Conjunctival stromal tumor: Longitudinal evolution of a progressive, infiltrating tumor

Purpose: To report a case of progressive conjunctival stromal tumor (COST) resistant to surgical debulking and radiotherapy (RT), resulting in orbital exenteration. Observations: A 43-year-old male presented with a hypervascularized nasal bulbar conjunctival lesion infiltrating the rectus muscles of the left eye. Despite three surgical debulking procedures, the tumor recurred and progressed, affecting the superior, nasal, and inferior bulbar conjunctiva and the lower eyelid. RT was administered (30 Gy in 10 fractions) with minimal tumor response. The tumor continued to expand, requiring orbital exenteration to prevent intracranial extension. Histopathology confirmed COST, and genomic testing revealed no actionable variants. The patient's postoperative course has been stable with no evidence of recurrence in the last 32 months. Conclusions: This case highlights the limitations of RT in managing progressive COST. It underscores the importance of considering more aggressive surgical management in progressive cases. Further studies are needed to establish optimal treatment strategies for COST.