Abstract
A 69-year-old man developed keloid overgrowth on his left cornea in response to an injury from a fingernail. The lesion was removed by superficial lamellar keratectomy and was studied by electron microscopy, and light microscopy after immunoperoxidase staining for actin. The surgical specimen revealed disorganised, anteriorly atrophied and posteriorly vascularised connective tissue stroma. The epithelium was oedematous, thin, non-keratinised, and contained cells with features of myoblastic differentiation. Stromal fibroblasts were found in several distinct ultrastructural forms including young active fibroblasts, myofibroblasts, inactive fibroblasts (fibrocytes) and fibroblasts with prominently fibrillar cytoplasm. Fibroblasts with glycogen storage and/or pseudonuclear inclusions were also seen. Macrophages and lymphocytes were scattered in the stroma, and intact nerves were also present. An irregular 2-65 µm band of 10 nm filament meshwork existed at the posterior border of the keloid stroma, and deep localised patches of climatic degeneration were detected.
Similar content being viewed by others
Article PDF
References
Lever WF, Schaumburg-Lever G . Tumors of fibrous tissue. In: Histopathology of the skin. Philadelphia: Lippincott, 1984:604–5.
Linares HA, Kischer CW, Dobrkovsky M, Larsen DL . The histiotypic organisation of the hypertrophic scar in humans. J Invest Dermatol 1972;59:323–31.
Mancini RE, Quaife JV . Histogenesis of experimentally produced keloids. J Invest Dermatol 1962;38:143–81.
Cohen K, Diegelmann RF, Keiser HR . Collagen metabolism in keloid and hypertrophic scars. In: Longaere JJ, editor. The ultrastructure of collagen. Illinois: CC Thomas, 1976:199.
Konuralp HZ . Keloids and hypertrophie scars: their properties, principles and therapy. In: Longaere JJ, editor. The ultrastructure of collagen. Illinois: CC Thomas, 1976: 390–448.
Smith HC . Keloid of the cornea. Trans Am Ophthalmol Soc 1940;38:519–38.
Fenton RH, Tredici TJ . Hypertrophie corneal scars (keloids). Surv Ophthalmol 1964;9:561–6.
Farkas TG, Znajda JR . Keloid of the cornea. Am J Ophthalmol 1968;66:319–23.
Frederique G, Howard RO, Bonuik V . Corneal ulcers in rubeola. Am J Ophthalmol 1969;68:996–1003.
O'Grady RB, Kirk HQ . Corneal keloids. Am J Ophthalmol 1972;73:206–13.
Brown SI . Corneal transplantation of the infant cornea. Trans Am Acad Ophthalmol Otolaryngol 1974;78: OP461–6.
Shukla IM, Arora NP, Arora MM . Corneal keloid. Ind J Ophthalmol 1975;23:18–9.
Cotlier E . Discussion: In: Bergsma D, Born AJ, Cotlier E, editors. The eye and inborn errors of metabolism. New York: Liss, 1976:579–95.
Pouliquen Y, Dehrmy P, Chauvaud M . Une lesion cornéenne bien particulière: pannus hypertrophique. Bull Soc Ophthalmol Fr 1979;79:501–2.
Cibis GW, Tripathi RC, Tripathi BJ, Harris DJ . Corneal keloid in Lowe's syndrome. Arch Ophthalmol 1982; 100: 1795–9.
Lahav M, Cadet JC, Chirambo M, Rehani U, Ishii Y . Corneal keloids: a histopathological study. Graefe's Arch Clin Exp Ophthalmol 1982;218:256–61.
Weiner MJ, Albert DM . Congenital corneal keloid. Acta Ophthalmol (Copenh) 1989;67:188–96.
Holbach LM, Font RL, Shivitz IA, Jones DB . Bilateral keloid like myofibroblastic proliferations of the cornea in children. Ophthalmology 1990;97:1188–93.
Zimmerman LE, Font RL, Tso MOM, Fine BS . Application of electron microscopy to histopathologic diagnosis. Trans Am Acad Ophthalmol Otolaryngol 1972;76:101–7.
Eishi Y, Hatakeyama S, Takemura T, Hajikano H, Hirokawa K . Demonstration of various antigens on paraffin sections of formalin fixed tissues: trypsin treated indirect peroxidase-labelled antibody technique. Bull Tokyo Med Dental Univ 1981;28:27–43.
Ghadially FN . Ultrastructural pathology of the cell and matrix. London: Butterworth, 1982:330–7, 704-9.
Krawczyk WS . A pattern of epidermal cell migration during wound healing. J Cell Biol 1971;49:247–63.
Gabbiani G, Ryan GB . Development of a contractile apparatus in epithelial cells during epidermal and liver regeneration. J Submicross Cytol 1974;6:143–57.
Vracko R, Benditt EP . Capillary basal lamina thickening. J Cell Biol 1970;47:281–5.
Hidayat AA, Risco JM . Amyloidosis of corneal stroma in patients with trachoma. Ophthalmology 1989;96:1203–11.
Sobel HJ, Schwarz R, Marguet E . Non-viral nuclear inclusions. I. Cytoplasmic invaginations. Arch Pathol 1969;87:179–92.
Ross R, Odland G . Human wound repair. II. Inflammatory cells, epithelial-mesenchymal interrelations and fibrogenesis. J Cell Biol 1968;39:152–68.
Williams G . The late phase of wound healing: histological and ultrastructural studies of collagen and elastic tissue formation. J Pathol 1970; 102:61–8.
Shelburne JD . Ultrastructural alterations in pathologic states. In: Garner A, Klintworth GK, editors. Pathology of ocular disease. New York: Dekker, 1982:349.
Yanoff M, Fine BS . Cornea. In: Ocular pathology. Philadelphia: Harper & Row, 1982:306–82.
James WD, Besancency CD, Odom RB . The ultrastructure of a keloid. J Am Acad Dermatol 1980;3:50–7.
Chiu HF, McFarlane RM . Pathogenesis of Dupuytren's contracture: a correlative clincopathologic study. J Hand Surg 1978;3:l–10.
Rudolph R, Gubers S, Suzuki M, Woodward M . The life cycle of the myofibroblast. Surg Gynecol Obstet 1977; 145: 389–94.
Gabbiani G, Ryan GB, Majno G . Presence of modified fibro-blasts in granulation tissue and their possible role in wound contraction. Experientia 1971;27:549–55.
Hogan MJ, Alvarado JA, Weddell JE . The cornea. In: Histology of the human eye. Philadelphia: WB Saunders, 1971:62–4.
Dyer FR, Enna CD . Ultrastructure of keloid: an unusual incident involving lepromatous leprosy. Int J Dermatol 1975;14:743–54.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shoukrey, N., Tabbara, K. Ultrastructural study of a corneal keloid. Eye 7, 379–387 (1993). https://doi.org/10.1038/eye.1993.76
Issue Date:
DOI: https://doi.org/10.1038/eye.1993.76
Keywords
This article is cited by
-
Corneal keloid: four case reports of clinicopathological features and surgical outcome
BMC Ophthalmology (2016)
-
Corneal keloid: Aetiology and management in Lowe's syndrome
Eye (1995)