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Finding of conjunctival melanocytic pigmented lesions within
pterygium.Histopathology. 2006
Mar;48(4):387-93.
AIMS:
Conjunctival pigmented lesions have characteristic clinical and
histopathological appearances. Melanocytic pigmented lesions commonly
occur in the conjunctiva, although they have not been previously
reported in pterygium, a common lesion which originates from
conjunctiva. Our aim was to evaluate the possibility of an association
between pterygium and conjunctival melanocytic pigmented lesions.
METHODS AND RESULTS: A total of 80 samples of pterygium excised from
Ecuadorian patients in 2002 were collected. Clinical data were
available regarding age, sex, race and place of residence.
Histological sections were evaluated for the presence of melanocytic
pigmented lesions. Nine cases of conjunctival melanocytic, pigmented
lesions within pterygium were found and were classified according to
the histopathological criteria previously published for pigmented
lesions of the conjunctiva, as naevi and primary acquired melanosis
(PAM) with varying degrees of atypia. Five of the nine cases showed
primary acquired melanosis without atypia, while two cases had atypia;
one case showed features of compound naevus and one lesion was
designated as subepithelial naevus. CONCLUSIONS: Our findings suggest
that conjunctival melanocytic, pigmented lesions occasionally occur in
pterygium. All surgically removed pterygia should undergo careful
histopathological examination.
Expression of sex
hormone receptors and cell cycle proteins in melanocytic lesions of
the ocular conjunctiva.Graefes
Arch Clin Exp Ophthalmol. 2006 Jan;244(1):113-7.
BACKGROUND:
Both dermal and ocular melanocytic nevi have been reported to undergo
changes during pregnancy. This has been proposed to be related to
hormonal influences; however, few studies have provided any proof. We
therefore set out to evaluate the expression of sex hormone receptors
and cell cycle proteins in melanocytic lesions of the ocular
conjunctiva. METHODS: Formalin-fixed, paraffin-embedded material from
76 tumors--69 conjunctival nevi, 5 specimens of primary acquired
melanosis (PAM), and 2 conjunctival melanomas--were included in a
tissue microarray (TMA) format. The TMA sections were analyzed by
immunohistochemistry with antibodies for progesterone and estrogen
receptors, and cell cycle-related proteins (p16, MIB1-Ki67). RESULTS:
Progesterone receptors were highly (96%) and similarly expressed in
all lesions. In addition, progesterone receptor expression showed a
tendency to increase with age (p=0.06). In contrast, estrogen receptor
expression was completely absent in all tumors. The cell cycle
regulator p16 was expressed in 97% of the lesions. The proliferation
marker MIB1-Ki67 was expressed at low levels (mean+/-SD: 13+/-14%) in
79% of the lesions. No differences of expression were found between
the different lesions and nevi types. The mean age of the patients was
highest in conjunctival melanoma (70+/-22 years), followed by PAM
(60+/-19 years) and nevi (36+/-18 SD years). The different types of
nevi also showed significant age dependency (junctional 25+/-17 years,
compound 34+/-17 years, dermal 49+/-15 years). CONCLUSION: Our
findings reveal the expression of progesterone, but not estrogen, in
melanocytic lesions of the ocular conjunctiva. In benign conjunctival
lesions, p16 and MIB1-Ki67 expression was comparable to that in benign
nevi of the skin.
Immunophenotypic markers to differentiate between benign and malignant
melanocytic lesions.Br
J Ophthalmol. 2006 Feb;90(2):213-7.
BACKGROUND/AIMS:
The authors investigated the expression of S100A1, S100A6, S100B,
MelanA, and CEA in conjunctival naevi, primary acquired melanosis
(PAM), conjunctival melanoma, and uveal melanoma in order to assess
their potential usefulness in the pathological differential diagnosis
of these entities. METHODS: Paraffin embedded sections of 18
conjunctival naevi, 14 PAM, 16 conjunctival melanomas, and 20 uveal
melanomas were immunostained for S100A1, S100A6, S100B, MelanA, and
CEA, and expression was scored semiquantitatively. RESULTS: Expression
of S100A1 differed significantly between conjunctival naevi and
conjunctival melanoma, with percentages of positive cells of 30.6% and
71.4%, respectively. Conjunctival melanomas had high average scores
for S100A1 and S100B (71.4%, 62.9%, respectively), while uveal
melanomas also had high S100A1 but low S100B scores (88.5%, 18.5%,
respectively). MelanA was highly variable; naevi and uveal melanoma
had higher average scores than conjunctival melanoma. CEA was hardly
detectable in all four groups. CONCLUSION: S100A1 seems to be a
possible candidate to differentiate conjunctival naevi from
conjunctival melanoma. S100B seems to differentiate between uveal
melanoma and conjunctival melanoma. However, the study size was small
and therefore the data have to be confirmed by others.
Expression of
intermediate filaments in conjunctival melanocytic lesions.Graefes
Arch Clin Exp Ophthalmol. 2002
Oct;240(10):846-50.
BACKGROUND: To
our knowledge there have been no studies on intermediate filament (IF)
expression in conjunctival melanocytic tumors to date. Melanocytic
lesions occurring at various body sites are known to express, in
addition to the predominant IF protein vimentin, the
epithelial-specific cytokeratins (CKs) and the neuronal IF peripherin.
The present study was therefore carried out to assess the expression
of IF proteins in conjunctival melanocytic lesions. METHODS:
Paraffin-embedded material from 34 tumors - 16 conjunctival nevi, nine
specimens of primary acquired melanosis (PAM; eight with and one
without atypia), and nine conjunctival melanomas - was assessed after
the application of a panel of antibodies directed against diverse IF
proteins, including vimentin, CKs and peripherin. RESULTS: The most
significant finding of this study was that all the tumors investigated
expressed vimentin exclusively. While simple-epithelium CKs were found
in epithelial cysts of nevi and in pseudoglandular portions adjacent
to the melanoma, they were not identified in the tumor cells
themselves. Similarly, peripherin and neurofilaments were not detected
within any of the tumor cells. CONCLUSION: The IF expression pattern
of conjunctival melanocytic lesions differs from that seen in
melanocytic tumors of other body sites (including uveal melanomas), in
that it includes neither CKs nor peripherin.
Differential
immunoreactivity of melanocytic lesions of the conjunctiva.
Histopathology. 2001 Oct;39(4):426-31.
AIMS: To evaluate
the expression of S100NKI/C3 and HMB45 antigens in melanocytic lesions
of the conjunctiva and the ability of HMB45 to aid assessment of
neoplasia. METHODS AND RESULTS: Stored formalin-fixed specimens of
conjunctival melanomas and primary acquired melanosis were considered
as participants and conjunctival naevi and racial melanosis as
controls. Ninety-seven conjunctival melanocytic lesions were analysed
using formalin-fixed paraffin-embedded material. These included 20
melanomas arising in the context of primary acquired melanosis (PAM),
22 melanomas arising without evidence of pre-existing PAM, seven cases
of PAM with atypia, nine cases of PAM with no atypia, 35 conjunctival
naevi and four cases of racial melanosis. S100 and NKI/C3 were
similarly expressed in all lesions, with at least one of these markers
positive in 100% of the lesions examined. HMB45 was expressed in 72.7%
of primary melanomas and 85% of melanomas in the context of PAM; 42.8%
of PAM with atypia expressed HMB45 while it was expressed in 11.1% of
PAM without atypia and 8.5% of naevi. Racial melanosis cases did not
express HMB45. S100 and NKI/C3 were expressed to a similar extent in
all groups. CONCLUSIONS: S100 and NKI/C3 are useful markers to assess
the extent of melanocytic lesions in the conjunctiva. HMB45
immunoreactivity can act as a useful aid to histopathology for the
distinction of benign from malignant conjunctival lesions,
particularly in the context of primary acquired melanosis.
Immunohistochemical diagnosis of malignant melanoma of the conjunctiva
and uvea: comparison of the novel antibody against melan-A with S100
protein and HMB-45.Melanoma
Res. 2000 Aug;10(4):350-4.
A novel antibody
A103, which recognizes melan-A/MART-1, has been found to be more
sensitive than the antibody HMB-45, which recognizes gp100, in
melanocytic lesions of the skin and might therefore also be useful in
the diagnosis of uveal and conjunctival melanocytic lesions. In this
study we compared the staining characteristics of anti-melan-A,
anti-S100 protein and HMB-45 in 13 conjunctival, 11 iris and 37
ciliary and choroidal malignant melanomas. The ciliary and choroidal
melanomas comprised 13 spindle cell (10 spindle B and three spindle
A), 14 mixed cell and 10 epithelioid cell tumours. In the conjunctival
melanomas the diagnostic sensitivity was 100% for anti-S100 and anti-melan-A
and 85% for HMB-45. In the iris melanomas the sensitivity was 100% for
anti-S100 and anti-melan-A and 55% for HMB-45. A high staining
intensity of anti-melan-A was particularly noticed in iris melanomas.
In the choroidal malignant melanomas, the spindle cell and mixed cell
types showed a sensitivity of only 69-79% with all three antibodies.
In the epithelioid cell type the sensitivity was 80% for anti-S100 and
100% for HMB-45 and anti-melan-A. In conclusion, anti-melan-A was
found to be a useful addition to antibody panels for ocular
melanocytic lesions. Anti-melan-A has a higher sensitivity than HMB-45
in conjunctival and iris melanomas, but the sensitivity is similar to
HMB-45 in choroidal melanomas. Anti-melan-A stains in a very similar
pattern to anti-S100, but the staining intensity of anti-melan-A is
higher than that of anti-S100 in iris melanoma.
Immunohistochemical
markers for cytoplasmic antigens in acquired melanosis, malignant
melanomas, and nevi of the conjunctiva.Klin
Monatsbl Augenheilkd. 1998 Oct;213(4):230-7.
BACKGROUND:
Benign and malignant melanocytic lesions of the conjunctiva are
difficult to differentiate histologically. At present in the
ophthalmologic literature there is not known a high specific and
simply applicable histological feature (tumor marker) of
differentiation to identify melanocytic lesions of the conjunctiva.
METHODS: In this study 55 nevi, 15 primary acquired melanoses (stage
Ia) and 54 melanomas of the conjunctiva were examined retrospectively
immunhistochemically by antibodies vs. S-100 protein, and the
melanoma-associated antigens HMB-45 and NKI/C3 using the labelled
avidin-biotin method. 45 patients (25 female, 20 male) with malignant
melanomas of the conjunctiva have been followed up clinically.
RESULTS: S-100, HMB-45 and NKI/C3 are highly significant markers to
identify malignant melanomas of the conjunctiva (sensitivity: S-100:
96.4%, HMB-45: 96.3%, NKI/C3: 98.1%), whereas markers in acquired
melanoses (sensitivity: 93.3%, 78.6% and 92.9%), and nevi
(sensitivity: 92.9% 40.7%, 98.2%) are not. Positive tumor markers do
not correlate with local recurrences or metastasis. The localization
of malignant melanomas and the lymphocytic infiltration are not
prognostically significant. The only significant risk factor (p =
0.0485) predicting the development of recurrence or metastasis is
tumor thickness > 1.5 mm. CONCLUSIONS: The tumor markers S-100, HMB-45
and NKI/C3 cannot differentiate reliably between benign and malignant
melanocytic lesions of the conjunctiva, and positive tumor markers do
not correlate with local recurrences or metastasis. The only
significant risk factor (p = 0.0485) predicting the development of
metastasis is tumor thickness (> 1.5 mm).
Pigmented conjunctival and scleral lesions.Mayo
Clin Proc. 1994 Feb;69 (2):151-61.
OBJECTIVE: The
multiple causes of pigmentations of the conjunctiva and sclera are
reviewed, and the recommended therapeutic modalities are discussed.
DESIGN: Information from personal experience and the recent literature
is summarized to determine the optimal diagnostic and treatment
approaches for suspicious pigmented conjunctival and scleral lesions.
MATERIAL AND METHODS: Clinical descriptions and illustrations are
presented to characterize these ocular lesions. RESULTS: Pigmented
lesions of the conjunctiva and sclera arise from either melanocytes or
nonmelanocytes and have a diverse differential diagnosis. These
lesions can be classified into congenital melanosis, conjunctival
nevi, acquired melanosis (secondary or primary), and conjunctival
melanomas. In secondary acquired melanosis, the increased conjunctival
pigmentation is caused by irradiation, hormonal changes, chemical
irritation, or chronic inflammatory conjunctival disorders. The
biologic behavior of primary acquired melanosis of the conjunctiva is
a controversial topic with important implications because it may
progress to melanoma. In patients with primary acquired melanosis, a
biopsy is recommended in order to grade the disease, offer a
prognosis, and direct further treatment. Conjunctival melanomas may
arise from primary acquired melanosis, from nevi, or de novo, or they
may be metastatic lesions. CONCLUSION: Of the wide spectrum of
melanocytic conjunctival lesions, those with malignant potential are
melanosis oculi, nevus of Ota, junctional nevus, compound nevus,
primary acquired melanosis, and melanomas.
Distribution of melanoma-associated antigens (HMB 45 and S 100) in
benign and malignant melanocytic tumors of the conjunctiva.Klin
Monatsbl Augenheilkd. 1991 Sep;199(3):187-91.
The reactivity of
the monoclonal antibody HMB 45 was evaluated in melanocytic tumors of
the conjunctiva. Among these are 10 acquired melanoses, 19 nevi and 34
melanomas. Results were compared with the presence of the S 100
antigen. Especially the intraepithelial and junctional components of
primarily benign lesions were stained with HMB 45. Within malignant
melanoma this antibody reacts with melanocytes in the epithelial,
junctional and subepithelial areas. The polyclonal antibody S 100
stains all melanocytes in pigmented lesions of the conjunctiva.
Intraepithelial or subepithelial malignant infiltrating tumor cells
show very intense staining with HMB 45. HMB 45 has therefore high
specificity for stimulated melanocytes, but it does not distinguish
benign and malignant proliferating melanocytic cells.
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