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Immunostaining of the estrogen receptor in conjunctival primary acquired melanosis.

Conjunctival primary acquired melanosis (PAM) is a frequent precursor of conjunctival melanoma. Since there is indirect evidence that the conjunctiva is an estrogen-responsive tissue, and since it was suspected that estrogen has a role in the etiology of melanoma, we decided to evaluate whether PAM may be responsive to estrogen. Formalin-fixed, paraffin-embedded sections from 13 cases of PAM and 2 cases of conjunctival melanoma were immunostained with an estrogen-receptor (ER)-specific antibody. All lesions and the normal conjunctival tissue adjacent to the lesions were found to be ER negative. It is concluded that PAM and normal conjunctiva are not sensitive directly to estrogen. When considering previously reported data, it is conceivable that the normal conjunctiva, but not PAM, is indirectly affected by estrogen.

Adolescent↗

Orbital spread of conjunctival squamous cell carcinoma following evisceration: a reminder of the importance of thorough evaluation before and after destructive surgery.

Evisceration is a neglected surgery usually performed by the most junior ophthalmologists in unsalvageable eyes with panophthalmitis. It is universal knowledge that evisceration is contraindicated in eyes with intraocular malignancy. We report 2 patients who presented to us with squamous cell carcinoma (SCC) in eviscerated sockets. While one of them was diagnosed with SCC on histopathological examination of the eviscerated contents, the other had history suggestive of conjunctival SCC prior to evisceration. The second patient presented to us with complaints of poorly fitting prostheses. We conclude that it is imperative to rule out not just intraocular but also adnexal malignancy prior to evisceration, and these eyes should be regularly followed up and carefully examined if poor fitting of the prostheses develops.

Adult↗

Clinical analysis of benign eyelid and conjunctival tumors.

PURPOSE: To assess the relative frequency and clinicopathologic characteristics of benign conjunctival tumors. METHODS: A retrospective study of 80 consecutive patients admitted to our hospital with benign eyelid and conjunctival tumor between April 2000 and November 2002 was undertaken, and clinical records including age, sex and involved site of tumors and pathology slides of the patients were reviewed retrospectively. RESULTS: Twenty-three males and 33 females presented with benign eyelid tumors and 12 males and 12 females with conjunctival tumors. Mean age was 42.3 and 29.7 years, respectively. The lower eyelid was involved in 27 (48.2%) of eyelid tumors and the medial conjunctiva in 14 (58.3%) of conjunctival tumors. The most frequent tumor was intradermal nevus (44.6%), seborrheic keratosis (16.1%) and compound nevus (10.7%) in eyelid tumors, and compound nevus (29.2%) and intradermal nevus (25.0%) in conjunctival tumors. CONCLUSION: This report will provides a basic analysis of benign eyelid and conjunctival tumors.

Adult↗

Topical mitomycin C for the treatment of conjunctival tumor.

BACKGROUND: To evaluate the efficacy of topical mitomycin C (MMC) for the treatment of conjunctival tumor in a prospective design. METHODS: Nine patients (nine eyes) with conjunctival tumor were studied. The patients received topical MMC 0.04% four times daily by one to six courses. Each course consisted of medication for consecutive 7 days followed by 1 week without medication. Follow-up was conducted on patients for control of disease, and side effects. RESULTS: In 7 patients, the tumor completely disappeared during the mean follow-up period of 24.57 +/- 5.94 months (range 18-35 months) with no recurrence. In 1 patient, there was no regression of the tumor, and in 1 patient cessation of the treatment was needed because of an adverse effect of the drug. CONCLUSION: Topical MMC is effective for the treatment of conjunctival tumor. Longer follow-up and large series are needed to assess the duration of tumor control.

Administration, Topical↗

Monocytic sarcoma of the sclera.

A patient with acute monocytic leukaemia and gross ocular involvement successfully treated with local irradiation is described. Leukaemic infiltration of the sclera developed at a time when the patient appeared to be in haematological remission. Despite the frequency of extramedullary disease in monocytic leukaemia the diagnosis of monocytic sarcoma may be very difficult.

Aged↗

[Spontaneous corneal rupture after strontium irradiation of a conjunctival squamous cell carcinoma].

A 87-year-old female patient with a squamous cell carcinoma of the conjunctiva was treated with local strontium-90 irradiation (with a so-called 'Dermaplatte'). In spite of a relatively low dosage, radiotherapy was followed by a corneal ulcer with consecutive rupture of the cornea. The cause of this unexpected perforation was, besides the effect of low-dose irradiation, probably a metabolic disorder of the cornea and a disturbance of the tear film due to the carcinoma which had spread on Bowman's layer of the cornea in an exophytic manner and was accompanied by a dense lymphocytic infiltration. An exenteration was performed and, at the last examination (1 year later), no local recurrence could be detected.

Aged↗

Late manifestation of conjunctival malignant melanoma.

The patient, who is now 60, had a nevus and areas of cystic changes in the conjunctiva in her right eye, which had been present from birth to the age of 59. In 1987, rapid tumor growth aroused suspicion that malignant change could be occurring and so the nevus as well as the area of the conjunctiva containing cystic changes were excised. Histological finding: conjunctival malignant melanoma, containing compressed (densely arranged) atypical cells with pleomorphic hyperchromatic nuclei and prominent nucleoli. The biopsy specimen of the conjunctiva showed a typical nevocellular nevus with large inclusion cysts of the conjunctival epithelium.

Biopsy↗

Fractionated beta-irradiation of a conjunctival lymphangioma.

Fractionated beta-radiation was applied on a conjunctival lymphangioma, which had been known for several years. Histological diagnosis was established 3 years previously. Excision was not possible because the tumor had involved a considerable part of the conjunctiva. Using a strontium-90 applicator a total dose of 30 Gy was applied in 6 fractions with 5 Gy each. The initial tolerance was satisfactory. No radiogenic damage occurred, an involution of the tumor could be observed. During a follow-up time of nearly 2 years no further progression was noted. We consider the beta-radiation as an interesting therapeutic alternative for conjunctival lymphangiomas which are difficult to treat surgically due to their size.

Beta Particles↗

Conjunctival malignant melanoma with xeroderma pigmentosum.

A 10-year-old male patient with xeroderma pigmentosum had a recurrent, pigmented, conjunctival tumor. Conjunctival malignant melanoma was diagnosed from the histopathological examination of the resected biopsy specimens. To our knowledge, this case of conjunctival malignant melanoma in a patient with xeroderma pigmentosum may be the second such report in the literature. We believe that malignant melanoma must be considered with squamous cell carcinoma in the differential diagnosis of conjunctival tumors in patients with xeroderma pigmentosum. Fontana-Masson and S-100 staining techniques helped diagnose this conjunctival malignant melanoma.

Child↗

Combined local excision and brachytherapy with ruthenium-106 in the treatment of epibulbar malignancies.

Two patients with epibulbar malignancies were treated by local excision and brachytherapy with ruthenium-106. One patient showed a large melanoma on the epibulbar conjunctiva, the other patient suffered from a recurrent squamous cell carcinoma at the limbus. After excision of the tumor including lamellar sclerectomy and keratectomy, a ruthenium-106 plaque was sutured to the sclera, and a total dose of 290 and 320 Gy, respectively, was delivered to the tumor bed. No severe radiogenic complications were observed except for a rarefaction of the sclera in the treatment area and a slow cataract increase. After a follow-up period of 50 and 22 months, respectively, both patients do not show any recurrence or metastatic disease.

Aged↗

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

A 70-year-old man complained of the sensation of having a foreign body in his left eye in June 1992. A papillary tumor was found growing from the palpebral conjunctiva of the left upper eyelid. On June 30, the conjunctival tumor was excised: the histopathologic findings indicated a malignancy. On August 18, full-thickness excision of the upper eyelid, including the rest of the tumor, was performed. Histopathologic findings showed a well-differentiated sebaceous gland carcinoma. We believe that sebaceous gland carcinoma presenting as conjunctival papilloma, as found in our patient, may be uncommon.

Adenocarcinoma, Sebaceous↗

Aspiration cytology of the conjunctival surface.

OBJECTIVE: To evaluate a method of obtaining conjunctival cells that utilizes aspiration of the conjunctival surface. STUDY DESIGN: Eighteen eyes from 16 patients with epibulbar lesions underwent aspiration of the conjunctival surface using a tuberculin syringe without a needle. The aspirated cells were prepared by the cytocentrifuge or Millipore filter technique. The lesions were subsequently biopsied, and the cytologic and histologic diagnoses were compared. RESULTS: Diagnoses of the conjunctival lesions, in decreasing order of frequency, were conjunctival intraepithelial neoplasia (dysplasia, carcinoma in situ), squamous cell carcinoma, squamous metaplasia, nevus, lymphoma and inflammation. In this feasibility study, the cytologic diagnosis accurately correlated with the histologic diagnosis in most cases. There were two cases in which the cytologic diagnosis led to the correct histologic diagnosis. CONCLUSION: Aspiration cytology of the conjunctival surface is useful in obtaining diagnostic material and may be used as a guide to where a biopsy should be performed. Limitations include inadequate samples and lack of observer experience.

Adult↗

Primary malignant melanoma of the conjunctiva of the upper eyelid. A case report.

BACKGROUND: Malignant melanoma of the conjunctiva is rare. The nomenclature and clinical and pathologic features of cutaneous and conjunctival melanomas are different. CASE: A 62-year-old male presented with a history of slight bleeding of the upper conjunctiva for the previous six months. On clinical examination the ophthalmologist observed a smooth, partly nodular, pigmented lesion on the conjunctiva under the left eyelid, 1.5 cm in diameter. Fine needle aspiration (FNA) biopsy of the mass showed tumor cells dispersed as single cells with eccentric, round nuclei; coarsely granular chromatin; prominent nucleoli; and dense cytoplasm with occasional brownish pigmentation as well as small aggregates of spindle-shaped neoplastic cells with hyperchromatic nuclei and no cytoplasmic pigment. CONCLUSION: FNA cytology is a simple and efficient method of making the diagnosis of malignant melanoma in conjunctival masses. Careful correlation with the clinical history and histologic findings is often necessary for confirmation of the diagnosis.

Biopsy, Needle↗