Acquired Capillary Hemangioma of the Palpebral Conjunctiva in a Child with Vernal Keratoconjunctivitis: A Case Report and Pathogenetic Hypothesis.

INTRODUCTION

Acquired capillary hemangioma of the conjunctiva is a rare benign vascular tumor, particularly in the pediatric population and when arising from the palpebral conjunctiva. Its clinical appearance often overlaps with reactive vascular lesions such as pyogenic granuloma, making accurate diagnosis challenging. Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammatory disorder characterized by a pro-angiogenic microenvironment, which may contribute to vascular proliferation.

CASE PRESENTATION: An 8-year-old boy with a known history of VKC presented with a 1-year history of a painless, slowly enlarging reddish mass on the right upper palpebral conjunctiva. The lesion was refractory to intensive topical anti-inflammatory and immunomodulatory therapy. Surgical excision was therefore performed. Histopathological examination revealed a well-circumscribed lobular proliferation of thin-walled capillary-sized vessels separated by fibrous septa, with an eosinophil-rich inflammatory infiltrate. Immunohistochemical analysis demonstrated strong CD34 positivity, negative glucose transporter-1 staining, and a low Ki-67 proliferation index, confirming the diagnosis of an acquired capillary hemangioma. Postoperatively, the patient showed complete resolution with an excellent cosmetic and functional outcome.

CONCLUSION

This case highlights a rare occurrence of acquired capillary hemangioma of the palpebral conjunctiva in a child with VKC. The findings suggest a possible association between chronic allergic inflammation and vascular tumor development. Histopathological and immunohistochemical evaluation is essential to distinguish this entity from reactive vascular lesions such as pyogenic granuloma.