Two Cases of Conjunctival Benign Lymphoid Hyperplasia Initially Presenting as a Pyogenic Granuloma

Purpose: Benign lymphoid hyperplasia (BLH) of the conjunctiva is a rare, non-neoplastic lymphoid proliferation that may mimic conjunctival lymphoma clinically and radiographically. Although classically described in older adults, BLH can also occur in young patients, raising diagnostic challenges for potential malignant transformation. Methods: We describe 2 cases of BLH presenting as conjunctival masses in young patients. Case 1 was a 21-year-old man with a vascular temporal conjunctival lesion arising at the site of prior pterygium excision. Initial clinical impression favored pyogenic granuloma. Excisional biopsy was performed due to growth and discomfort despite topical corticosteroids. Case 2 was a 10-year-old boy with no trauma or surgical history who presented with a nasal conjunctival lesion slowly growing over a 3-month period. Differential included nasal choristoma, pyogenic granuloma, or lymphoid lesion. Both lesions underwent excisional biopsy with conjunctival autograft placement. Results: Histopathologic evaluation in both cases demonstrated dense infiltrates of mature lymphocytes with well-formed follicles and germinal centers. Immunohistochemistry confirmed mixed polyclonal B-cell and T-cell populations without light chain restriction, consistent with BLH. Case 2 demonstrated follicular centers positive with CD10 and bcl-6, and negative with bcl-2, consistent with BLH. Postoperative recovery was uneventful, and neither case has demonstrated recurrence to date. Conclusions: We highlight conjunctival BLH as an important diagnostic consideration in young patients with conjunctival masses. Histopathologic confirmation with immunophenotyping is essential to distinguish BLH from malignant lymphoma. While prognosis is favorable, long-term follow-up is warranted given the risk of recurrence and malignant transformation.