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Conjunctival lesions in adults. A clinical and histopathologic review.Cornea.
1987;6(2):78-116.
A total of 2,455
conjunctival lesions in adults (over 15 years old) obtained during a
61-year period were reviewed and histopathologically classified as
congenital, acquired epithelial, acquired subepithelial, pigmented,
inflammatory/degenerative, and miscellaneous. The most common lesions
in decreasing order of frequency were: pterygium, nevus, dysplasia,
nonspecific nongranulomatous inflammation, and epithelial inclusion
cyst. The most common conjunctival malignancy in adults was squamous
cell carcinoma, followed by melanoma, and pagetoid change associated
with sebaceous gland carcinoma. Squamous cell carcinomas arise from
progressive stages of mild, moderate, and severe dysplasia. These
tumors have a low malignant potential but may behave more aggressively
in the spindle cell and mucoepidermoid variants. Melanomas arise de
novo, from nevi or, most commonly, from acquired melanosis and have an
associated 14-32% mortality rate by metastatic spread. Sebaceous
carcinomas are often initially clinically misdiagnosed, involve the
conjunctiva by pagetoid spread, and can have a low rate of metastasis
and death if diagnosed early and excised with frozen-section
monitoring of the surgical margins.
Conjunctival tumors in children. A histopathologic study of 42 cases.J
Fr Ophtalmol. 2005 Oct;28(8):817-23.
PURPOSE: The aim
of this study was to describe the clinicopathological characteristics
of 42 conjunctival tumors surgically removed in children. PATIENTS AND
METHODS: Records of all conjunctival tumors surgically removed in
children during the 11-year period 1990-2001 were collected from the
records of the Department of Ophthalmology, Edouard Herriot Hospital,
Lyon. In all cases, the tumor was resected with no additional
treatment. Sections of all cases were reviewed by the same
pathologist. RESULTS: A total of 42 cases (40 patients) were included
in the study. The mean age of the subjects at the time of surgical
excision was 10 years, with a range of 1-17 years; 45% were male. The
most frequent indication for tumor removal was suspected growth. The
clinical diagnosis was accurate in 91% of cases. The tumor was
localized at the limbus in 57% of cases. Most tumors were pigmented
nevi, accounting for 83% of the lesions. The histopathological
diagnoses in decreasing order of frequency were: nevi (35), angioma
(2), dermolipoma (2), dermoid (1), papilloma (1), and squamous cell
carcinoma (1). In one case, the histological study revealed squamous
cell carcinoma in a child suffering from xeroderma pigmentosum.
CONCLUSIONS: This retrospective study suggests that malignancy of
pigmented conjunctival lesions is extremely rare in children. Although
squamous cell carcinoma is rare in children, surgical excision and
histological study are necessary when a conjunctival lesion is
associated with xeroderma pigmentosum or immunodeficiency.
Incidence of
benign and malignant lesions of eyelid and conjunctival tumors.Nippon
Ganka Gakkai Zasshi. 2005
Sep;109(9):573-9.
PURPOSE: To
examine the incidence of benign and malignant eyelid lesions and
conjunctival tumors. SUBJECTS AND METHODS: One-hundred-and
twenty-eight cases (131 eyes) which were treated during the period
from January 1990 to February 2004 were histopathologically diagnosed
for eyelid or conjunctival tumors (87 cases of eyelid tumors and 41
cases of conjunctival tumors) in retrospective evaluations. The
incidence of benign or malignant lesions, the pathological
classification, age, sex, and clinical diagnostic accuracy were all
investigated. RESULTS: Sixty-four (73%) of the tumors were found to be
benign eyelid tumors. The common benign eyelid tumors were 14
nevocellular nevi, 9 seborrheic keratosis, 7 epidermoid cysts, and 6
papillomas. Twenty-four (27%) eyelid tumors were malignant. These
included 9 basal cell carcinomas, 9 sebaceous gland carcinomas, 4
malignant lymphomas, and 2 metastatic tumors. Thirty-four (79%)
conjunctival tumors were benign, and the common benign conjunctival
tumors were 9 nevocellular nevi and 7 papillomas. Nine (21%)
conjunctival tumors were malignant, comprising 7 malignant lymphomas
and 2 squamous cell carcinomas. The mean ages of malignant eyelid and
conjunctival tumor patients were significantly older than those of
benign tumor patients. Clinical accuracy in predicting basal cell
carcinoma and sebaceous gland carcinoma was 11.1% and 44.4%,
respectively. CONCLUSIONS : Approximately 70 approximately 80% of all
eyelid and conjunctival tumors are benign. Clinicians should suspect
that the lesions are malignant when seeing elderly patients with
eyelid or conjunctival tumors. Excised eyelid lesions should be
submitted for histopathologic confirmation because there are some
cases where clinical diagnosis does not match pathological diagnosis.
Clinical
survey of 1643 melanocytic and nonmelanocytic conjunctival tumors.Ophthalmology.
2004 Sep;111(9):1747-54.
OBJECTIVE: To
report the spectrum and frequency of melanocytic and nonmelanocytic
conjunctival tumors in an ocular oncology practice. DESIGN:
Retrospective noninterventional case series. PARTICIPANTS: One
thousand six hundred forty-three consecutive patients with a
conjunctival mass evaluated at an ocular oncology department. METHODS:
A chart review was conducted to obtain the clinical features of the
patient and tumor and to tabulate and categorize the diagnoses. MAIN
OUTCOME MEASURES: Tumor diagnosis overall and relative to patient age,
race, and gender and relative to tumor location and laterality.
RESULTS: In 1643 consecutive patients, the tumor was classified as
melanocytic in 872 cases (53%) and nonmelanocytic in 771 cases (47%).
The nonmelanocytic categories included congenital choristomatous (n =
40 [2%]), epithelial (n = 219 [13%]), vascular (n = 63 [4%]), fibrous
(n = 7 [<1%]), neural (n = 1 [<1%]), xanthomatous (n = 1 [<1%]),
myxomatous (n = 1 [<1%]), lipomatous (n = 23 [1%]), lacrimal gland
origin (n = 12 [<1%]), lymphoid (n = 128 [8%]), leukemic (n = 3
[<1%]), metastatic (n = 13 [<1%]), secondary (n = 54 [3%]) tumors, and
non-neoplastic lesions simulating a tumor (n = 206 [13%]). Of the 872
melanocytic lesions, the specific tumor diagnosis was nevus in 454
cases (52%), melanoma in 215 (25%), and primary acquired melanosis in
180 (21%). Patients with choristomatous, vascular, fibrous,
xanthomatous, and myxomatous tumors presented at a mean age of <40
years, and those with malignant epithelial, lipomatous, leukemic, and
secondary tumors presented at a mean age of >60. Of the 219 patients
with epithelial tumors, 80% occurred in males, whereas the incidence
of melanocytic lesions was equal in males and females.
African-American patients represented only 7% of epithelial tumors,
<1% of melanomas, and 8% of lymphoid tumors. CONCLUSION: Conjunctival
tumors were of melanocytic origin in 53% of cases and nonmelanocytic
origin in 47%. Overall, melanocytic tumors, epithelial tumors, and
lymphoid tumors accounted for 74% of all cases. These tumors were far
more common in Caucasian patients, and epithelial tumors were found
more frequently in men.
Tumors of the
conjunctiva and cornea.Surv
Ophthalmol. 2004 Jan-Feb;49(1):3-24.
Tumors of the
conjunctiva and cornea comprise a large and varied spectrum of
conditions. These tumors are grouped into two major categories of
congenital and acquired lesions. The acquired lesions are further
subdivided based on origin of the mass into surface epithelial,
melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic,
lipomatous, lymphoid, leukemic, metastatic and secondary tumors.
Melanocytic lesions include nevus, racial melanosis, primary acquired
melanosis, melanoma, and other ocular surface conditions like ocular
melanocytosis and secondary pigmentary deposition. The most frequent
nonmelanocytic neoplastic lesions include squamous cell carcinoma and
lymphoma, both of which have typical features appreciated on clinical
examination. The caruncle displays a slightly different array of
tumors compared to those elsewhere on the conjunctiva, as nevus and
papilloma are most common, but oncocytoma and sebaceous gland
hyperplasia, adenoma, and carcinoma can be found. In this report, we
provide clinical description and illustration of the many conjunctival
and corneal tumors and we discuss tumor management.
Evaluation of
apoptosis markers in conjunctival and eyelid benign and malignant
tumors.Ann
N Y Acad Sci. 2003 Dec;1010:748-51.
The balance
between cell proliferation and programmed cell death plays a crucial
role in malignant development. Bcl-2 family proteins, including
proapoptosis protein Bak and antiapoptosis protein Bcl-2, regulate the
apoptotic process. Mutation of the p53 gene, which results in P53
protein accumulation, was observed in many types of human cancer. The
aim of our study was to evaluate immunohistochemical Bcl-2, Bak, and
P53 protein expression and the relation between these proteins in
conjunctival and eyelid benign and malignant tumors. We examined a
series of 42 papillomas (CEP), 12 squamous cell cancers (SCC), and 19
cases of basal cell cancer (BCC). The age in the CEP group ranged from
18-94 years, and in the SCC and BCC groups from 42-87 years. Staining
patterns were correlated with sex, age, and tumor localization. P53
protein-positive immunostaining was observed in 71% of cases, Bcl-2 in
83.9%, and Bak in 74.2 cases in the SCC and BCC groups. In the CEP
group, P53 overexpression was observed in 90.5% of cases, Bcl-2 in
71.4%, and Bak in 76.2%. No statistically significant correlation was
found between examined protein expression and sex, age, and tumor
localization. An inverse correlation was observed between P53 and Bak
protein expression in the CEP group. No statistically significance
correlation was noted between Bcl-2 and P53 and Bcl-2 and Bak protein
expression in both examined groups. The obtained data suggests that
P53 and Bcl-2 protein expression coupled with decreasing Bak
expression are associated with apoptosis and proliferation as well as
malignant progression in conjunctival and eyelid tumors.
Amniotic membrane transplantation for conjunctival tumor.Yan
Ke Xue Bao. 2003 Sep;19(3):165-7, 145.
PURPOSE: To
evaluate the possibility of amniotic membrane transplantation (AMT)
for the treatment of conjunctival tumor. METHODS: Preserved AMT was
performed in 26 patients (26 eyes) with conjunctival tumor, including
9 eyes (34.62%) with malignant tumor (conjunctival malignant melanoma,
corneal and conjunctival squamous cell carcinoma, conjunctival
lymphoma), 17 eyes (65.38%) with benign tumor (conjunctival papilloma,
conjunctival dermoid tumor, conjunctival nevus, hemangioma etc.).
RESULT: All the patients are followed up for 1-53 months. No acute
rejection was observed after preserved AMT. Ideal healing was found in
conjunctiva wound. CONCLUSION: Preserved AMT is a very effective
method to repair wound after giant conjunctival tumor operation.
Complete removal of tumor and perfect fixation are the key of ocular
surface reconstruction.
HPV type 16 in
conjunctival and junctional papilloma, dysplasia, and squamous cell
carcinoma.J
Clin Pathol. 1995 Dec;48(12):1106-10.
AIMS--To
clarify the role of human papillomavirus (HPV) infection in the
development of papilloma, dysplasia, squamous cell carcinoma, and
basal cell epithelioma arising from the eyelids, including the tunica
conjunctiva palpebrum (conjunctiva), its junction to epidemis of
eyelid skin (junction), and eyelid skin. METHODS--Sixteen cases of
papilloma, four of dysplasia, four of squamous cell carcinoma, and 12
of basal cell epithelioma were examined using formalin fixed and
paraffin embedded samples. Detection of HPV-DNA was performed by
PCR-RFLP and in situ hybridisation (ISH) methods. RESULTS--HPV-16 was
detected in 12/16 papillomas (75%), 2/4 dysplasias (50%), and 1/4
squamous cell carcinomas (25%) but in none of the basal cell
epitheliomas. No other HPV subtypes were found. ISH assay showed
positive signals in only two cases of dysplasia and squamous cell
carcinoma. The mean age of HPV-16 positive dysplasia and squamous cell
carcinoma cases (81.7 years) was significantly higher than that of
HPV-16 positive papilloma cases (p < 0.01). CONCLUSIONS--Based on the
presence of HPV-16 in both benign and malignant lesions and the age
distribution, it seems likely that HPV-16 alone may be incapable of
causing development of conjunctival and junctional dysplasia and
squamous cell carcinoma, and that any correlation between the
papilloma-squamous cell carcinoma sequence and HPV infection may be
due to rare events.
Suture
reaction masquerading as a conjunctival malignancy.Can
J Ophthalmol. 2006 Apr;41(2):207-9.
CASE REPORT:
We report a case of conjunctival inflammation secondary to a retained
suture masquerading as a neoplastic lesion. Excisional biopsy was
performed in the right eye on a superior bulbar conjunctival lesion
that appeared to be a conjunctival malignancy. A past history of
ptosis surgery was obtained. Careful repeated examination with
anesthesia, applying traction to the forniceal conjunctiva, revealed
an occult polypropylene suture. Despite clinical features typical of
malignancy, histologic examination revealed only chronic inflammatory
cells. COMMENTS: Patients with suspicious conjunctival lesions and a
history of ptosis surgery should be carefully explored for retained
suture fragments. Examination with anesthesia may be needed to find an
occult suture.
Human
papillomavirus in corneal and conjunctival carcinoma.Aust
N Z J Ophthalmol. 1997 Aug;25(3):211-5.
PURPOSE: To
investigate the role of human papillomavirus (HPV) types, 6, 11, 16
and 18 in corneal and conjunctival carcinoma, we examined 88
dysplastic corneal and conjunctival specimens and 66 controls that had
been formalin-fixed and paraffin-embedded. METHODS: Sections were
graded for histological abnormality by light microscopy and the
presence of HPV DNA was determined by polymerase chain reaction using
LI consensus primers. RESULTS: Human papillomavirus DNA was detected
in 34 (39%) dysplasias and in five (7.5%) controls. Of dysplasias that
were HPV-positive, 20 (59%) contained either types 16 or 18, 13 (38%)
contained only types 6/11, while combinations of HPV types were
present in 11 (32%). A histological correlation was found with HPV
positivity (all genotypes) and unusually large ('epithelioid')
dysplastic cells. CONCLUSION: The present study demonstrates a lower
incidence of HPV in corneal and conjunctival carcinoma than previously
reported, but shows an unexpectedly high incidence of HPV 6/11 in
conjunctival carcinomas.
Retrospective study of ocular
surface squamous neoplasia.Aust
N Z J Ophthalmol. 1997 Nov;25(4):269-76.
BACKGROUND:
Ocular surface squamous neoplasia (OSSN) encompasses the conditions of
simple dysplasia to carcinoma in situ to invasive squamous cell
carcinoma. It has a high rate of recurrence after treatment and the
potential to metastasize. The present retrospective study was aimed at
further defining the characteristics and clinical course of OSSN.
METHODS: With ethical approval, the records of all major pathology
laboratories in Queensland were surveyed. Two hundred and eighty-eight
cases were identified: 155 dysplasia, 71 carcinomas in situ and 62
invasive squamous cell carcinoma. The records were analysed and an
attempt was made to contact and re-examine the patients. RESULTS:
Ocular surface squamous neoplasia occurs mainly in males (78.5%) with
a mean age of 60.1 years (range 20-88 years). They present as
irritation (40.1%) and are located usually at the limbus (87.8%). The
majority of OSSN are treated by simple excision (87.5%), after which
there is a high rate of recurrence (23.3%). The main predictors for
recurrence include histological grade of the lesion, corneal location
and larger size (> 2 mm). CONCLUSIONS: Management of OSSN requires
adequate excision and careful follow up to monitor any recurrence. As
with other ultraviolet light-related conditions, preventative measures
must remain the key to disease control.
Tumors of the
cornea and conjunctiva.Curr
Opin Ophthalmol. 1997 Aug;8(4):55-8.
This article
reviews the literature published in 1996 regarding conjunctival and
corneal tumors. There is an increased incidence of squamous cell
carcinoma of the conjunctiva in patients with HIV infection,
especially in young individuals and Africans. Presumed causative
factors for conjunctival squamous cell carcinoma include ultraviolet
light, HIV infection, human papillomavirus and other unknown factors.
Metastatic tumors to the conjunctiva appear at an advanced stage of
the disease, and metastases to the conjunctiva are a poor prognostic
sign for survival. Reviews of premalignant lesions of the conjunctiva,
including diagnosis, treatment, and recurrence, are discussed. Spindle
cell and mucoepidermoid variants of squamous cell carcinoma of the
conjunctiva have a worse prognosis for intraocular extension compared
with usual conjunctival squamous cell carcinoma.
Differential diagnosis and prognosis of 112 excised epibulbar
epithelial tumors.
Klin Monatsbl Augenheilkd.
1995 Oct;207(4):239-46.
BACKGROUND:
Epithelial tumors of the epibulbar conjunctiva are rare in northern
Europe. There are no reliable clinical criteria to predict the
histological nature of the lesion. Even histologically proven
malignant tumors typically do not show ocular invasion or metastasis.
PATIENTS AND METHODS: From 1980 to 1993, 112 epithelial epibulbar
tumors were classified in our ophthalmopathological laboratory.
Surgical management of 50 papillomas (mean age 46 +/- 18 years, 58%
males), 49 conjunctival/corneal intraepithelial neoplasias (CIN) (28
mild, 21 severe) and 12 squamous cell carcinomas (mean age 63 +/- 13
years, 69% males) included excisional biopsy (61%), with additional
lamellar keratectomy (14%), epithelial abrasion (10%), cauterisation
(3%), cryotherapy (2%), excimer laser ablation (2%). Other management
regimes were lamellar keratoplasty (2%), penetrating keratoplasty
(2%), epithelial abrasion (2%). One eye with intraocular invasion of a
mucoepidermoid carcinoma was enucleated. RESULTS: Fifty five per cent
of the papillomas were located at the caruncle or semilunar fold.
Seventy eight percent of the papillomas had a pedunculated appearance.
Two lesions involved the epibulbar conjunctiva as well as the opposite
tarsal conjunctiva ("kissing papilloma"). Eighty eight percent of CIN/carcinoma
were located at the limbus. The clinical differential diagnoses of CIN/carcinoma
were squamous cell carcinoma (26%), papilloma (18%), leukoplakia
(10%), pinguecula/pterygium (10%), dysplasia (8%), malignant melanoma
(5%), trachoma (3%), chronic keratoconjunctivitis with corneal pannus
(2%), "granuloma" (2%), non-pigmented naevus (2%). After a mean
follow-up of 6.3 +/- 3.5 years, 13% of the papillomas showed a local
recurrence. After a mean follow-up of 4.8 +/- 3.7 years, there were
30% local recurrences of CIN/carcinoma (50% each in severe CIN and
carcinoma, 9% in mild CIN). But there was no recurrence of CIN/carcinoma
in patients who had received a complete tumor resection initially. If
the surgical margins were involved, there was a 64% recurrence rate
(80% each in severe CIN and carcinoma). Thirteen per cent of the
patients with CIN/carcinoma showed an additional malignant tumor
elsewhere in the body. CONCLUSIONS: Local recurrences after excision
of CIN/carcinoma did occur only if the surgical margins where
involved, and most often within the first year following surgery.
Dedifferentiation of epithelial tumors in recurrences was not
observed. The diagnosis of CIN/carcinoma of the conjunctiva requires
the exclusion of an additional extraocular neoplasia.
Histopathological classification and assessment of resection margins
of epibulbar tumors is indispensable, especially in view of the more
aggressive treatment necessary in mucoepidermoid carcinomas.
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