A 47-year-old man had a painless, slowly growing mass in the right bulbar conjunctiva since 3 months before admission. He underwent surgical removal of a 1.0-cm nodule. Grossly, the specimen consisted of tissue fragments with aggregated dimensions of 1.0 × 0.8 × 0.3 cm that were brownish and firm. Microscopical examination revealed a nonencapsulated subepithelial spindle cell proliferation composed of elongated cells with wavy nuclei and long, slender, eosinophilic cytoplasmic processes. The tumor cells showed an interweaving fascicular growth pattern and focal storiform arrangement, with hypercellular areas and mild cytologic atypia. There were 7 mitotic figures per 10 high-power fields and no necrosis (Figure 1). Immunohistochemical studies showed reactivity for epithelial membrane antigen (EMA) (titer, 1:150 [Dako Corp, Glostrup, Denmark]; antigen retrieval titer, 1:20 [Trilogy; Cell Marque Corp, Rocklin, California] for 40 minutes with heating at 95°C), glucose transporter protein 1 (GLUT-1) (titer, 1:200 [Cell Marque Corp]), and protein gene product 9.5 (titer, 1:100 [Neomarkers Inc, Fremont, California]); showed reactivity focally for claudin-1 (prediluted [Dako Corp]) and collagen IV (titer, 1:100 [Biogenex, Andhra Pradesh, India]); and showed negative results for AE1/3 (titer, 1:50 [Cell Marque Corp]), actin (titer, 1:30 [Cell Marque Corp]), CD34 (titer, 1:100 [Dako Corp]), and S-100 protein (titer, 1:4000 [Bio SB, Inc, Santa Barbara, California]). Ki-67 (titer, 1:25 [Cell Marque Corp]) labeled approximately 10% of the neoplastic cells (Figure 2). Based on the morphologic and immunohistochemical findings, the diagnosis of a perineurioma with atypical histological features in the bulbar conjunctiva was made. After the resection, the patient was lost to follow-up.