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Oral cimetidine adjuvant therapy for recalcitrant, diffuse
conjunctival papillomatosis.Cornea.
2006 Jul;25(6):687-90.
PURPOSE: To
describe a case of recurrent, advanced conjunctival papillomatosis,
treated by oral cimetidine (CIM) combined with secondary surgical
intervention and an application of intraoperative mitomycin C.
METHODS: Case report and literature review. RESULTS: A 9-year-old boy
suffered from recurrent, progressive, diffuse multifocal conjunctival
papillomatosis over the left upper and lower palpebral and the
fornical conjunctiva. He underwent 3 separate surgeries; however, they
did not prevent tumor recurrence. The recurrent lesions were more
severe and extensive than before the surgeries. To avoid postoperative
symblepharon, ankyloblepharon, dry eye, and possible corneal
neovascularization after extensive lesion excision, oral CIM at a
dosage of 200 mg 4 times daily was administered for 4 months before
surgery. A debulking excision of the residual tumor with an
intraoperative application of mitomycin C was performed as a secondary
therapy after the main mass decreased in size. Postoperative oral CIM
was continued for 6 months. The papillomatosis cleared without
recurrence or symblepharon, ankyloblepharon, conjunctival scarring, or
corneal neovascularization after 4 years of follow-up examinations.
CONCLUSION: Oral CIM can be used as an initial, nonsurgical strategy
for treating cases of massive, recalcitrant conjunctival
papillomatosis. If there is tumor shrinkage, surgical debulking with
applications of mitomycin C may be sufficient to eliminate any
residual tumor tissue without inducing conjunctival scarring or
corneal neovascularization.
Human papillomavirus
type 13 infecting the conjunctiva.Diagn
Microbiol Infect Dis. 2005 Sep;53(1):71-3.
Focal
epithelial hyperplasia (FEH) is a rare infection caused by human
papillomavirus (HPV) types 13 or 32 believed to infect exclusively
oral mucosa. This report illustrates a case of multiple conjunctival
papillomas similar to oral FEH caused by HPV-13, consisting in the
first description of its infection outside the oral mucosa in a
healthy patient.
Human
papillomavirus in conjunctival papilloma.Br
J Ophthalmol. 2001 Jul;85(7):785-7.
AIM: To
examine conjunctival papillomas for the presence of human
papillomavirus (HPV) and koilocytosis. METHODS: Archival paraffin
embedded tissue from 55 conjunctival papillomas was analysed for the
presence of HPV by polymerase chain reaction and subsequent filter
hybridisation. Histological sections of the 55 papillomas were
evaluated for the presence of koilocytosis. RESULTS: HPV was present
in 48 of 52 (92%) beta globin positive papillomas. HPV type 6/11 were
found in 40 of 47 investigated papillomas and a double infection with
HPV 6/11 and 16 was identified in a single papilloma. In six
papillomas the HPV type could not be identified. Koilocytosis was
present in 22 of 55 papillomas (40%). CONCLUSION: There is a strong
association between HPV and conjunctival papillomas. HPV type 6/11 is
the most common HPV type in conjunctival papilloma. The sensitivity of
koilocytosis as an indicator of HPV in conjunctival papilloma is low.
Papillomatous and nevus of the caruncle.J
Fr Ophtalmol. 2001;24(2): 209-12.
A 63-year-old
male patient was operated of a single conjunctival papillomatous
lesion located on the left caruncle. The curative tumoral excision was
followed by its histological analysis. Histologically, the tumor
associated an epithelial squamous papilloma with a subepithelial
nevus, confirming a combination of two different lesions.
Detection of
human papillomavirus in epithelial lesions of the conjunctiva.
Sao Paulo Med J. 2000 Sep
7;118(5):125-30.
CONTEXT: Many
factors like exposure to UV radiation, climatic conditions, genetic
predisposition, immunological state and, more recently, the presence
of HPV have been implicated in the genesis of some lesions of the
conjunctiva, especially the carcinoma. OBJECTIVE: To evaluate the
presence of HPV DNA in acquired lesions of the conjunctiva and in
normal mucosa. TYPE OF STUDY: Cross-sectional study. SETTING: A public
university referral center (the Ophthalmology Service of the A.C.
Camargo Hospital - A. Prudente Foundation, São Paulo). PARTICIPANTS:
Thirty patients with acquired lesions of the conjunctiva and 60
matched controls (by age and sex) were evaluated in this study, from
June 1993 to March 1995. PROCEDURES: The detection of HPV DNA in the
normal conjunctiva and in acquired lesions was done by the PCR
technique and dot blot hybridization. The material was collected by
scraping the normal mucosa and the surface of the lesions. A fragment
of fresh frozen tissue and paraffin embedded specimens of each lesion
were also included. MAIN MEASUREMENTS: The association between the HPV
infection and the presence or absence of conjunctival lesions.
RESULTS: Sequences of HPV DNA were detected in 4 of the 31 lesions
evaluated (12.9%) and in the healthy mucosa of one individual of the
control group (1.6%). HPV type 16 was detected in 2 carcinomas and in
the normal mucosa of one individual of the control group. HPV type 11
was demonstrated in 2 papillomas of one patient with lesions in both
eyes. CONCLUSIONS: The low frequency of HPV DNA found in the lesions
of this sample and the detection of the viral genome in the normal
mucosa indicate that there is a weak possibility of association
between HPV infection and the carcinoma of the conjunctiva.
Treatment of
recurrent conjunctival papillomatosis with mitomycin C.Am
J Ophthalmol. 1999 Nov;128(5):638-40.
PURPOSE: To
report an effective treatment for recurrent squamous papillomas of the
conjunctiva with excision and application of mitomycin C. METHOD: Case
report. RESULTS: A 5-year-old African-American girl with recurrent
squamous papillomas of the right bulbar and palpebral conjunctiva was
treated with multiple therapies, including excision, cryotherapy, and
conjunctival injection of alpha-interferon; all therapies were
followed by recurrence. After treatment with excision followed by
intraoperative application of mitomycin C to the involved conjunctiva,
the patient had no recurrence in a 30-month period. CONCLUSIONS:
Excision with application of mitomycin C was successful in managing a
case of squamous papillomatosis that was resistant to traditional
therapy.
Detection
of human papillomavirus infection in squamous tumours of the
conjunctiva and lacrimal sac by immunohistochemistry, in situ
hybridisation, and polymerase chain reaction.Br
J Ophthalmol. 1997 Apr;81(4):308-13.
BACKGROUND:
Squamous tumours of the ocular surface, including the lacrimal
pathway, range from benign lesions to invasive carcinomas. Some of
these tumours are associated with human papillomavirus (HPV)
infection, with the types of HPV differing among papillomas and
dysplastic or malignant lesions. METHODS: The relation between
squamous tumours of the conjunctiva and lacrimal sac and HPV infection
was investigated in 17 individuals with such tumours. Nine of the 17
tumours were benign, four were dysplastic lesions, and four were
carcinomas. RESULTS: Eight specimens showed positive
immunohistochemical staining with antibodies to HPV; four of these
eight were papillomas, three were dysplastic lesions, and one was a
carcinoma. Koilocytosis was detected in seven of these eight tumours.
Five of the eight specimens positive for immunohistochemical staining
were also positive for HPV DNA by in situ hybridisation, and all eight
were positive for HPV DNA by the polymerase chain reaction (PCR)
method. CONCLUSION: Approximately 50% of squamous tumours of the
ocular surface and lacrimal sac were associated with HPV infection.
This is the first report, to our knowledge, of the detection of HPV in
the field of ophthalmology by a combination of immunohistochemistry,
in situ hybridisation, and PCR.
Human
papillomavirus 6/11 in conjunctival papilloma.Ann
Dermatol Venereol. 1996;123(2):90-2.
INTRODUCTION:
Human papilloma virus is highly prevalent, but rarely localized in the
conjunctiva. CASE REPORT: A 19-year-old man with no past history of
skin or mucosal disease consulted for tumefaction of the conjunctiva.
Exeresis revealed a viral papilloma. In situ hybridization was
positive for human papilloma virus 6/11. DISCUSSION: Conjunctival
lesions of human papilloma virus are often located in the caroncula as
in our patient. The papillomatous aspect of the tumour may suggest
squamous cell carcinoma (sometimes induced by human papillomavirus
16/18). Contamination may be manual or occur at birth via the maternal
genital mucosa. Treatment usually is based on wide exeresis with cryo-application
although spontaneous regression is possible.
Detection of
human papillomavirus type 11 DNA in a conjunctival squamous cell
papilloma by in situ hybridization with biotinylated probes.
Acta
Ophthalmol (Copenh). 1989
Aug;67(4):425-9.
A 44-year-old
man presented with an exophytic papillomatous growth in the tarsal
conjunctiva of his right eye. The tumour was excised and subjected to
histological examination. On light microscopy, a squamous cell
papilloma without signs of dysplasia was disclosed, because the entire
tissue block was cut into sections, the performance of a conventional
in situ hybridization for detection of human papillomavirus (HPV) DNA
was not possible. An alternative approach was used to demonstrate the
presence of HPV 11 DNA in the papilloma. The cover slip was removed.
The individual van Gieson-stained sections on the (routine, uncoated)
slides were cut apart by glass knife, and mounted (still attached on
the original slide) separately on new microscopy slides. These slides
were subjected to in situ DNA hybridization with biotin-labelled DNA
probes of HPV 6, 11, 16, and 18, under conditions of high stringency
(Tm-17 degrees C). Special caution was taken to prevent the detachment
of sections. The papilloma displayed positive hybridization with the
HPV-II probe, the intense signals being localized on the nuclei of
koilocytotic cells. Infection with HPV-6 (or the closely related
HPV-11) appears to be responsible for the majority of the conjunctival
papillomas of children and young adults reported so far. The presence
of genital tract HPV types 6/11 in these lesions suggests that some of
the infections might have been acquired during the passage through an
infected birth canal. The presence of HPV 6/11 in adult conjunctival
papillomas might reflect a) an activation of a latent infection
acquired as above, or b) a new infection transmitted from other
mucosal sites, the genital tract included. The role of HPV in
conjunctival dysplasias and malignant transformation is not clear as
yet.
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