|
Inflammatory juvenile conjunctival nevus (IJCN)
Klin Monatsbl Augenheilkd.
2007 May;224(5):422-6
BACKGROUND:
Pathologists may occasionally have difficulties in reliably assessing
the dignity of tumour cells in histological sections, especially in
nevi with junctional activity. PATIENT HISTORY: This case history of a
boy suffering from an inflammatory juvenile conjunctival nevus (IJCN)
is reported with a follow-up period of 25 years. Seven years after
first surgical treatment of a histologically proven nevus, a recurrent
pigmented lesion within the former operation area aroused the
suspicion of it being a malignant melanoma. Logically, a second
excision was performed followed by cryotherapy with liquid nitrogen
(spray freezing). The histological diagnosis performed by a
pathologist resulted in a malignant melanoma. A second recurrent
pigmented conjunctival tumour developed fourteen years later. This
lesion again aroused another strong clinical suspicion of malignant
transformation into a melanoma. However, the histological examination
of the biopsy at this time only showed benign nevus cells and areas of
conjunctival melanosis without atypia. DISCUSSION: Especially in young
patients, IJCN must be regarded as an independent type of nevus, which
might lead even experts in ophthalmic pathology to over-diagnose this
lesion as a malignant melanoma. This could mean that the wrong
therapeutic steps were taken with surgical procedures that cause
unnecessary mutilation. A reappraisal of the former histological
specimens of the first recurrent tumour by other pathologists came to
the conclusion that the initial diagnosis of melanoma could not be
maintained. Nevertheless, we also strongly recommend follow-up
examinations at regular intervals in cases of IJCN since we are aware
of the fact that melanocytic tumours of the conjunctiva behave
unpredictably.
Treatment
of large conjunctival nevus by resection and reconstruction using
amniotic membrane.Graefes
Arch Clin Exp Ophthalmol. 2006
Jun;244(6):761-4.
BACKGROUND:
Nevus of the bulbar conjunctiva is a benign pigmented lesion of the
ocular surface. Unless a biopsy is required for ruling out malignant
melanoma, a nevus is usually excised for cosmetic reasons only.
However, with large lesions involving two or more quadrants of the
bulbar conjunctiva, a total resection can be difficult. In this
report, we present a case of a huge nevus treated by surgical excision
and amniotic membrane transplantation for reconstruction of the bulbar
conjunctiva. METHODS: A 54-year-old Japanese man was referred to our
clinic with suspected malignant tumor of the bulbar conjunctiva in his
right eye. A large and diffuse pigmented tumor with numerous small
cysts was present mainly on the upper bulbar conjunctiva. Resection of
the conjunctival tumor and amniotic membrane transplantation for
reconstruction of the bulbar conjunctiva were performed. RESULTS: The
histopathological diagnosis was conjunctival nevus. Epithelialization
of the bulbar conjunctiva over the amniotic membrane sheet was
completed 4 weeks after resection. At 44-month follow-up, there was no
recurrence or any postoperative complication. CONCLUSION: Surgical
resection combined with reconstruction by amniotic membrane
transplantation is effective for the treatment of large conjunctival
nevus.
Conjunctival
nevi: clinical features and natural course in 410 consecutive
patients.Arch
Ophthalmol. 2004 Feb;122(2):167-75.
OBJECTIVES: To
describe the clinical features of a conjunctival nevus and to evaluate
the lesion for changes in color and size over time. DESIGN:
Retrospective, observational, noncomparative case series.
PARTICIPANTS: Four hundred ten consecutive patients with conjunctival
nevi. MAIN OUTCOME MEASURES: The 2 main outcome measures were changes
in tumor color and size. RESULTS: Of the 410 patients, 365 (about 89%)
were white, 23 (about 6%) were African American, 8 (2%) were Asian, 8
(2%) were Indian, and 6 (1%) were Hispanic. The iris color was brown
in 55% (229/418), blue in 20% (85/418), green in 20% (83/418), and not
indicated in 5% (21/418). The nevus was brown in 65%, tan in 19%, and
completely nonpigmented in 16%. The anatomical location of the nevus
was the bulbar conjunctiva (302 eyes, 72%), caruncle (61 eyes, 15%),
plica semilunaris (44 eyes, 11%), fornix (6 eyes, 1%), tarsus (3 eyes,
1%), and cornea (2 eyes, <1%). The bulbar conjunctival lesions most
commonly abutted the corneoscleral limbus. The nevus quadrant was
temporal (190 eyes, 46%), nasal (184 eyes, 44%), superior (23 eyes,
6%), and inferior (21 eyes, 5%). Additional features included
intralesional cysts (65%), feeder vessels (33%), and visible intrinsic
vessels (38%). Cysts were clinically detected in 70% of
histopathologically confirmed compound nevi, 58% of the subepithelial
nevi, 40% of the junctional nevi, and 0% of the blue nevi. Of the 149
patients who returned for periodic observation for a mean of 11 years,
the lesion color gradually became darker in 5% (7 patients), lighter
in 8% (12 patients), and was stable in 87% (130 patients). The lesion
size was larger in 7% (10 patients), appeared smaller in 1% (1
patient), and was stable in 92% (137 patients). There were 3 patients
who developed malignant melanoma from a preexisting compound nevus (2
cases) or blue nevus (1 case) over a mean interval of 7 years.
CONCLUSIONS: Conjunctival nevus is a benign tumor most often located
at the nasal or temporal limbus and rarely in the fornix, tarsus, or
cornea. Over time, a change in tumor color was detected in 13%
(20/149) and a change in tumor size was detected in 8% (12/149).
Conjunctival balloon cell nevi--light- and electronmicroscopic
findings in 2 patients.Klin
Monatsbl Augenheilkd. 2001
Apr;218(4):269-72.
CASE REPORTS:
Two 19-year-old patients presented with small nasal conjunctival
tumors. Histologic examination revealed subepithelial tumors
consisting of large cells with deeply basophilic, small,
centrally-placed nuclei and abundant, slightly eosinophilic cytoplasm
with microvesicles. Electron microscopy showed premelanosomes in some
of the balloon cells. CONCLUSION: The balloon cell nevus is a rare
variant of the conjunctival nevi. The characteristic intracellular
microvesicles are probably degenerative remnants of premelanosomes.
Pigmented spindle
cell naevus of reed presenting in the conjunctiva.Acta
Ophthalmol Scand. 2000 Feb;78(1):104-6.
PURPOSE: This
study aimed to present the clinical and histopathological features of
a pigmented spindle cell naevus (PSCN) appearing in the conjunctiva.
METHODS: Histopathological examination of the lesion following
excision and review of the pertinent literature. RESULTS: The features
were consistent with those previously recognized in the skin as the
PSCN of Reed. CONCLUSION: The PSCN can appear in the conjunctiva and
should not be confused with conjunctival melanoma.
Combined nevi of the conjunctiva.
Trans Am Ophthalmol Soc. 1999;97:170-83;discussion
183-5.
PURPOSE: To
report the clinical and histologic features of combined nevi of the
conjunctiva, a type of nevus that is not uncommon in the skin but has
rarely been reported in the conjunctiva. METHODS: Conjunctival nevi
and melanomas from the files of the University of California, San
Francisco, eye pathology laboratory were reviewed from 1984 to 1999
for the presence of features of both standard nevocytic nevi and blue
nevi. Clinical histories and, when available, clinical photographs
were obtained. RESULTS: Thirty-one combined nevi were discovered
during the 15-year period between 1984 and 1999. One case before 1984
had been incorrectly diagnosed as a junctional nevus. The dendritic
and spindle-shaped blue nevus cells had been overlooked because they
were not recognized as distinct from the standard nevocytic nevus
cells. The recognition of a blue as well as a brown color, a deep as
well as a superficial component in the lesion, or a history of
pigmentation since birth may help to establish the correct clinical
diagnosis and prevent an unnecessarily deep surgical resection.
Although growth of the lesion or "satellites" in some patients may
favor a clinical diagnosis of melanoma, none of the lesions in this
series were malignant. CONCLUSION: Despite a paucity of reports of
combined nevi of the conjunctiva in the medical literature, this type
of nevus--a combination of a nevocytic and a blue nevus--is common and
has been overlooked in the past.
Morphology of
conjunctival progressive nevus.Vestn
Oftalmol. 1999 Nov-Dec;115(6):20-3.
Structural
features of 59 progressive nevuses of the conjunctiva were studied.
The proliferation of the epithelium and melanocytes is partially
compensated by spontaneous regression of the nevus structures. The
growth of a nevus is structurally similar to tumor growth, but the
nevuses lack the melanocyte dysplasia, the main sign of malignant
degeneration. The immune reactions are involved in the tissue
restructuring of the growing nevus. Permanent foci of photoelastosis
reflect the significance of ultraviolet exposure as a factor of risk
of the nevuses progress.
Conjunctival
melanocytic nevi of childhood.
J Cutan
Pathol. 1999 May;26 (5):248-52.
Two young
patients with conjunctival compound nevi are presented to illustrate
two types of abnormalities that lead to difficulty in distinction of
these nevi from invasive melanomas. In Case 1, inflammation is
associated with disruption of the nevus cell architecture and
cytologic atypia. In Case 2, the occurrence of a combined nevus
(compound and blue nevus types) in the conjunctiva leads to diagnostic
problems. Circumscription of the lesions, lack of mitoses in the
substantia propria, and lack of pagetoid spread of atypical cells in
the adjacent conjunctival epithelium support benign diagnoses in both
cases.
Blue nevi of
the conjunctiva.Klin
Monatsbl Augenheilkd. 1994 Oct;205(4):
242-3.
PATIENT
AND METHODS: A 54-year-old man presented with multifocal pigmentations
of the left bulbar and palpebral conjunctiva. He had first noticed
these changes 5 years ago without any evidence of progression. The
pigmented lesions were located in the plica, caruncle, the lower
fornix and the mucocutaneous junction of the lower lid. The right
cornea showed a focal superficial scar paracentrally due to a herpes
simplex keratitis in 1970. Visual acuity was 20/20, otherwise the eyes
were unremarkable. Biopsies were performed in all areas. One year
after surgery, there was no recurrence of the lesions. MICROSCOPY:
Histopathologically, the conjunctival epithelium is essentially
unremarkable. The substantia propria display mostly uniformly
pigmented spindle-shaped melanocytic cells. Many cells contain
coarsely clumped melanin granules. Other areas reveal poorly pigmented
to unpigmented melanocytic cells, some of them with Schwannian
features. Intranuclear vacuoles are commonly present. The tumor cells
are often located in stromal areas displaying increased amounts of
collagen. A few polyhydral melanophages are present within the lesion.
DIAGNOSIS: Biopsy A (plica)--blue nevus with areas of cellular blue
nevus. Biopsy B (caruncle)--cellular blue nevus. Biopsy C (lower
fornix)--cellular blue nevus. Biopsy D (mucocutaneous junction of left
lower lid)--Blue nevus.
Cellular blue
nevus of the conjunctiva.Ophthalmology.
1992 Nov;99(11): 1714-7.
BACKGROUND:
Cellular blue nevi of the conjunctiva are extremely rare, and their
natural history and malignant potential have not been fully
ascertained. METHODS: A report of an unusually well-documented case of
growth of a cellular blue nevus is presented, along with a review of
current knowledge of this lesion. RESULTS: A 71-year-old woman
presented with a darkly pigmented raised lesion of the conjunctiva,
which had slowly enlarged over 47 years. There were nonconfluent areas
of involvement of the upper and lower lids. Results of biopsy showed
the lesion to be a cellular blue nevus, with no evidence of
malignancy. CONCLUSION: This well-documented case of slow growth and
spread without malignant transformation adds to the knowledge of this
rare lesion.
A case of
conjunctival Spitz nevus: review of literature and comparison with
cutaneous locations.Ann
Ophthalmol. 1989 May;21(5):176-9.
We report a
case of Spitz nevus of the bulbar conjunctiva in a 15-year-old boy.
Clinically, the lesion was juxtalimbic, nodular, red, and 6mm in
diameter. Only histologic examination provided the diagnosis. Perusal
of the literature revealed seven cases of Spitz nevus of the
conjunctiva, but for some of them the histology was incompletely
described. We compare the clinical and histologic features in
cutaneous and conjunctival nevi and stress the similarity between the
two. The histologic criteria which permit differentiation of melanomas
and Spitz nevi in conjunctival locations are identified.
Benign
conjunctival melanocytic lesions. Clinicopathologic features.
Ophthalmology. 1989 Apr;96(4):436-61.
The
common acquired conjunctival nevus usually undergoes progressive
maturation and only exceptionally gives rise to conjunctival melanoma.
Pure junctional nevi are rare except in childhood. Histologically,
however, a junctional nevus may be indistinguishable from primary
acquired melanosis (PAM) with atypia, a condition of middle-aged and
elderly individuals that has a tendency to evolve into melanoma. Nevi
in adolescents may attract a vigorous lymphocytic response and may
cause clinical and histologic confusion with other entities,
particularly a regressing nodule of melanoma that occurs predominantly
in adults. Rarely, congenital conjunctival nevi are identified,
sometimes in patients with adjacent congenital nevi of the eyelid. A
variety of unusual nevi, including balloon-cell nevi, Spitz nevi,
epithelioid cell nevi, dysplastic nevi, recurrent nevi, episcleral
melanosis and the nevus of Ota, blue and cellular blue nevi,
melanocytoma, and composite or mixed nevi all may be identified in the
conjunctiva. Concepts of histogenesis as well as the clinical, light
microscopic, and ultrastructural features of these and other benign
pigmentary conditions of the conjunctiva are described.
Melanocytic nevi of the palpebral conjunctiva. An extremely rare
location usually signifying melanoma.Ophthalmology.
1988 Aug;95(8):1053-7.
Nevi of the
conjunctiva generally develop during the first 2 decades of life, and
are almost entirely restricted to the epibulbar surface, the plica,
the caruncle, and the lid margin. Therefore, any elevated pigmented
lesion of the forniceal or tarsal conjunctiva acquired later in life
must be regarded with suspicion as a melanoma or melanoma precursor,
and a biopsy should be done routinely. This report is, to the best of
the authors' knowledge, the first histopathologic documentation of
nevi located in the palpebral conjunctiva. One nevus was acquired and
the other was probably congenital.
|
