Limbal Mass Mimicking Neoplasia in Vernal Keratoconjunctivitis: Immunohistochemical Correlation and Literature Review

Abstract

This case report emphasises the role of immunohistochemistry (IHC) in diagnosing a large, vascular limbal mass in a child with vernal keratoconjunctivitis (VKC). The 11-year-old patient, with a history of VKC managed intermittently for five years, presented with a progressively enlarging limbal mass over four months. Clinical examination revealed a well-defined, vascular mass measuring 4 × 7 × 2 mm, occupying nearly three clock hours of the limbus and encroaching on the peripheral cornea. Given the suspicious clinical features suggestive of ocular surface squamous neoplasia (OSSN), excision biopsy with amniotic membrane transplantation was performed. Histopathology showed dense lymphoid infiltration, raising concern for lymphoid hyperplasia or lymphoma. Subsequent immunohistochemical evaluation supported reactive lymphoid hyperplasia and showed no evidence of a lymphoid malignancy. This report underscores the importance of histopathological and immunohistochemical evaluation in distinguishing benign reactive conditions from malignant lesions in cases of limbal masses in VKC.