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Conjunctival squamous cell carcinoma in a patient with hemodialysis-related porphyria cutanea tarda.

Hemodialysis-related porphyria cutanea tarda (HRPCT) is characterized by porphyria-like blisters on sun-exposed parts of the face, arms and hands due to elevated porphyrin levels. Conjunctival squamous cell carcinoma (CSCC) is a rare cancer that typically occurs on the sun-damaged ocular surface of elderly male patients. Herein, we report a case of CSCC in a 72-year-old patient who had been on hemodialysis for 8 years, and had been followed up with a diagnosis of HRPCT for 3 years. To our knowledge, this is the first case report documenting an association between HRPCT and CSCC, which may reflect a pathogenetic process connecting them.

Aged↗

Primary low-grade B-cell lymphoma of the conjunctiva: a mucosa-associated lymphoid tissue type lymphoma.

We describe the clinical presentation, morphology, immunophenotypic features and molecular biology of seven cases of conjunctival lymphoid infiltration. In five cases there was either immunophenotypic or molecular evidence of B-cell lymphoma. Each of these cases showed the morphological, immunophenotypic and molecular feature of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. The findings suggest that most conjunctival lymphomas are of this type and explains their uniformly favourable prognosis.

Adult↗

Finding of conjunctival melanocytic pigmented lesions within pterygium.

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.

Adolescent↗

Conjunctival melanomas.

BACKGROUND: The nomenclature and the clinical and pathologic features of cutaneous and conjunctival melanomas are different. A comparison is made to familiarize dermatologists and ophthalmologists with these differences. METHODS: Five cases of conjunctival malignant melanoma from December 1983 to December 1990 were reviewed. RESULTS: The nomenclature of primary acquired melanosis is not used for cutaneous melanomas, and terms such as dysplasia and Clark's nevus are not used for conjunctival melanomas. Technical difficulties exist in orienting thin conjunctival tissues because of a tendency to curl during fixation, resulting in tangential sectioning and making a false diagnosis of a prognostically ominous pagetoid spread for an otherwise banal basilar hyperplastic pattern. Excision, cryotherapy, and rarely exenteration are the therapeutic measures in managing conjunctival melanomas; these have far more serious consequences for the patient compared with the excision of a skin melanoma. CONCLUSION: Differences exist in several aspects between melanomas located in the skin and the eye.

Adult↗

Variations in management of adnexal tumours.

Three interesting cases in which unconventional treatment has been very successful are presented. The first was a fibrous histiocytoma of the conjunctiva which recurred twice after apparently complete surgical excision, but which responded to immunotherapy using dinitrochlorobenzene. The second was a squamous cell carcinoma of the lower eyelid treated by total surgical excision of the lid; the wound was allowed to heal by granulation with an excellent cosmetic result. The third was a squamous cell carcinoma of the limbus treated by lamellar excision with the Crock Contact-lens Corneal Cutter; the wound was allowed to granulate, and in so doing, caused negligible astigmatism.

Aged↗

Conjunctival and limbal tumours.

One hundred cases of histologically proven corneal and conjunctival tumours were extracted from the records at the Princess Alexandra Hospital and from the senior author's private practice in the last ten years. The tumours were analysed according to Duke-Elder's classification. There were 78 epithelial tumours, 15 pigmented naevi, four melanomas, two dermolipomas and one limbal dermoid. Fourteen of the 41 epithelial carcinomas were followed for three years or more. None of the 14 recurred.

Adult↗

Malignant melanoma of the eyelid and conjunctiva.

Four patients with malignant melanoma of the eyelid skin and 14 patients with conjunctival malignant melanoma are presented. Surgery was recommended for eyelid lesions and local excision followed by cryotherapy for conjunctival lesions. One patient with an eyelid skin malignant melanoma died and two patients with extensive malignant melanoma of the conjunctiva died. Nodular lesions involving the lid margin have the worst prognosis of eyelid skin malignant melanomas, and the greater the extent of conjunctival involvement the worse the prognosis for conjunctival malignant melanomas. The complications of cryotherapy are minor, but the follow-up period in this series is too short to comment on survival times.

Adult↗

Squamous cell carcinoma of the conjunctiva: case presentation and treatment.

A case of the rare condition of invasive squamous cell carcinoma of the conjunctiva is presented. The plan for surgical excision of the area involved, determined by results of frozen section biopsies, is outlined. The methods of treatment of other authors are briefly reviewed, including this method (from Fraunfelder) of combined excision and cryotherapy.

Carcinoma, Squamous Cell↗

Primary eyelid malignant melanoma associated with primary conjunctival malignant melanoma.

Two patients presented with the unusual occurrence of isolated foci of malignant melanoma of the upper eyelid and ipsilateral inferior conjunctiva. Neither patient had clinical evidence of primary acquired conjunctival melanosis, but in one case there was histopathologic evidence of this condition. The clinical features, histopathologic findings, and possible significance of this unusual occurrence are discussed.

Aged↗

Clinical features and surgical management of dermolipomas.

Dermolipomas are solid choristomas which present as a lateral canthal mass. A series of 35 cases is reported, 27 of whom were female. Six patients had features of Goldenhar's syndrome. Proximity of the dermolipoma to the lacrimal ductules, the lateral rectus and upper lid structures makes extensive surgical excision dangerous. A microsurgical technique of partial excision of the lesion is described and was used successfully in 13 cases without significant complications.

Adolescent↗

Histopathologic, immunophenotypic and genotypic analyses in ocular adnexal lymphoproliferative disorders.

This study reports on fourteen biopsies from patients presenting to our orbital and oncology service with ocular adnexal lymphoid proliferations between November 1988 to September 1991. The biopsies were studied using histologic, immunophenotypic and genotypic analyses. By histologic criteria, there were two reactive, five indeterminate and seven lymphomatous lesions. On immunophenotypic analysis, there were two monoclonal and 10 polyclonal lesions in the 12 specimens analysed. Genotypic analysis confirmed the histopathologic diagnoses for the reactive lesions by showing them to be germline. It also confirmed that both the histopathologic lymphomas and immunophenotypically monoclonal lesions were clonally rearranged. Genotypic analysis was able to separate the histologically indeterminate group into two subsets: clonally rearranged, of which there was one, and germline, of which there were four. In addition, it demonstrated that immunophenotypic polyclonality cannot always be equated with genotypic polyclonality as was the situation in four out of 10 lesions in our series. The significance of clonal arrangements in the histologically indeterminate and immunophenotypically polyclonal groups can only be determined by prospective study.

Adult↗

Isolated bulbar conjunctival Kaposi's sarcoma.

We present a case of an isolated bulbar conjunctival Kaposi's sarcoma in a man with HIV infection. This is an unusual site for the initial presentation of Kaposi's sarcoma and in this site can be confused with a caroticocavernous fistula, cavernous haemangioma or chronic subconjunctival haemorrhage. Biopsy is required to confirm the diagnosis in isolated disease. Local radiotherapy is the preferred treatment for isolated Kaposi's sarcoma.

Adult↗

Human papillomavirus in corneal and conjunctival carcinoma.

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.

Adult↗

Retrospective study of ocular surface squamous neoplasia.

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.

Adult↗

Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma.

An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.

Adenocarcinoma, Sebaceous↗

Conjunctival squamous cell carcinoma: atypical presentation of HIV.

Metastatic squamous cell carcinoma (SCC) of the conjunctiva is uncommon in Western countries. A Nigerian patient who presented with right lower lid swelling treated as a chalazion is described here. She re-presented 5 months later with widespread metastatic conjunctival SCC and positive HIV serology. Conjunctival SCC may be difficult to distinguish on clinical appearance alone and in an era of increasing global travel, young patients with a history of high ultraviolet-B radiation exposure and from countries with a high HIV prevalence should be given a low threshold for excision biopsy.

Adult↗