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Year : 2017  |  Volume : 55  |  Issue : 4  |  Page : 313-314

Lobular capillary hemangioma of caruncle: A rare presentation

Oculoplasty Services, M. N. Eye Hospital Pvt. Ltd., Chennai, Tamil Nadu, India

Date of Web Publication25-Apr-2018

Correspondence Address:
Dr. Anjali Kavthekar
M. N. Eye Hospital Pvt. Ltd., #781, T.H. Road, Tondiarpet, Chennai - 600 021, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_1_18

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Lobular capillary haemangioma also called as pyogenic granuloma is a hyperplastic vascular lesion generally found in mucus membranes of head and neck region especially the nasal and oral mucosae. It is rapidly growing and more common in paediatric age group, pregnancy and after surgery or trauma. Its occurrence involving caruncle is uncommon. Here we report a case of a 46 year old male who presented to us with caruncular nodular mass which on excision biopsy was diagnosed as lobular capillary hemangioma. The purpose of this case report is to make readers aware of its rare site of presentation and management. Pyogenic granuloma should be borne in mind as one of the differentials in cases like this and complete excision should be done to prevent recurrence and to rule out malignant entities.

Keywords: Caruncle, excision biopsy, pyogenic granuloma

How to cite this article:
Kavthekar A, Nivean PD, Nivean M, Ariga M. Lobular capillary hemangioma of caruncle: A rare presentation. TNOA J Ophthalmic Sci Res 2017;55:313-4

How to cite this URL:
Kavthekar A, Nivean PD, Nivean M, Ariga M. Lobular capillary hemangioma of caruncle: A rare presentation. TNOA J Ophthalmic Sci Res [serial online] 2017 [cited 2020 Jul 14];55:313-4. Available from: http://www.tnoajosr.com/text.asp?2017/55/4/313/231114

  Introduction Top

Caruncular nodular lesions are less commonly encountered in day-to-day ophthalmic practice. Histopathological examination by excision biopsy plays a major role in their diagnosis and treatment. Most of the caruncular tumors are benign in origin (95%), with only 5% having malignant potential.[1] Pyogenic granuloma is next in frequency after caruncular papilloma and nevus.[2] Levy et al. reported epithelial cyst occurrence along with nevi and papilloma.[3]

  Case Report Top

A 46-year-old male patient presented with the complaint of elevated red mass in the inner corner of the left eye for 2–3 days. On examination, his vision in both eyes was 6/6 for distance and N6 for near and there was a vascularized nodular lesion measuring 2 mm × 2 mm × 1 mm in caruncular area [Figure 1]. Rest of the ocular examination was normal. The patient was advised for excision biopsy, but he was not willing. He presented to us after 15 days with increase in size of the swelling. On examination, the lesion was vascular and of 3 mm × 5 mm × 2 mm in size. Excision biopsy was done and the specimen was sent for histopathological examination. The histopathological examination showed multiple lobules of tightly packed capillary blood vessels, scattered large blood-filled vascular spaces with portions of epithelium, and extensive inflammatory cells with bacterial clumps suggestive of lobular capillary hemangioma [Figure 2]. The patient was started on antibiotic–steroid combination eye drop which was tapered over 1-month period with artificial tear substitutes for 1 month and systemic nonsteroidal anti-inflammatory drugs with paracetamol combination twice a day for 3 days.
Figure 1: Vascular caruncular lesion measuring 3 mm × 5 mm × 2 mm

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Figure 2: Multiple lobules of tightly packed capillary blood vessels, scattered large blood-filled vascular spaces with portions of epithelium, and extensive inflammatory cells with bacterial clumps suggestive of lobular capillary hemangioma

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  Discussion Top

Caruncle is lined by a nonkeratinized epithelium which is similar to conjunctival epithelium. Apart from this, it also contains hair follicles, sweat glands, sebaceous glands, and accessory lacrimal glands.[2] Hence, caruncle can be involved by tumors of skin, conjunctiva, and lacrimal gland.

Lesions commonly found at caruncle are papillomas and nevi.[2] Other lesions of caruncle include oncocytoma, pyogenic granuloma, inclusion cysts, sebaceous hyperplasia, and sebaceous adenoma.[1] Malignant tumors occurring rarely in the caruncle are squamous cell carcinoma, melanoma, lymphoma, and sebaceous carcinoma.[1]

Lobular capillary hemangioma is also called pyogenic granuloma. It is a misnomer as the condition is neither pyogenic (pus forming) nor granulomatous. It is a hyperplastic vascular lesion that occurs after trauma or inflammation.[4]

Clinically, pyogenic granuloma begins as small red papule that rapidly increases in size ranging from a few millimeters to several centimeters and its rapid growth can be followed by stabilization or regression.[5] Common differentials are nodular Kaposi's sarcoma and angiosarcoma.[6] Management involves excisional biopsy which is diagnostic as well as therapeutic.[2] Histopathological examination plays a crucial role in diagnosing and differentiating it from other carunculur lesions. In India, one case has been reported for lobular capillary hemangioma of caruncle in 1968 by Ahmad and Hafeez.[7]

Although the occurrence of pyogenic granuloma is common overall, caruncular occurrence is not common. Levy et al.[3] compared various studies and found that occurrence of pyogenic granuloma was ranging from 1.5% to 8.8% (1.5%, 2.7%, 2.7%, and 8.8%) in four various studies.[8],[9],[10],[11]

  Conclusion Top

Caruncular tumors present rarely. Excisional biopsy should be done and malignancy should be ruled out whenever presented. Pyogenic granuloma is a rare presentation at caruncle. The predisposing factors should be corrected along with the definitive treatment to prevent further recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Honavar SG, Manjandavida FP. Tumors of the ocular surface: A review. Indian J Ophthalmol 2015;63:187-203.  Back to cited text no. 1
[PUBMED]  [Full text]  
Shields JA, Shields CL. Eyelid, conjunctival and orbital tumors. An Atlas and Textbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 250-445.  Back to cited text no. 2
Levy J, Ilsar M, Deckel Y, Maly A, Pe'er J. Lesions of the caruncle: A description of 42 cases and a review of the literature. Eye (Lond) 2009;23:1004-18.  Back to cited text no. 3
Cherif N, Hermies F, Cori-Melki M, Pouliquen Y. Caruncular location of a pyogenic granuloma. About an anatomo-clinical observation. J Fr Ophthalmol 1994;17:617-9.  Back to cited text no. 4
Ravi V, Jacob M, Sivakumar A, Saravanan S, Priya K. Pyogenic granuloma of labial mucosa: A misnomer in an anomalous site. J Pharm Bioallied Sci 2012;4:S194-6.  Back to cited text no. 5
Christopher FD. Vascular tumors. Diagnostic Histopathology of Tumors. 3rd ed., Vol. 2. UK, PA: Elsevier Health Sciences; 2007. p. 41-82.  Back to cited text no. 6
Ahmad SH, Hafeez MA. Haemangioma of the caruncle of the eye. J All India Ophthalmol Soc 1968;16:103-4.  Back to cited text no. 7
Kaeser PF, Uffer S, Zografos L, Hamédani M. Tumors of the caruncle: A clinicopathologic correlation. Am J Ophthalmol 2006;142:448-55.  Back to cited text no. 8
Luthra CL, Doxanas MT, Green WR. Lesions of the caruncle: A clinicohistopathologic study. Surv Ophthalmol 1978;23:183-95.  Back to cited text no. 9
Santos A, Gómez-Leal A. Lesions of the lacrimal caruncle. Clinicopathologic features. Ophthalmology 1994;101:943-9.  Back to cited text no. 10
Shields CL, Shields JA, White D, Augsburger JJ. Types and frequency of lesions of the caruncle. Am J Ophthalmol 1986;102:771-8.  Back to cited text no. 11


  [Figure 1], [Figure 2]


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