An unusual case of corneal lipoma.

A 24-year-old male presented with a painless yellowish lesion on the nasal part of his cornea that extended to the paracentral area. Without a confirmed clinical diagnosis, the patient was advised surgical removal of the lesion. The lesion showed a smooth, elevated anterior surface without any signs of inflammation. On making a small incision over the lesion, we found yellowish material being extruded from the lesion. Cytological evaluation of the material revealed clear vacuolated cells suggestive of lipocytes, based on which we diagnosed it a rare case of corneal lipoma.

Lipomas are commonly reported in the extremities and trunk, but orbital lipoma is rare.[1] Herein, we present an unusual case of a corneal lipoma.

Case Report

A 24-year-old male presented with complaints of a painless yellowish lesion over the surface of his right eye that had steadily grown over a year. Slit lamp examination revealed a yellow placoid lesion at the limbus, extending toward the center of the cornea. The surface of the cornea and adjacent conjunctiva were smooth, and there were no signs of inflammation [Fig. 1a]. The patient was advised surgical removal of the mass. When a small incision was made in the superior aspect of the lesion, and gentle pressure was applied, yellowish material extruded from it [Fig. 1b]. The material was collected, placed on a slide, and sent for cytopathological examination. Intraoperatively, we noted that there was a cleavage within the corneal stroma filled with the yellowish material. The remainder of the material was aspirated and washed with normal saline [Fig. 1c]. We further observed that the yellowish material extended to the intrascleral space adjacent to the cornea. Hence, we presumed the lesion was possibly an intrascleral lipoma with corneal extension [Fig. 1d]. Cytopathological examination confirmed the presence of lipid material containing clear vacuolated fat cells with the nuclei pushed to the periphery. There was no evidence of inflammatory cell infiltration [Fig. 2]. Immunohistochemistry confirmed S100 positivity, suggestive of mature adipocytes. Postoperatively, the patient recovered well, with a clear cornea at the site of the lesion. There was no recurrence at 6-week follow-up [Fig. 3].

Figure 1

(a) A smooth surfaced yellow lesion in the nasal part of the cornea in the left eye (b) Surgical incision given over the lesion (c) Showing yellowish lipid-like material extruding out (d) Demonstration of lamellar scleral extension of the lesion

Figure 2

Multiple vacuolated cells seen in hematoxylin and eosin stain with nucleus pushed to periphery suggestive of mature adipocytes

Figure 3

Postoperative picture of the eye at the end of 6 weeks showing no recurrence

Discussion

Lipomas are well-circumscribed benign lesions filled with fat cells in lobules surrounded by connective tissue. A meta-analysis of the largest orbital tumor series demonstrated a very low incidence of lipoma.[2] A review of 1264 consecutive lesions conducted by Shields et al. reported only two lipomas, which is indicative of the rarity of this benign tumor in the eye and orbit.[3] The occurrence of lipomas and their variants in various parts of the orbit has been reported worldwide; however, lipomas are rarely observed in the cornea.[456] Lipomas are always confused with the prolapse of the retro-orbital fat, which commonly occurs in the superotemporal aspect of the globe.[7] The cornea is an avascular structure of the globe; thus, the occurrence of a lipoma is theoretically confounding; however, the extension of a lipoma from the limbal area into the cornea is possible. Congenital dermolipoma of the limbus is rarely observed in isolation or as part of a syndrome, but histopathology usually reveals a dermatological component in addition to lipocytes.[8] In our case, cytopathological examination revealed only mature adipocytes, confirmed by S100 positivity on immunohistochemistry.[9]

Conclusion

The rare possibility of lipoma may be considered in a yellow corneal lesion with smooth surface.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.