PMC5343237_01
Slit-lamp photographs of anterior segment at the initial visit (a) and three months after the first visit (b). At the initial visit, subconjunctival hemorrhages masked a mass. Three months later, a salmon-pink mass was detected in the superior area of the subconjunctiva.
CRIOPM2017-5423027.001.jpg
PMC5343237_01_CRIOPM2017-5423027.001.jpg
fig1
Three months later, the subconjunctival hemorrhage had partially cleared and a pink mass was detected in the superior area of the subconjunctiva (Figure 1).
Representative histopathologic findings in the biopsy specimen of the mass in the subconjunctiva. (b) High magnification of H-E stained section showing an infiltration of inflammatory cells. (a) Lower magnification of H&E stained section showing an accumulation of amorphous, acellular eosinophilic material in the substantia propria of the conjunctiva. (c) Accumulated materials are direct fast scarlet (DFS) positive. (d) Polarized microscopy shows green birefringence and dichroism of amyloid fibers.
CRIOPM2017-5423027.002.jpg
PMC5343237_01_CRIOPM2017-5423027.002.jpg
fig2
Histopathological examinations of the biopsy specimen showed amyloid fibers that appeared greenish under polarized light illumination (Figure 2).
In situ hybridization of immunoglobulin light chains of the specimens. Both lambda and kappa chains subunits were strongly detected in the infiltrated inflammatory cells.
CRIOPM2017-5423027.003.jpg
PMC5343237_01_CRIOPM2017-5423027.003.jpg
fig3
In situ hybridization detected both lambda and kappa chains in the infiltrated inflammatory cells (Figure 3).
Results of immunofixation electrophoresis of the serum. Abnormalities of the lambda-light chain are present (red arrows). SP is the total proteins. G is the IgG, A is the IgA, and M is the IgM.
CRIOPM2017-5423027.004.jpg
PMC5343237_01_CRIOPM2017-5423027.004.jpg
fig4
Immunofixation electrophoresis detected lambda-light chain abnormality (Figure 4) but systemic examinations did not find any in the heart and the gastrointestine.
Slit-lamp photographs before and three months after surgery. (b) After surgery, the subconjunctival hemorrhage was not observed. (a) The preoperative subconjunctival hemorrhage can be seen.
CRIOPM2017-5423027.005.jpg
PMC5343237_01_CRIOPM2017-5423027.005.jpg
fig5
Although the subconjunctival hemorrhage did not recur after two months of biopsy, the temporal subconjunctival hemorrhage recurred a few times during a year after the biopsy (Figure 5).