J Korean Ophthalmol Soc.  2015 Jul;56(7):1117-1121. 10.3341/jkos.2015.56.7.1117.

Primary Systemic Amyloidosis of the Eyelid: A Case Report

• Kang YS
• Choi W
• Yoon KC

• KMID: 2148814
• DOI: http://doi.org/10.3341/jkos.2015.56.7.1117

Abstract

PURPOSE
Amyloidosis involving the eyelid is a rare condition. We report a case of primary systemic amyloidosis of the eyelid.
CASE SUMMARY
A 26-year-old female presented with multiple nodules on the bilateral upper and lower eyelids that had stopped growing several years prior. Multiple pearl-colored small nodular lesions were present on the upper and lower eyelid bilaterally and no clinically specific signs were observed. Surgical excision, biopsy and electrocauterization were performed. Histological examination showed amorphous and eosinophilic substances on hematoxylin & eosin (H&E) staining and orange-colored amyloid deposits stained with Congo-red. Systemic evaluation showed amyloid nodules invading the vocal cords and external auditory canal, therefore the patient was diagnosed with primary systemic amylodosis. At the postoperative 6-month follow-up, recurrence or inflammation at the operation site was not observed.
CONCLUSIONS
To the best of our knowledge, this is the first case of primary systemic amyloidosis of the eyelid in Korea. Amyloidosis should be considered in a differential diagnosis of a mass in the eyelid and can be successfully managed with surgical excision and electrocauterization.

Keyword

Amyloidosis; Eyelid mass; Molluscum contagiosum

MeSH Terms

Adult
Amyloid
Amyloidosis*
Biopsy
Diagnosis, Differential
Ear Canal
Eosine Yellowish-(YS)
Eosinophils
Eyelids*
Female
Follow-Up Studies
Hematoxylin
Humans
Inflammation
Korea
Molluscum Contagiosum
Plaque, Amyloid
Recurrence
Vocal Cords
Amyloid
Eosine Yellowish-(YS)
Hematoxylin

Figure

• 

  Figure 1. Clinical photograph of a 26 year-old woman with multiple, yellowish nodular lesion in the right upper (A), left upper (B), right lower (C), left lower (D) eyelid.

• 

  Figure 2. (A) Hematoxylin and eosin stained section (×200) shows amorphous, eosinophilic substances. (B) Congo-red stained sec-tion (×200) reveals orange colored stained amyloid deposits.

• 

  Figure 3 At the postoperative 6-month follow-up, there was no recurrence or inflammation at the operation site. (A) Right eyelid. (B) Left eyelid.

Reference

References

1. Aryasit O, Preechawai P, Kayasut K. Clinical presentation, treat-ment, and prognosis of periocular and orbital amyloidosis in a uni-versity-based referral center. Clin Ophthalmol. 2013; 7:801–5.

2. Tyradellis C, Peponis V, Kulwin DR. Surgical management of re-current localized eyelid amyloidosis. Ophthal Plast Reconstr Surg. 2006; 22:308–9.

3. Gean-Marton AD, Kirsch CF, Vezina LG, Weber AL. Focal amy-loidosis of the head and neck: evaluation with CT and MR imaging. Radiology. 1991; 181:521–5.

4. Chung EH, Oum BS, Lee SH, Hong SH. A case of corneal amyloidosis. J Korean Ophthalmol Soc. 1983; 24:383–6.

5. Kim DS, Kim CH, Kim YK. A case of corneal amyloidosis. J Korean Ophthalmol Soc. 1996; 37:554–8.

6. Park YH, Lee JY, Chung SK, Myung YW. Corneal amyloidosis de-veloped after penetrating keratoplasty. J Korean Ophthalmol Soc. 1998; 39:3093–7.

7. Nam H, Cho KR. Primary systemic amyloidosis involved the conjunctiva. J Korean Ophthalmol Soc. 1991; 32:604–8.

8. Song BR, Kim YK, Yoo JH, Chu YC. Primary localized amyloi-dosis of bulbar conjunctiva and cornea. J Korean Ophthalmol Soc. 1993; 34:352–6.

9. Lee JH, Kim YD. Primary localized orbital amyloidosis. J Korean Ophthalmol Soc. 2001; 42:1793–7.

10. Kim WT, Kim JS, Park HB. A case of vitreous amyloidosis. J Korean Ophthalmol Soc. 2003; 44:1948–53.

11. Choi HJ, Choung HK, Khwarg SI. Primary localized amyloidosis of the lacrimal gland. J Korean Ophthalmol Soc. 2004; 45:1567–72.

12. Kim YT, Kim JY, Kim YD. Primary localized amyloidosis of the lacrimal gland. J Korean Ophthalmol Soc. 2004; 45:1573–7.

13. Kim JT, Kim EY, Lee HI, et al. A report of localized corneal amy-loidosis secondary to the trichiasis. J Korean Ophthalmol Soc. 2006; 47:2035–40.

14. Kim BY, Song JH, Yang SW, Kim MS. A case of bilateral con-junctiva amyloidosis treated with mass excision and cryotherapy. J Korean Ophthalmol Soc. 2011; 52:628–32.

15. Lyu IJ, Woo KI, Kim YD. Primary orbital MALT lymphoma asso-ciated with localized amyloidosis. J Korean Ophthalmol Soc. 2013; 54:1109–13.

16. Caggiati A, Campanella A, Tenna S, et al. Primary amyloidosis of the eyelid: a case report. In Vivo. 2010; 24:575–8.

17. Brownstein MH, Elliott R, Helwig EB. Ophthalmologic aspects of amyloidosis. Am J Ophthalmol. 1970; 69:423–30.

18. Kosch G, Meyer-Rüsenberg HW. Primary localized amyloidosis of the eyelid and conjunctiva. Klin Monbl Augenheilkd. 1993; 202:56–9.

19. George TF, John SL, Ronald ES. The cornea in systemic disease. Tasman W, Jaeger EA, editors. Duane’s clinical ophthalmology. re-vised. Philadelphia: JB Lippincott;1993. chap. 15.

20. Edward LH, Narsing AR. Basic mechanisms in pathology. Spencer WH, editor. Ophthalmic pathology: an atlas and textbook. re-vised. Philadelphia: WB Saunders;1990. chap. 13.

21. Schornack MM, Siemsen DW, Bradley EA, et al. Ocular manifes-tations of molluscum contagiosum. Clin Exp Optom. 2006; 89:390–3.

22. Massa AF, Borges-Costa J, Soares-Almeida L, Sacramento-Mar ques M. Molluscum contagiosum eyelid lesions in an HIV-patient. Dermatol Online J. 2013; 19:10.

23. Ingraham HJ, Schoenleber DB. Epibulbar molluscum conta-giosum. Am J Ophthalmol. 1998; 125:394–6.

24. Nair AG, Mukherjee B, Krishnakumar S, et al. Unilateral primary cutaneous amyloidosis of the eyelid masquerading as a chalazion. Can J Ophthalmol. 2014; 49:e112–4.

25. Picken MM. Amyloidosis-where are we now and where are we heading? Arch Pathol Lab Med. 2010; 134:545–51.

26. Mollee P, Renaut P, Gottlieb D, Goodman H. How to diagnose amyloidosis. Intern Med J. 2014; 44:7–17.

27. Bozkurt B, Kiratli H, Soylemezoglu F, Irkec M. In vivo confocal microscopy in a patient with conjunctival amyloidosis. Clin Experiment Ophthalmol. 2008; 36:173–5.

28. Patrinely JR, Koch DD. Surgical management of advanced ocular adnexal amyloidosis. Arch Ophthalmol. 1992; 110:882–5.

29. Stack RR, Vote BJ, Evans JL, Elder MJ. Bilateral ptosis caused by localized superficial eyelid amyloidosis. Ophthal Plast Reconstr Surg. 2003; 19:239–40.

30. Iijima S. Primary systemic amyloidosis: a unique case complaining of diffuse eyelid swelling and conjunctival involvement. J Dermatol. 1992; 19:113–8.

31. Demirci H, Shields CL, Eagle RC Jr, Shields JA. Conjunctival amyloidosis: report of six cases and review of the literature. Surv Ophthalmol. 2006; 51:419–33.

32. Leibovitch I, Selva D, Goldberg RA, et al. Periocular and orbital amyloidosis: clinical characteristics, management, and outcome. Ophthalmology. 2006; 113:1657–64.