Corneal myxoma associated with keratoconus and Down's syndrome

Primary myxoma of the cornea is extremely rare. Until now, only four primary corneal myxomas were reported in the literature, whereas secondary involvement of the cornea by conjunctival and limbal tumors is much more common.

We report an additional case in a 26-year-old woman with keratoconus and Down's syndrome. Excision of the corneal mass was performed by penetrating keratoplasty. Histochemical, immunohistochemistry, and ultrastructural studies were used to obtain a definitive diagnosis.

The tumor exhibited the characteristic histologic features of myxoma. The tumor cells showed immunoreactivity for vimentin but not for S-100 protein, epithelial membrane antigen, CAM 5.2, HHF-35, or muscle-specific actin. Ultrastructural features were fibroblast-like or stellate cells with cytoplasm containing abundant, rough reticulum and dilated cisternae. No recurrence was observed 36 months after penetrating keratoplasty.

This is only the fifth report of such an occurrence. Although the coexistence of myxoma in Down's syndrome with keratoconus is described here for the first time, the differential diagnosis of apparently evident acute hydrops on clinical inspection should not rule out the possibility of a corneal myxoma. Histologic analysis should therefore be performed.