title: Acquired sessile hemangioma of the conjunctiva: a report of 10 cases.
abstract: OBJECTIVE
  To report 10 cases of an unusual conjunctival lesion that has been termed acquired sessile hemangioma.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  A chart review was conducted on patients coded as having a conjunctival vascular tumor at the Ocular Oncology Service at Wills Eye Institute, Thomas Jefferson University. A cohort of these patients was identified as having a lesion comprising a complex sessile arrangement of conjunctival blood vessels that were remarkably similar to one another, but were distinctly different from other known conjunctival vascular tumors and malformations. These lesions were called acquired sessile hemangioma of the conjunctiva. Each case was evaluated for patient age, gender, race, laterality, and follow-up. Each tumor was assessed for anatomic location in the conjunctiva, quadrant of involvement, diameter, thickness, margin (sharp or ill-defined), and presence of feeder blood vessels.
  
  
  RESULTS
  Ten cases were identified. The median age at the time of diagnosis was 58 years (mean, 58 years; range, 31-83 years). There were 8 women and 3 men, and all patients were white. Only 1 patient was referred specifically for the vascular lesion. In the other 9 cases, it was a coincidental finding by the authors on referral for unrelated problems. There were no related systemic or ocular findings that seemed to be related to acquired sessile hemangioma. In each case, acquired sessile hemangioma was characterized by a flat array of intertwining, mildly dilated blood vessels, usually on the bulbar conjunctiva. Fluorescein angiography, performed in 1 case, demonstrated a feeding artery, draining vein, and leakage of dye from the deeper blood vessels in the lesion and minimal or no leakage of dye from the more superficial blood vessels. Histopathologic analysis, obtained in 1 case, disclosed that the lesion comprised 2 to 3 layers of dilated congested blood vessels that were otherwise of normal appearance. A literature review failed to detect any previous reports on this lesion.
  
  
  CONCLUSIONS
  Acquired sessile hemangioma is an unusual conjunctival vascular lesion of adults that has characteristic clinical features. It should be differentiated from other conjunctival vascular lesions. There are no systemic associations. The best management is observation only, since most remain stable and have no known complications.
authors.affiliation: Oncology Service Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. jas.cls@comcast.net
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.forename: Brad E
authors.initials: BE
authors.lastname: Kligman
authors.forename: Arman
authors.initials: A
authors.lastname: Mashayekhi
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000098:blood supply / Q000473:pathology; D003230:Conjunctival Neoplasms / Q000473:pathology*; D005260:Female; D005451:Fluorescein Angiography; D018324:Hemangioma, Capillary / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies