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Herskowitz WR, De Arrigunaga S, Greenfield JA, Cohen NK, Galor A, Karp CL. Can high-resolution optical coherence tomography provide an optical biopsy for ocular surface lesions? CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00214-X. [PMID: 39103154 DOI: 10.1016/j.jcjo.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/31/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024]
Abstract
High-resolution optical coherence tomography (HR-OCT) has transformed the diagnosis and management of ocular surface lesions. Providing a detailed cross-sectional view of the cornea and conjunctiva, HR-OCT can be used to identify characteristic features of various benign and malignant ocular surface lesions, aiding in their diagnosis and guiding treatment. When incorporated into an ophthalmology clinic, HR-OCT provides morphological images of lesions in a noninvasive means, akin to an "optical biopsy". The characteristic HR-OCT features of several lesions have been well described in the literature, including for ocular surface squamous neoplasia, papilloma, melanoma, primary acquired melanosis, complexion associated melanosis, nevus, pterygium, pinguecula, lymphoma, and amyloidosis. HR-OCT can be used to differentiate between lesions with similar clinical features, lesions that co-exist on the same ocular surface, and atypically presenting lesions, such as pigmented ocular surface squamous neoplasia or amelanotic melanoma. The management of ocular surface lesions has been transformed by the implementation of HR-OCT, providing clinicians with the ability to monitor tumor response to topical chemotherapies, follow previously excised lesions for recurrence, and map out tumor borders intraoperatively. While there are some limitations to HR-OCT, including imaging of thick or deep lesions, it has become an essential tool for ocular oncologists in the management of ocular surface lesions.
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Affiliation(s)
| | - Sofia De Arrigunaga
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
| | - Jason A Greenfield
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
| | - Noah K Cohen
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL; Brown University, Providence, RI
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL.
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Huang JJ, Locatelli EVT, Chocron A, Camacho MR, Dubovy S, Karp CL, Galor A. Conjunctival Nevus. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:104-112. [PMID: 38390435 PMCID: PMC10883671 DOI: 10.1007/s40135-023-00315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 02/24/2024]
Abstract
Purpose of Review To provide an up-to-date review of the epidemiology, presentation, diagnosis, and treatment options for conjunctival nevi (CN). Recent Findings Around 17.2%-42% of all conjunctival tumors have been found to be CN, which most frequently present in White individuals between the first to early third decade of life, with equal distribution between males and females. CN commonly occur in the interpalpebral bulbar conjunctiva with pigmentation ranging from amelanotic to dark. Diagnosis is typically made through slit lamp examination, visualized by a well circumscribed, variably elevated, variably pigmented, solitary lesion with clear cysts distributed throughout the pigment. In ambiguous cases, anterior segment optical coherence tomography (AS-OCT) can highlight the presence of sub-clinical cysts, whose presence points to a diagnosis of nevus. However, excisional biopsy with histopathology examination is the gold standard for identifying CN. Summary CN are benign, variably pigmented lesions. They are the most common of the conjunctival melanocytic tumors. Due to the extremely low risk of transformation to malignant melanoma (MM), CN are usually managed with routine observation and photo documentation.
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Affiliation(s)
- Jaxon J Huang
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Elyana V T Locatelli
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Alberto Chocron
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Matthew R Camacho
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Sander Dubovy
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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Eder A, Milman T, Singh Mudhar H, Lally SE, Shields CL, Bui K, Wells JR, Grossniklaus HE. Unusual conjunctival melanocytic proliferations. Report of five cases and review of the literature. Surv Ophthalmol 2023:S0039-6257(23)00141-8. [PMID: 37890676 DOI: 10.1016/j.survophthal.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Abstract
Indeterminate melanocytic proliferations of the conjunctiva have both benign and malignant features that previously made these lesions nearly impossible to categorize in existing classification schemes. With the evolution of immunohistochemistry and molecular genetics, however, subclassifications have emerged that allow for a more tailored diagnosis and management. These conjunctival melanocytic proliferations include deep penetrating nevus, granular cell nevus, and nevoid melanoma. There remains a small subset of conjunctival melanocytic proliferations that defy precise characterization as nevi, primary acquired melanosis, or melanomas despite currently available ancillary diagnostic modalities and remain indeterminate. We highlight these unusual types of nevi and melanomas, with an update on their morphologic, immunohistochemical, and molecular genetic characteristics.
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Affiliation(s)
- Adrianna Eder
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States
| | - Tatyana Milman
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Dept of Histopathology, Royal Hallamshire Hospital, Sheffield S10 2JF, England, UK
| | - Sara E Lally
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Carol L Shields
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Khanh Bui
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Jill R Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States.
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Carvajal P, Zoroquiain P. PRAME/MELAN-A double immunostaining as a diagnostic tool for conjunctival melanocytic lesions: A South American experience. Pathol Res Pract 2023; 250:154776. [PMID: 37696245 DOI: 10.1016/j.prp.2023.154776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION PRAME (PReferentially expressed Antigen in Melanoma) is an antigen that is predominantly expressed in human melanomas. In cutaneous melanocytic lesions, PRAME expression is associated with malignancy. The objective of this study was to evaluate the co-expression of PRAME and Melan A to evaluate their diagnostic value in different conjunctival melanocytic lesions (CML). METHODS 37 CML (23 nevi, 9 primary acquired melanosis (PAM), and 5 conjunctival melanomas) were evaluated by immunohistochemistry for PRAME and Melan-A. The percentage of melanocytic cells co-expressing PRAME and Melan-A was qualitatively evaluated as follows: negative, 0%; 1 + , 1-25%; 2 + , 26-50%; 3 + , 51-75% and 4 + , ≥ 76%. RESULTS Of the invasive melanoma cases, 80% showed a 4 + pattern of marking, whereas 20% showed a 3 + pattern. 11% of the PAMs showed a 4 + pattern and 88.9% showed a 1 + pattern. All the nevi showed a 1 + pattern. The sensitivity and specificity of PRAME 4 + for differentiating high-grade CML from the benign and low-grade grouped CML are 93% and 100%, respectively. CONCLUSION PRAME/MELAN-A double immunostain is particularly useful to differentiate benign from malignant conjunctival melanocytic lesions.
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Affiliation(s)
- Pedro Carvajal
- Pathology Department, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - Pablo Zoroquiain
- Pathology Department, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
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Nüßle S, Glegola M, Schulz T, Lagrèze W, Reinhard T, Auw-Hädrich C. [Conjunctival tumors in children : Histopathological diagnoses in 262 cases]. DIE OPHTHALMOLOGIE 2023; 120:804-810. [PMID: 37493685 DOI: 10.1007/s00347-023-01896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The spectrum of conjunctival tumors in children and adolescents significantly differs from that of adults. OBJECTIVE The aim of this study was to show the distribution of histopathological diagnoses of pediatric conjunctival tumors. MATERIAL AND METHODS Retrospective case series including all conjunctival tumors of children and adolescents under 18 years of age examined histologically over a period of 25 years (1990-2015) at the Eye Center in Freiburg, Germany. RESULTS Among the 262 conjunctival specimens, the most common diagnoses were conjunctival nevi (148, [56%]), most often with junctional activity (106/148, [72%]), pyogenic granulomas (26, [10%]), and dermolipomas (18, [7%]). In one case a malignant tumor (conjunctival melanoma) was detected (1, < 1%). CONCLUSION The results suggest that pediatric conjunctival tumors are benign in most cases. Most of them were of melanocytic origin, with a junctional conjunctival nevus being the most common diagnosis.
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Affiliation(s)
- Simone Nüßle
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Mateusz Glegola
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Tabea Schulz
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Wolf Lagrèze
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Auw-Hädrich
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Oh AJ, Glasgow BJ. Dendritic Melanocytic Hyperplasia in Pterygia: A Potential Source of Diagnostic Confusion with Primary Acquired Melanosis. Ocul Oncol Pathol 2023; 9:48-55. [PMID: 38376097 PMCID: PMC10821784 DOI: 10.1159/000530514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/27/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction The aim of this study was to report the nearly ubiquitous prevalence of melanocytic hyperplasia in benign pterygia/pingueculae and establish that the entity is insufficiently recognized. Methods This is a retrospective immunohistochemical pathology case series of 30 consecutive pterygia/pingueculae samples selected from an ophthalmic pathology database at a single institution. Histopathologic and immunohistochemistry analyses with anti-SOX-10 and anti-MART-1 antibodies were used for identifying melanocytes. The number of squamous cells intervening between melanocytes was determined. Results The frequency of dendritic melanocytes was found to meet the criteria for dendritic melanocytic hyperplasia in 29 of 30 pterygia/pingueculae samples using specific antibodies. Melanocytes were found in several patterns: diffuse (28%), multifocal (28%), and focal (44%). In each case, the melanocytes were distributed as single melanocytes at the base; clusters of melanocytes were seen in 17% of samples. There were an average of about two intervening epithelial cells between melanocytes at the base. Conclusion When diagnosed with immunohistochemistry, dendritic melanocytic hyperplasia is nearly ubiquitous in pterygia and pingueculae. Melanocytic hyperplasia may have a distribution that includes nests and single melanocytes above the basal layer, which can be confused with forms of primary acquired melanosis. It is important for pathologists to recognize these lesions as a distinct benign clinicopathologic entity.
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Affiliation(s)
- Angela J. Oh
- Departments of Ophthalmology, Los Angeles, CA, USA
| | - Ben J. Glasgow
- Departments of Ophthalmology, Los Angeles, CA, USA
- Pathology and Laboratory Medicine, Jules Stein Eye Institute, University of California, Los Angeles, CA, USA
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Auw-Hädrich C, Gasser L, Reinhard T. Bindehautdegenerationen und -neoplasien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1488-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungErhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium
und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese,
Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.
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Auw-Hädrich C, Gasser L, Reinhard T. [Conjunctival Degeneration and Neoplasia]. Klin Monbl Augenheilkd 2022; 239:823-845. [PMID: 35609810 DOI: 10.1055/a-1831-2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.
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