






































Hrev_master


[Eye Reports 2011; 1:e7] [page 17]

Oncocytoma of the upper 
conjunctival fornix
Zaina Al-Mohtaseb, Seongmu Lee,
Michael T. Yen
Cullen Eye Institute, Department of
Ophthalmology, Baylor College of
Medicine, Houston, Texas, USA

Abstract 

Oncocytomas are tumors characterized by
large, eosinophilic epithelial cells with abun-
dant mitochondria that form ductular or glandu-
lar spaces. While these tumors have been
described in other organs, those of the ocular
adnexa occur infrequently, with the caruncle
being the most common site of involvement.
Conjunctival oncocytomas are extremely rare
and are believed to arise from the ductal ele-
ments of the lacrimal gland proper and the
accessory lacrimal glands of the conjunctiva. We
describe the clinical and histological features of
a case of an oncocytoma presenting as an atyp-
ically located superior fornix mass in a 78-year-
old female, with a review of the literature.

Case Report

Oncocytomas are tumors characterized by
large, eosinophilic epithelial cells with abun-
dant mitochondria that form ductular or glan-
dular spaces. While these tumors have been
described in many organs including the sali-
vary, thyroid, adrenal glands, and kidneys,
those of the ocular adnexa are uncommon and
are believed to arise from metaplasia of the
ducts of the lacrimal gland epithelium. The
caruncle is the most common site of involve-
ment, representing approximately 3% of
tumors in this region.1-3 Oncocytomas of the
conjunctiva, however, are extremely rare.1-6 We
report a case of an atypically located conjuncti-
val oncocytoma and review the literature.
A 78-year-old female was referred for evalu-

ation of fornix lesion. Examination revealed a
round, well-circumscribed, mobile, elevated
red lesion measuring 3.0¥3.0¥3.0 mm in the
bulbar conjunctiva of the superior fornix near
the right medial canthus, concealed under the
eyelid (Figure 1). Histological examination
showed a well-demarcated mass composed of
tubular epithelial structures with a central
lumen (Figure 2). The cells showed uniform
round/oval nuclei surrounding central lumina
and prominent basement membrane. The cyto-
plasm of the epithelial cells contained promi-
nent eosinophilic granules that stained with
Masson trichrome. The luminal border of the
tubules also stained with PAS and colloidal
iron. A diagnosis of oncocytoma was made.

Discussion

Oncocytomas of the ocular adnexa are
uncommon and have been described in the

Eye Reports 2011; volume 1:e7

Correspondence: Seongmu Lee, Cullen Eye
Institute, Department of Ophthalmology, Baylor
College of Medicine, 6565 Fannin NC-205,
Houston, Texas 77030, USA. 
Tel. +1.713.798-3231 - Fax: +1.713.798.8739. 
E-mail: SeongL@bcm.edu

Key words: oncocytoma, oxyphil adenoma, con-
junctival, lacrimal, caruncle.

Contributions: the authors contributed equally.

Conflict of interest: the authors report no con-
flicts of interest. 

Funding: supported in part by an unrestricted
educational grant from Research to Prevent
Blindness, Inc. (New York, NY). 

Received for publication: 22 June 2011.
Accepted for publication: 22 August 2011.

This work is licensed under a Creative Commons
Attribution NonCommercial 3.0 License (CC BY-
NC 3.0).

©Copyright Z. Al-Mohtaseb et al., 2011
Licensee PAGEPress, Italy
Eye Reports 2011; 1:e
doi:10.4081/eye.2011.e7

Figure 1. Anterior segment image revealing
a round, well-circumscribed, mobile, ele-
vated red lesion measuring 3.0¥3.0¥3.0
mm in the bulbar conjunctiva of the supe-
rior fornix concealed under the eyelid.

Figure 2. A) Histological examination showed a well-demarcated mass composed of tubu-
lar epithelial structures with a central lumen consistent with oncocytoma. B) The cyto-
plasm of the epithelial cells contained prominent eosinophilic granules that stained with
Masson trichrome.  The luminal border of the tubules also stained with C) PAS and D)
colloidal iron.



[page 18] [Eye Reports 2011; 1:e7]

caruncle, lacrimal sac, lacrimal gland, and
accessory glands of Krause.3,4 Conjunctival
oncocytomas are extremely rare.1-5 The tumor
location in the conjunctival fornix in this case
is particularly atypical. Of the reported cases in
the published English literature, the average
age was 68-years, and 60% were female. The
duration of symptoms ranged from two months
to five years, with no evidence of recurrence
reported after excision (Table 1).1-5,7-8

Clinically, oncocytomas have been described
as red-brown or yellow-tan lesions that are ele-
vated and at times lobulated or cystic.
Histopathologically, these tumors are charac-
terized by a proliferation of large, uniform,
polygonal epithelial cells that exhibit abun-
dant, fine granular eosinophilic cytoplasm and
contain dark round to ovoid paracentral nuclei.
The cytoplasm contains dark granules that are
positive for modified phosphotungstic acid-
haematoxylin and immunostain with mono-
clonal antimitochondrial antibodies due to the
high density of mitochondria.1 The oncocytes
form solid cords and tubular structures that
occasionally display papillary infoldings and
have a characteristic absence of inflammatory
cells. In some areas, the tubules form large
cystic spaces, which contain a seromucinous
material that is periodic acid schiff and alcian-
blue positive.3,6

Many authors believe that oncocytomas
arise from age-related oncocytic metaplasia of
ducts and acinar cells of the accessory lacrimal
glands of the ocular adnexa, while others sug-
gest oncocytic transformation of the caruncu-
lar surface and conjunctival epithelium as the
site of origin.1,3,6 In a more recent study,
Ostergaard et al. examined the cytokeratin
profile of oncocytic lesions of the ophthalmic
region to investigate the origin of these
tumors. The authors reported that oncocy-
tomas of the ocular adnexa demonstrated a
profile similar to that of the lacrimal gland
proper and the accessory lacrimal gland duct
elements, and that all lesions showed a similar
expression pattern irrespective of histological
differentiation, suggesting that oncocytic
metaplasia, hyperplasia, and oncocytoma may
represent the same type of lesion in different
stages of development.1

In summary, oncocytomas of the conjunctiva
are benign epithelial tumors most likely aris-
ing from ductal elements of the lacrimal gland
proper and accessory lacrimal glands of the
conjunctiva and may present in the conjuncti-
val fornix. 

References

1. Ostergaard J, Prause JU, Heegaard S.
Oncocytic lesions of the ophthalmic
region: a clinicopathological study with

ArticleCase Report

Ta
bl

e 
1.

 S
um

m
ar

y 
of

 r
ep

or
te

d 
ca

se
s 

of
 c

on
ju

nc
tiv

al
 o

nc
oc

yt
om

a:
 c

lin
ic

al
 fe

at
ur

es
 a

nd
 o

ut
co

m
es

 

Ca
se

St
ud

y
Ag

e
Ge

nd
er

D
ur

at
io

n
D

ia
gn

os
is

Cl
in

ic
al

 
Lo

ca
tio

n
Si

ze
 (

m
m

)
Tr

ea
tm

en
t

Re
cu

rr
en

ce
Ye

ar
 o

f s
tu

dy
 

of
 le

si
on

de
sc

rip
tio

n

1
Bi
gg
s

65
F

3 m
on

th
s

On
co

cy
to
m
a c

om
bi
ne

d 
wi
th
 

Pe
du

nc
ul
at
ed

 m
as
s

Bu
lb
ar
 co

nj
un

ct
iva

, n
ea

r p
lic

a s
em

ilu
na

ris
*

Ex
cis

io
n

No
19
77

sq
ua

m
ou

s  
ce

ll p
ap

ill
om

a
2

Bi
gg
s

72
F

*
On

co
cy
to
m
a

*
Bu

lb
ar
 co

nj
un

ct
iva

, 1
m
m
 fr

om
 p
lic

a s
em

ilu
na

ris
1

Ex
cis

io
n

No
19
77

3
Bi
gg
s

55
M

2 m
on

th
s

On
co

cy
to
m
a

*
Co

nj
un

ct
iva

 at
 lo

we
r f

or
ni
x

*
Ex

cis
io
n

No
19
77

4
Bi
gg
s

80
M

*
On

co
cy
to
m
a

Lo
bu

lat
ed

 ch
er
ry
-re

d 
m
as
s

Co
nj
un

ct
iva

 at
 lo

we
r f

or
ni
x

15
 X
 12

Ex
cis

io
n

No
19
77

5
Re

id
el

*
*

*
On

co
cy
to
m
a

*
Co

nj
un

ct
iva

*
Ex

cis
io
n

No
19
83

6
Gr

os
sn

ikl
au

s
87

M
*

On
co

cy
to
m
a

*
Bu

lb
ar
 co

nj
un

ct
iva

*
Ex

cis
io
n

No
19
87

7
Sp

ra
ul

72
F

2 y
ea

rs
On

co
cy
to
m
a

Ch
er
ry
 re

d 
le
sio

n
Bu

lb
ar
 co

nj
un

ct
iva

 n
ea

r p
lic

a s
em

ilu
na

ris
*

Ex
cis

io
n

No
19
96

8
Pe

rc
or
el
la

55
M

2 m
on

th
s

On
co

cy
to
m
a

Sw
el
lin

g
Co

nj
un

ct
iva

 at
 lo

we
r f

or
ni
x

*
Ex

cis
io
n

No
19
97

9
Pe

rc
or
el
la

68
F

*
On

co
cy
to
m
a

Pa
pi
llo

m
a

Co
nj
un

ct
iva

 at
 m

ed
ial

 ca
nt
hu

s
*

Ex
cis

io
n

No
19
97

10
Ku

rli
49

F
5 y

ea
rs

On
co

cy
to
m
a

El
ev
at
ed

 re
d-
or
an

ge
 tu

m
or

Co
nj
un

ct
iva

 ad
jac

en
t t
o 
ca
ru
nc

le
 

*
Ex

cis
io
n

No
20
06

11
Os

te
rg
aa
rd

*
*

*
On

co
cy
to
m
a

*
Co

nj
un

ct
iva

*
Ex

cis
io
n

No
20
09

12
Al
-M

oh
ta
se

b 
78

F
un

kn
ow

n
On

co
cy
to
m
a

M
ob

ile
, e

le
va
te
d 
re
d 
tu
m
or

Co
nj
un

ct
iva

 at
 su

pe
rio

r f
or
ni
x

3 X
 3 

X 
3

Ex
cis

io
n

No
20
10

*I
nf
or
m
at
io
n 
un

av
ail

ab
le



[Eye Reports 2011; 1:e7] [page 19]

emphasis on cytokeratin expression. Acta
Ophthalmol 2011;89:263-7.

2. Kurli M, Finger PT, Garcia JP Jr, Schneider
S. Peribulbar oncocytoma: high-frequency
ultrasound with histopathologic correla-
tion. Ophthalmic Surg Lasers Imaging
2006;37:154-6.

3. Biggs SL, Font RL. Oncocytic lesions of the
caruncle and other ocular adnexa. Arch

Ophthalmol 1977;95:474-8.
4. Pecorella I, Garner A. Ostensible oncocy-

toma of accessory lacrimal glands.
Histopathology 1997;30:264-70.

5. Grossniklaus HE, Green WR, Luckenbach
M, Chan CC. Conjunctival lesions in
adults: A clinical and histopathologic
review. Cornea 1987;6:78-116.

6. Rennie IG. Oncocytomas (oxyphil adeno-

mas) of the lacrimal caruncle. Br J
Ophthalmol 1980;64:935-9.

7. Reidel K, Stefani FH, Kampik A.
Oncocytoma of the ocular adnexa. Klin
Monatsbl Augenheilkd 1983;182:544-8.

8. Spraul CW, Lang GK. Oncocytoma of the
conjunctiva. Klin Monbl Augenheilkd
1996;209:176-7.

Case Report


