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Squamous spindle cell carcinoma of the conjunctiva is an infrequent entity that behaves distinctly different from "ordinary' squamous cell carcinoma. This case report reviews the clinical and histopathological features of a lesion, that despite an insidious clinical appearance caused the patient's death 14 months following the initial excision. Data from previous reports are outlined.
The clinicopathological characteristics of 343 naevi of the conjunctiva were studied. A significant increase in the number of naevi excised per annum was observed. This may have been caused by an increased exposure to actinic rays. Approximately even distribution in the three main locations: caruncle, limbal area and eyeball, was found. Intrastromal naevi were excised at a higher median age than compound naevi, and the lowest observed median age at excision was for junction naevi, which is in accordance with the known histopathological nature of naevi. Recurrence occurred in nine patients (2.7%), and one transformed to a malignant melanoma. Eight of the recurring naevi were located in the limbal area. Eight of the nine patients were women, suggesting hormonal factors as a possible cause. Recommendations for the handling of conjunctival naevi are given, based on the present findings and on previous reports.
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PURPOSE: Pigmented lesions of the conjunctiva are often difficult to classify clinically. Exfoliative cytology may be helpful, but reliable data regarding the sensitivity and specificity of this test are currently lacking. We determined the value of exfoliative cytology with regard to pigmented conjunctival lesions. METHODS: A total of 294 smears from 182 patients were screened for malignancy within 6 months of exfoliative cytology. Smears were classified according to the following categories: grade 0 = insufficient material for diagnosis; grade 1 = normal conjunctival cells; grade 2 = melanocytes with mild atypia; grade 3 = melanocytes with moderate atypia, and grade 4 = melanocytes with severe atypia. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of exfoliative cytology were 85%, 78%, 59% and 93%, respectively. CONCLUSION: Exfoliative cytology is a fast, easy and non-invasive technique that may be used in the evaluation of patients with a pigmented conjunctival lesion.
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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.
Low-grade non-Hodgkin's lymphomas of the conjunctiva may be cured by radiotherapy, but complications are frequent and relapses may occur. Other treatment modalities including resection, cryotherapy, injection of interferon-alpha or systemic chemotherapy have been used with varying success. We treated two patients with relapsed extranodal marginal zone lymphoma (ENMZL) of mucosa-associated lymphoid tissue (MALT) of the conjunctiva with the anti-CD20 monoclonal antibody rituximab (375 mg/m2 intravenously once weekly for 4 wk) which has previously been shown to be effective in a variety of other B-cell non-Hodgkin's lymphomas. Treatment was well tolerated and resulted in one partial and one complete remission. With a follow-up of 32 or 30 months, respectively, further recurrences have not been observed. Rituximab is a highly effective and well-tolerated treatment of conjunctival MALT lymphoma, which may not only be of value in relapse, but also in cases of contraindication to radiotherapy.
Five cases of unilateral bulbar conjunctival papillomata are reported in five different breeds of dog. The dogs ranged from six to nine years of age, four were female and one was male. In all but one case the mass was an incidental finding. The morphology and histopathology are described. The authors have been unable to find any details or descriptions of this type of papilloma in the veterinary literature.
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Ten cases of Bowen's disease at the limbus have been clinicopathologically studied and followed up for 1 1/2 to 9 years. The clinical appearance might be classified into 3 principal forms; i.e., papillomatous, leukoplakic and gelatinous forms. However, histopathological differences could not be detected in the respective forms. In the follow-up study no recurrence was observed in the 8 cases treated with excision and cryotherapy, though recurrence and malignant change took place in one case of the remaining 2 cases, treated with excision only.
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.
Squamous cell carcinoma of the conjunctiva is a distinct rarity, often arising at the corneoscleral limbus and initially resembling pterygium or chronic keratoconjunctivitis. In this paper we report 4 patients with conjunctival squamous cell carcinoma/carcinoma in situ, which comprise all the cases found in the files of Kuopio University Hospital during 1959-1991. The clinical appearance, diagnosis and treatment of the lesions are described. All biopsies were studied for the presence of Human papillomavirus (HPV) DNA (recently demonstrated in conjunctival squamous cell papillomas, precancer lesions and carcinomas) by using in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). Both techniques failed to demonstrate the DNA of any of the following HPV types: HPV 6, 11, 16 and 18 in any of the lesions. The results are discussed in the light of the recently proposed HPV etiology of these lesions.
Clinical information, follow-up and histopathological parameters of the primary lesions were assessed for all (45) individuals with conjunctival malignant melanomas in Sweden presenting during a 22.5 year period (1969 to mid 1991). The annual incidence of conjunctival malignant melanoma in Sweden was 0.0240 per 100,000. On average, two new cases were diagnosed each year (population 8.6 million in 1991). Sixty-two per cent of the lesions recurred, but re-growth in itself was not correlated to reduced survival. The actuarial 10-year survival proportion using life-table analysis was 70%. A significantly reduced survival due to tumour-related death was noted in patients with tumours with high mitotic indices, many epithelioid cells and in lesions exceeding 10 mm in diameter. Other factors that may influence survival are presented in the context of previous reports. The present policy in Sweden for treating patients with malignant melanoma of the conjunctiva is outlined and discussed.
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AIM: To report symptoms and findings of lacrimal duct malfunction after topical mitomycin C (MMC) for conjunctival neoplasia. METHODS: 14 consecutive patients treated with 1-6 cycles of topical 0.04% MMC four times daily for periods of 2 weeks were interviewed about symptoms of lacrimal duct malfunction. Patients who complained of tearing had examination of the puncta and canaliculi including probing and lacrimal duct irrigation. RESULTS: Nine patients complained of epiphora after topical MMC. Three of these patients had normal puncta and canaliculi, patent to irrigation. In these patients epiphora ceased spontaneously after probing and irrigation. The additional six patients had stenosis of the punctum (n = 3), the common canaliculus (n = 1), both puncta and both canaliculi (n = 1) and complete occlusion of the lower canaliculus (n = 1). CONCLUSION: Obstruction of the puncta or canaliculi is not an infrequent event after topical 0.04% MMC.