title: The epidemiology, clinical characteristics, histopathology and management of juvenile- and adult-onset corneoscleral limbus xanthogranuloma.
abstract: OBJECTIVE
  Adult-onset xanthogranuloma (AOX) of the corneoscleral limbus is a rare inflammatory condition of unknown aetiology. Similar to limbal juvenile xanthogranuloma (JXG), it presents as a growing mass at the corneoscleral junction. Limbal AOX and JXG can lead to sight-threatening complications if not managed in a timely manner. This systematic review summarises the main clinical and histopathological features of limbal AOX/JXG and discusses the management of this uncommon disease.
  
  
  METHODS
  We performed a literature search in the MEDLINE database for all historical entries, using the search terms "limbus", "limbal" and "xanthogranuloma", and retrieved all articles reporting on limbal xanthogranuloma. After refining the search to articles relevant to limbal AOX, we were able to identify ten adult cases of limbal AOX and compare those with all reported cases of limbal JXG.
  
  
  RESULTS
  Clinically, AOX usually presents as an isolated smooth, yellowish, dome-shaped nodule at the corneoscleral junction, similar to an ocular presentation of JXG, with which it also shares similar histopathological features.
  
  
  CONCLUSIONS
  Limbal JXG and AOX may represent the same disease entity. Diagnosis relies on the clinical presentation, pathology and immunohistochemical profile. Spontaneous regression is unlikely, and thus prompt surgical intervention should be considered to prevent sight-threatening complications. Xanthogranuloma should be included in the differential diagnosis of corneoscleral limbal masses in patients of all age groups.
authors.affiliation: Department of Ophthalmology, Royal Glamorgan Hospital, Ynysmaerdy, Pontyclun, Mid Glamorgan, CF72 8XR, Wales, UK. georgios.kontos@nhs.net.
authors.forename: G
authors.initials: G
authors.lastname: Kontos
authors.affiliation: Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, Scotland, UK.
authors.forename: S
authors.initials: S
authors.lastname: Borooah
authors.affiliation: Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, Scotland, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.affiliation: Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, Scotland, UK.
authors.forename: B W
authors.initials: BW
authors.lastname: Fleck
authors.affiliation: Pathology, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Daulby Street, Liverpool, L69 3GA, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Coupland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D003316:Corneal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D016850:Limbus Corneae; D008297:Male; D008875:Middle Aged; D014972:Xanthogranuloma, Juvenile / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014973:Xanthomatosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
keywords: Adult-onset limbal xanthogranuloma; Corneoscleral limbal mass; Juvenile limbal xanthogranuloma