inset}.

Immunohistochemically, tumour cells showed diffuse expression of vimentin (Table/Fig 1)d, focal expression of smooth muscle actin and were negative for S100. The myxoid matrix stained positively with alcian blue stain at pH 2.5. Ki 67 proliferation index was less than 1% (Table/Fig 1)e. A diagnosis of conjunctival myxoma was rendered based on the microscopic and IHC findings. Further systemic evaluation was advised to rule out presence of associated tumour syndromes. On follow-up, patient was asymptomatic and underwent two dimensional (2D) echo and Electrocardiography (ECG) to rule out cardiac involvement which were normal. There was no skin pigmentation or endocrine abnormality.

Case 2

A 65-year-old male patient presented to the Ophthalmology Department with complains of swelling in the left eye that was present for one year associated with mild redness since one week. On examination, a cystic mass was seen in the infero-temporal aspect of the left bulbar conjunctiva which was diagnosed as pinguecula and it was excised (Table/Fig 2)a. Grossly, a partly cystic translucent nodule was seen measuring 5×4 mm with gelatinous cut surface. On microscopy, a subconjunctival paucicellular tumour was seen having myxoid matrix with scattered spindle cells, stellate cells, blood vessels and ropy collagen bundles. Some cells showed mild pleomorphism with intracytoplasmic and intranuclear vacuoles (Table/Fig 2)b,c. Immunohistochemically, tumour cells showed strong and diffuse positivity for vimentin (Table/Fig 2)d with focal expression for smooth muscle actin. S 100 was negative. The myxoid matrix was positive for alcian blue stain at pH 2.5 (Table/Fig 2)e. Ki 67 proliferation index was less than 1%. On follow-up, the patient was asymptomatic without skin pigmentation or endocrine dysfunction. Cardiac involvement was ruled out by 2D echocardiography which was normal.

Case 3

A 56-year-old female patient presented to the Ophthalmology Department with itching and watering of left eye for four months and fullness in the upper eyelid since three months. On clinical examination a yellowish white, lesion measuring 5×5 mm over the upper palpebral conjunctiva was seen (Table/Fig 3)a. Clinical diagnosis was pyogenic granuloma and excision was done. Grossly, a yellowish-white, soft partly translucent nodule was seen measuring 5×5 mm. Cut section of the nodule had a gelatinous appearance. On histology a subconjunctival lesion composed of spindle and stellate cells in a myxoid background was seen (Table/Fig 3)b,c. Some cells showed pleomorphism with prominent intranuclear and intracytoplasmic vacuoles {(Table/Fig 3)c-inset}. Stroma showed ropy collagen, mast cells, lymphocytes and plasma cells and few blood vessels. On IHC, cells expressed vimentin and were negative for smooth muscle actin (Table/Fig 3)d and S100. Stroma was alcian blue positive at pH 2.5 (Table/Fig 3)e. Ki 67 proliferation index was less than 1%. No systemic involvement was present on follow-up as patient was asymptomatic and had normal 2D echocardiogram, absence of pigmentation and endocrine dysfunction.


Myxomas are benign mesenchymal tumours that commonly involve the heart, skin, bone, skeletal muscle, nasal sinuses, gastrointestinal and genitourinary system (1). Ocular myxomas are rare and can involve the eyelid, ocular adnexa, conjunctiva or the cornea (2). Conjunctival myxomas can occur as isolated tumours or rarely as a part of Carneys or Zollinger Ellison Syndrome with multi-systemic involvement (3),(4),(5). The incidence of conjunctival myxomas was estimated to be 0.002% and 0.001% in two reviews of conjunctival leisons studied by Grossniklaus HE et al., and Shields CL et al., respectively (6),(7). Though, it was first described by Magalif NI in 1913, on review of literature till date only about 50 cases of conjunctival myxomas have been reported (8). The involvement of palpebral conjunctiva is very rare with only three cases reported uptil now (1),(2),(3). Demicri H et al., reviewed 22 cases of conjunctival myxoma and described their clinical and histopathological features (9). Xiong MJ and Dim DC reviewed and presented the findings of 42 cases with this lesion (3).

The tumour presented as a slow growing painless yellowish pink cystic or solid mass which commonly involved the bulbar conjunctiva. It involved the temporal region in 49% cases, nasal region in 27% and other locations in 24% cases. The mean age of presentation was 47.6 years and no sex predilection was seen. The size varied from 1×1 mm to 16×12 mm. The first two patients were asymptomatic which was similar to previously reported cases (3). The third case presented with symptoms of watering, itching and heaviness of upper eyelid which has not been commonly reported. These symptoms may be attributed to the unusual location of this tumour. Jain P et al., reported the high frequency ultrasound findings of conjunctival myxoma which showed homogenous low internal reflectivity with no evidence of intraocular extension (10). Grossly, conjuctival myxomas are usually well circumscribed, yellow or translucent masses which may be cystic or solid. Only three cases of diffuse involvement are described in literature (3),(10).

Microscopically, the tumour is lined by conjunctival epithelium. It is paucicellular with scattered spindle and stellate cells, some showing intranuclear and intracytoplasmic inclusions. Intranuclear inclusions are due to invagination of the nuclear membrane while intracytoplasmic inclusions represent dilated endoplasmic reticulum (9). The tumour shows collagen fibres and paucity of blood vessels. The second case in the present study showed increased vascularity with presence of lymphocytes probably because of inflammation secondary to itching which was an unusual symptom. Presence of mast cells and cystic change differentiate ocular myxomas from non ocular myxomas (11). These tumours can show cellular pleomorphism with nuclear atypia as was seen in the present study cases. Alcian blue at pH 2.5 and mucicarmine stain mucopolysaccaride rich stroma. Tumour is vimentin positive, S100 negative and shows variable expression of SMA. All the three reported cases showed strong and diffuse positivity for vimentin. Ki-67 index is less than 5% (2),(3).

Clinically, differential diagnosis of conjunctival myxomas is varied. In older patients, these tumours may be mistaken for malignant tumours such as lymphoma, ocular surface squamous neoplasia and amelanotic melanoma. High frequency ultrasonography findings of conjunctival myxoma could not distinguish it from these tumours (10).

Microscopically, the differential diagnosis includes its close morphologic mimics with abundant myxoid stroma. Nerve sheath myxomas and myxoid neurofibromas contain dense wavy collagen fibres with spindly cells which are S100 positive. Spindle cell lipoma shows presence of adipocytes and CD 34 positive spindle cells while myxoid liposarcomas contains vacuolated lipocytes and lipoblasts with increased vascularity. Conjunctival myxomas are treated with simple excision and no recurrence has been reported. Myxomas can be a component of Carneys complex which includes cutaneous and cardiac myxomas, multiple pigmented lesions, schwannomas and endocrine overactivity and has significant morbidity and mortality (9). Kennedy RH et al., have reported conjunctival myxoma as a part of Carneys complex in which patient had palpebral and eyelid lesions along with cardiac involvement (12). Hence, following its diagnosis syndromic involvement of heart, endocrine system and skin has to be ruled out.


Conjunctival myxomas are rare benign tumours which commonly present as cystic lesions. They can be differentiated from other benign and malignant conditions on the basis of its characteristic histological features. Hence, excision biopsy followed by histology is advisable. Moreover, its diagnosis can give a clue to underlying Carneys syndrome which needs to be ruled out by further work-up.


Ríos YVD, Hernández AI, Rodríguez MHA, Medina CA, Salcedo CG, Rodríguez RAA, et al. Primary conjunctival myxoma: Case series and review of literature. Histopathology. 2017;71(4):635-40. [crossref] [PubMed]
Sharma N, O'Hagan S, Phillips G. Conjunctival myxoma- Atypical presentation of a rare tumour. Case report and review of literature. BMC Ophthalmol. 2016;16(1):54. [crossref] [PubMed]
Xiong MJ, Dim DC. Conjunctival Myxoma: A Synopsis of a rare ocular tumour. Archives of Pathology and Laboratory Medicine: 2015;139(5):693-97. [crossref] [PubMed]
Chinchurreta CA, Trueba A, Hernández FJ, Piñas P, López S, Tena ME, et al. Ocular findings in Carney Complex. Arch Soc Esp Oftalmol. 2006;81(12):709-11. [crossref]
Ramaesh K, Wharton SB, Dhillon B. Conjunctival myxoma, Zollinger-Ellison syndrome and abnormal thickening of the inter-atrial septum: A case report and review of the literature. Eye. 2001;15(Pt.3):309-12. [crossref] [PubMed]
Grossniklaus HE, Green WR, Luckenbach M, Chan CC: Conjunctival lesions in adults. A clinical and histopathologic review. Cornea. 1987;6(2):78-116. [crossref] [PubMed]
Shields CL, Demirci H, Karatza EC, Shields JA. Clinical survey of 1,643 melanocytic and nonmelanocytic conjunctival tumours. Ophthalmology. 2004;111(9):1747-54. [crossref] [PubMed]
Magalif NI. Myxoma conjunctivae. Klin Monatsbl Augenheilkd. 1913;51:844.
Demirci H, Shields CL, Eagle RC, Shields JA. Report of a conjunctival myxoma case and review of the literature. Arch Ophthalmol. 2006;124(5):735-38. [crossref] [PubMed]
Jain P, Finger PT, Lacob CE. Conjunctival myxoma: A case report with unique high frequency ultrasound (UBM) findings. Indian Journal of Ophthalmology. 2018;66(11):1629-31. [crossref] [PubMed]
Chen CL, Tai MC, Chen JT, Chen CH, Jin JS, Lu DW. A rare case of conjunctival myxoma and a review of the literature. Ophthalmologica. 2008;222(2):136-39. [crossref] [PubMed]
Kennedy RH, Flanagan JC, Eagle RC Jr., Carney JA. The carney complex with ocular signs suggestive cardiac myxoma. Am J Ophthalmol. 1991;111(6):699-702. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/51706.16077

Date of Submission: Aug 03, 2021
Date of Peer Review: Nov 02, 2021
Date of Acceptance: Dec 26, 2021
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Aug 04, 2021
• Manual Googling: Dec 20, 2021
• iThenticate Software: Feb 26, 2022 (3%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)