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Li K, Xin L. Palpebral conjunctiva melanoma with dermoscopic and clinicopathological characteristics. J Am Acad Dermatol 2014; 71:e35-7. [PMID: 25037804 DOI: 10.1016/j.jaad.2013.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Kun Li
- Department of Dermatology, Qianfoshan Hospital of Shandong Province, Shandong University, Jinan, Shandong, China; Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Linlin Xin
- Department of Dermatology, Qianfoshan Hospital of Shandong Province, Shandong University, Jinan, Shandong, China.
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Rasmussen PK, Ralfkiaer E, Prause JU, Sjö LD, Toft PB, Siersma VD, Heegaard S. Diffuse large B-cell lymphoma of the ocular adnexal region: a nation-based study. Acta Ophthalmol 2013; 91:163-9. [PMID: 22551232 DOI: 10.1111/j.1755-3768.2011.02337.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the clinicopathological features of diffuse large B-cell lymphoma (DLBCL) of the ocular adnexal region. METHODS The present series of orbital and adnexal DLBCLs were found by searching the Danish Registry of Pathology between 1980 and 2009. Histological specimens were re-evaluated using a panel of monoclonal antibodies. Clinical files from all patients with confirmed DLBCL were collected. RESULTS A total of 34 patients with DLBCL of the ocular adnexal region were identified. Eighteen of the patients were men. The patients had a median age of 78 years (range 35-97 years). Ninety-seven per cent of the patients had unilateral ocular adnexal region involvement, and the orbit (76%) was the most frequently affected site. Nineteen patients (56%) presented with Stage I lymphoma. Of these, 18 were diagnosed with primary lymphoma. Four patients (12%) had Stage II, one patient (3%) had Stage III and ten patients (29%) presented with Stage IV lymphoma. The 5-year overall survival (OS) rate for the whole study group was 20%. The patients with Stage I lymphoma had a significantly better 5-year OS rate (28%) than patients in Stage II-IV (5-year OS rate, 9%). In Cox regression analysis, concordant bone marrow involvement and the International Prognostic Index (IPI) score were prognostic factors for OS. CONCLUSIONS Diffuse large B-cell lymphoma of the ocular adnexal region is mainly prevalent in elderly patients. Most patients had unilateral orbital involvement. The overall prognosis is poor. Concordant bone marrow involvement and the IPI score were independent prognostic factors for mortality.
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Affiliation(s)
- Peter K Rasmussen
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Denmark
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Clement CG, Potluri VR, Gonzales J, Qian YW. Translocation (5; 11) in a conjunctival MALT lymphoma. Int J Clin Exp Pathol 2011; 4:722-726. [PMID: 22076174 PMCID: PMC3209614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 09/07/2011] [Indexed: 05/31/2023]
Abstract
Lymphoma is the most frequent malignant tumor of the ocular adnexa with the most common histologic type being extranodal marginal zone B-cell lymphoma (EMZL) of mucosa-associated lymphoid tissue (MALT lymphoma). Here we report a case of a 28 year-old male who presented with a left conjunctival mass of one year duration. A diagnosis of primary MALT lymphoma of the conjunctiva was made based on morphologic and immunopheno-typic studies. Chromosome analysis revealed a male karyotype with a translocation t (5;11) (q33;p11.2) as the primary chromosomal abnormality, which, to the best of our knowledge, is the first reported translocation in MALT lym-phomas and ocular MALT lymphomas as well.
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MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 5
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/genetics
- Conjunctival Neoplasms/pathology
- Humans
- Immunohistochemistry
- Karyotyping
- Lymphoma, B-Cell, Marginal Zone/chemistry
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Translocation, Genetic
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Affiliation(s)
- Cecilia G Clement
- Departments of Pathology, University of Texas Medical BranchGalveston, Texas, USA
| | | | - John Gonzales
- Departments of Ophtalmology and Visual Sciences, University of Texas Medical BranchGalveston, Texas, USA
| | - You-Wen Qian
- Departments of Pathology, University of Texas Medical BranchGalveston, Texas, USA
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5
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Ozdemir G, Bakaris S. Ocular adnexal lymphoma mimicking glaucoma: a case presentation. Can J Ophthalmol 2010; 45:296-7. [PMID: 20436540 DOI: 10.3129/i10-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
PURPOSE To report an unusual case of ocular peripheral T-cell lymphoma presenting as sclerouveitis. METHODS A 53-year-old woman presented with painful, unilateral sclerouveitis and was initially treated with antivirals and corticosteroids for what was presumed to be isolated ocular HSV infection with vasculitis. When she failed to improve the conjunctiva was biopsied and characterized by immunohistochemical and molecular methods. The literature regarding conjunctival T-cell lymphomas as well as lymphomas mimicking scleritis is reviewed. RESULTS Biopsies of a scleral/conjunctival nodule from the right eye were obtained on 2 occasions, the second of which revealed the presence of intermediate to large size lymphocytes that were CD3, T-cell intracellular antigen 1 and Granzyme B positive but CD56 and Epstein Barr virus negative. Polymerase chain reaction showed clonal T-cell receptor gamma rearrangements in DNA samples isolated from biopsy tissue. Another biopsy was obtained from a mucosal lesion in the oropharynx, which was shown to contain an identical T-cell receptor gamma rearrangement. These results led to the diagnosis of peripheral T-cell lymphoma. Conjunctival T-cell lymphomas have been reported in two other patients both of which also had involvement of upper airway structures. Five other reports of lymphoma mimicking scleritis are discussed. CONCLUSIONS Peripheral T-cell lymphoma should be considered in the differential diagnosis of patients who present with sclerouveitis of unknown etiology unresponsive to conventional therapy. If a conjunctival T-cell lymphoma is identified a systemic evaluation for lymphoma with particular attention to the upper airway is justified.
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Affiliation(s)
- Thomas J Kirn
- Department of Microbiology and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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8
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Combined Modality Therapy
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/pathology
- Conjunctival Neoplasms/therapy
- Humans
- Immunotherapy
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Proteins/analysis
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Abstract
Myeloid sarcoma is an unusual manifestation of acute leukemia. These leukemic tumors have been described in multiple organ systems. Leukemia is almost always present, but may be undiagnosed when the myeloid sarcoma comes to medical attention. We present a clinicopathologic report of a previously healthy young woman with conjunctival myeloid sarcomas of all 4 eyelids without evidence of an underlying hematologic disorder over 15 months' follow-up, despite refusal of consolidation chemotherapy. Isolated, multifocal myeloid sarcoma of the periorbital region is a very rare manifestation of acute leukemia.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Combined Modality Therapy
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/pathology
- Conjunctival Neoplasms/therapy
- Eyelid Neoplasms/chemistry
- Eyelid Neoplasms/pathology
- Eyelid Neoplasms/therapy
- Female
- Humans
- Leukemia, Monocytic, Acute/metabolism
- Leukemia, Monocytic, Acute/pathology
- Leukemia, Monocytic, Acute/therapy
- Sarcoma, Myeloid/metabolism
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
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Affiliation(s)
- Scott A Thomas
- Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado, Aurora, Colorado 80045, USA
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Abstract
A 25-year-old woman presented for evaluation of a rapidly enlarging mass of the left bulbar conjunctiva. Debulking biopsy was performed, which led to the diagnosis of myxoid malignant fibrous histiocytoma. The patient underwent left orbital exenteration with clear margins. Histopathology showed involvement of the conjunctiva substantia propria, superior conjunctival fornix, and episclera, as well as extension from the lateral rectus muscle sheath. Immunohistochemical staining was strongly positive for CD68, alpha1-antitrypsin, CD34, and vimentin.
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Abstract
A nodular, epibulbar mass appearing in an adult woman without antecedent inflammation or injury prompted concern for possible malignancy. Excision was performed, and pathologic examination demonstrated a conjunctival fibroma. The rarity of the fibroma and its clinical similarity to other benign or malignant tumors render its clinical diagnosis elusive.
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Affiliation(s)
- Norman C Charles
- Department of Ophthalmology, New York University Medical Center, New York, New York 10016, USA.
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Zárate JO, Pelayes DE, Gioino JM, Piantoni GR. [Giant cell collagenoma of the bulbar conjunctiva]. ACTA ACUST UNITED AC 2007; 82:233-5. [PMID: 17443429 DOI: 10.4321/s0365-66912007000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE/METHODS To report a rare case of a tumor in a conjunctival location, a giant cell collagenoma. Tissue was stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichromic stain and studied by immunohistochemistry. RESULTS/CONCLUSION The clinical and histopathologic features of conjunctival giant cell collagenoma are similar to characteristics of the same tumor occurring in other parts of the body. This is the first report of this tumor in the eye.
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Affiliation(s)
- J O Zárate
- II Cátedra de Oftalmología, Departamento de Patología, Universidad de Buenos Aires, Buenos Aires, Argentina.
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Affiliation(s)
- Jacob Pe'er
- Department of Ophthalmology, Hadassah University Hospital, PO Box 12000, 91120 Jerusalem, Israel.
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Abstract
CASE REPORT We report a case of conjunctival Kaposi's sarcoma (KS) in a nonimmunocompromised patient. The resected tumour recurred locally. No additional lesion was seen 20 months after the second surgery. COMMENTS Before onset of AIDS, few reports described primary conjunctival KS, although it has been described in other immunocompromised disease stages, i.e. systemic KS.
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Affiliation(s)
- Franz Fogt
- Departments of Pathology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pa. 19104, USA.
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Kim HJ, Shields CL, Eagle RC, Shields JA. Fibrous histiocytoma of the conjunctiva. Am J Ophthalmol 2006; 142:1036-43. [PMID: 17157587 DOI: 10.1016/j.ajo.2006.07.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 07/11/2006] [Accepted: 07/12/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the clinical features and course of six patients with fibrous histiocytoma (FH) of the conjunctiva. DESIGN Retrospective, observational clinical case series. METHODS Chart review of six consecutive patients with unilateral cases of conjunctival FH was conducted. Clinical presentation, treatment, histopathologic condition, and follow-up information were recorded. RESULTS The mean patient age was 37 years (median, 38 years; range, 12 to 72 years). There were five white patients, one black patient, five male patients, and one female patient. The tumor was present for a mean of three months (median, five months; range, one to 12 months) and was unilateral (one right eye, five left eyes). In all cases, the tumor was a tan, dome-shaped limbal mass in the conjunctival stroma with visible intrinsic vessels. The mean tumor basal dimension was 7 mm (median, 5 mm; range, 4 to 11 mm). Surgical resection was performed in all cases, and histopathologic study demonstrated benign FH in four cases and malignant FH in two cases. Those cases with benign FH showed no recurrence over nine months (median, eight months; range, three to 18 months). One patient with malignant FH showed recurrence and required repeat excision. The other patient with malignant FH was treated with plaque radiotherapy to maintain control. There was no evidence of orbital invasion or remote metastasis in any case over the mean follow-up period of 21 months (median, 10 months; range, three to 80 months). CONCLUSION FH is a rare conjunctival tumor that can show benign or malignant features. Complete resection is advised. Malignant FH can demonstrate recurrence that necessitates wide resection and radiotherapy.
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Affiliation(s)
- Hyunjin Jane Kim
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Abstract
A 62-year-old man visited the authors' clinic complaining of a mass on the palpebral conjunctiva of the right upper eyelid. The 2.0 cm x 1.2 cm sized, red and painless mass underwent incision and biopsy for histopathological examination. The mass was confirmed to be Kaposiform haemangioendothelioma characterized by densely packed spindle cells. These cells were positive to vimentin, CD31 and factor VIII-related antigen by immunohistochemical stain. The mass was completely resolved by oral steroid therapy and has not recurred through the presentation. Kaposiform haemangioendothelioma generally occurs in infant and adolescent periods and is characterized by rapid progression and invasion to adjacent tissue. Herein, an unusual case of Kaposiform haemangioendothelioma affecting the conjunctiva of the upper eyelid on a middle-aged man is reported.
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Affiliation(s)
- Sang Hyoung Cho
- Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea.
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18
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Aspiotis M, Gorezis S, Asproudis I, Tsanou E, Papadiotis E, Kamina S, Agnantis NJ, Bai M. Primary mantle cell lymphoma of the conjunctiva: a case report. Virchows Arch 2006; 449:472-5. [PMID: 16969632 DOI: 10.1007/s00428-006-0268-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 07/04/2006] [Indexed: 11/29/2022]
Abstract
Primary non-Hodgkin's lymphomas of the conjunctiva are uncommon. They are almost exclusively extranodal marginal zone B-cell lymphomas/mucosa-associated lymphoid tissue lymphomas. In this study, we report an extremely rare case of conjunctival mantle cell lymphoma in a 78-year-old man, presenting as a unilateral epibulbar mass.
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Affiliation(s)
- Miltiadis Aspiotis
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
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Shields JA, Eagle RC, Shields CL, Marr BP. Orbital-conjunctival glomangiomas involving two ocular rectus muscles. Am J Ophthalmol 2006; 142:511-3. [PMID: 16935608 DOI: 10.1016/j.ajo.2006.03.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 03/21/2006] [Accepted: 03/24/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To report two glomangiomas in one orbit, each isolated to a rectus muscle. DESIGN Clinicopathologic correlation. METHODS A 12-year-old boy developed two separate vascular tumors, near the insertions of the medial rectus and superior rectus muscles, respectively. A biopsy of one tumor was studied by light microscopy and immunohistochemistry. RESULTS Histopathology revealed blood vessels surrounded by cuboidal cells characteristic of glomangioma. The cells showed immunoreactivity for smooth muscle actin and vimentin, supporting the diagnosis. CONCLUSIONS Glomangioma can involve the rectus muscles in the conjunctiva and orbit, and should be considered in differential diagnosis of vascular tumors in the ocular region.
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Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Shen YC, Wang CY, Huang TY, Lo YS, Fong SC, Lee YF. Multiple myeloma manifesting as a salmon patch conjunctival mass. Am J Ophthalmol 2006; 141:948-9. [PMID: 16678514 DOI: 10.1016/j.ajo.2005.11.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 10/29/2005] [Accepted: 11/23/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We report a 70-year-old man with a salmon patch conjunctival mass diagnosed as multiple myeloma. DESIGN Case report. METHODS Surgical biopsies of the salmon patch conjunctival mass and bone marrow, as well as hematologic workup for multiple myeloma were performed. RESULTS Conjunctival biopsy revealed heavy myeloma cells with eccentric nuclei and basophilic cytoplasm infiltrate in the conjunctival stroma. Bone marrow biopsy and aspirate showed interstitial infiltrated by myeloma cells, which stained monoclonally for immunoglobulin G (IgG)-kappa light chains. Hematologic tests confirmed the diagnosis of multiple myeloma. CONCLUSIONS Multiple myeloma is one of the causes of a salmon patch conjunctival lesion and may be included in the differential diagnosis.
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Affiliation(s)
- Ying-Cheng Shen
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 160 Section 3 Taichung Harbor Road, Taichung, Taiwan, ROC.
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Messmer EM, Mackert MJ, Zapp DM, Kampik A. In vivo confocal microscopy of pigmented conjunctival tumors. Graefes Arch Clin Exp Ophthalmol 2006; 244:1437-45. [PMID: 16598465 DOI: 10.1007/s00417-006-0284-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/13/2005] [Accepted: 01/19/2006] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze the appearance of conjunctival pigmented tumors as seen by in vivo confocal microscopy. METHODS Twenty-eight pigmented conjunctival tumors including 6 nevi, 13 acquired melanoses, 7 conjunctival melanomas, and 2 extrascleral growths of uveal melanomas were examined by in vivo confocal microscopy using the Heidelberg Retina Tomograph (HRTII)/Rostock Cornea Modul (RCM). Confocal images were analyzed using predefined criteria by an observer masked to final histological diagnosis and a preliminary diagnosis was established. After excision, histology and immunohistochemistry using antibodies against S-100, Melan-A, HMB-45, Ki-67, CD3, and CD68 were performed in all specimens and compared with in vivo confocal images of the same lesions. RESULTS Confocal microscopy images confirmed typical histopathological features of conjunctival pigmented tumors. Nest or diffuse collections of medium-sized uniform hyper- or hyperreflective cells in the stroma and stromal cysts lined with a multilayered epithelium were visible in 100% of conjunctival nevi. Small dendritic cells were typically observed in 100% of primary acquired melanoses (PAM) without atypia and in 2 out of 6 nevi. Large networks of hyperreflective dendritic cells were present in 100% of PAM with atypia. Whereas images of PAM without atypia and secondary complexion-associated melanosis showed hyperreflective granules confined to the basal epithelium in 67% of lesions, PAM with atypia presented with hyperreflective granules and patches throughout the epithelium in all cases. Malignant melanomas of the conjunctiva and extrascleral growths of uveal melanomas demonstrated large hyperreflective cells with prominent nuclei and nucleoli. In vivo confocal microscopy showed a sensitivity of 89% and a specificity of 100% to establish the correct diagnosis of conjunctival melanoma compared with histology. CONCLUSIONS High correlations were found between in vivo confocal microscopy using near-infrared laser light and histology in the diagnosis of pigmented conjunctival lesions. In vivo confocal microscopy seems to be a valuable new tool in the differential diagnosis and follow-up of pigmented conjunctival tumors. It does not replace histology, but may assist in performing guided biopsy in tumors suspected clinically and/or with in vivo microscopy. In addition, in vivo confocal microscopy may support the clinical diagnosis of extrascleral involvement in uveal melanoma.
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Affiliation(s)
- Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336 Munich, Germany.
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Tornesello ML, Duraturo ML, Waddell KM, Biryahwaho B, Downing R, Balinandi S, Lucas SB, Buonaguro L, Buonaguro FM. Evaluating the role of human papillomaviruses in conjunctival neoplasia. Br J Cancer 2006; 94:446-9. [PMID: 16404433 PMCID: PMC2361142 DOI: 10.1038/sj.bjc.6602921] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mucosal, cutaneous and Epidermodysplasia verruciformis (EV)-related human papillomaviruses (HPVs) were searched by broad-spectrum PCR in 86 conjunctival neoplasia biopsies and 63 conjunctival non-neoplastic control tissue from Ugandan subjects. Seven different EV-related HPV types, including a putative new HPV, and two mucosal HPVs were detected in 25% (14 out of 56) of HIV-positive, in 10% (three out of 30) of HIV-negative conjunctival neoplasia samples, and rarely (0-1.6%) in control subjects. The absence of high-risk HPVs and the low detection frequency of EV-related HPV types in more advanced tumour stages (10%) raise doubts about their role in conjunctival carcinomas.
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Affiliation(s)
- M L Tornesello
- Viral Oncology and AIDS Reference Centre, National Cancer Institute ‘Fond. Pascale’, Cappella Cangiani, I-80131 Naples, Italy
| | - M L Duraturo
- Viral Oncology and AIDS Reference Centre, National Cancer Institute ‘Fond. Pascale’, Cappella Cangiani, I-80131 Naples, Italy
| | - K M Waddell
- Uganda Eye Project, PO Box 4008, Kampala, Uganda
| | - B Biryahwaho
- Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
| | - R Downing
- Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
| | - S Balinandi
- Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
| | - S B Lucas
- Department of Histopathology, Guy's, King's & St Thomas' School of Medicine, St Thomas' Hospital, London SE1, UK
| | - L Buonaguro
- Viral Oncology and AIDS Reference Centre, National Cancer Institute ‘Fond. Pascale’, Cappella Cangiani, I-80131 Naples, Italy
| | - F M Buonaguro
- Viral Oncology and AIDS Reference Centre, National Cancer Institute ‘Fond. Pascale’, Cappella Cangiani, I-80131 Naples, Italy
- Viral Oncology and AIDS Reference Centre, National Cancer Institute ‘Fond. Pascale’, Cappella Cangiani, I-80131 Naples, Italy. E-mail:
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Kuo KT, Chang HC, Hsiao CH, Lin MC. Increased Ki-67 proliferative index and absence of P16INK4 in CIN-HPV related pathogenic pathways different from cervical squamous intraepithelial lesion. Br J Ophthalmol 2006; 90:894-9. [PMID: 16540490 PMCID: PMC1857176 DOI: 10.1136/bjo.2005.086314] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM It is generally assumed that similar pathways are involved in human papillomavirus (HPV) induced pathogenesis of cervical squamous intraepithelial lesions (SILs) and cancers and a subset of conjunctival intraepithelial neoplasm (CIN)-that the malignancies or pre-cancerous lesions arise through HPV oncoproteins E6 and E7, which disrupt the pathways of p53 and the product of the retinoblastoma (Rb) gene and, in turn, increase the protein product of gene p16INK4 through the mechanism of positive feedback. Several cell cycle molecules are detected to test this hypothesis. METHODS Nine cases of CIN and eight non-CIN cases were analysed for the expression of Ki-67, pRb, p53, and p16INK4 via immunohistochemistry. Nine cases of cervical high grade squamous intraepithelial lesion (HSIL), and 10 cases of cervical low grade squamous intraepithelial lesion (LSIL) were included for stain control of p16INK4a, and comparison of p16INK4a expression to CIN cases. A nested polymerase chain reaction and a genechip HPV typing were used to detect HPV infection and types in the CIN and non-CIN samples RESULTS HPV positivity was demonstrated in all of the CIN lesions but in none of the non-CIN lesions. The Ki-67 proliferative index (Ki-67 PI) was statistically higher in the CIN group than the non-CIN group; however, there were no differences of expression of pRb and p53 between the two groups and no expression of p16INK4 in all cases. All nine cases of HSIL, and seven out of 10 cases of LSIL used for stain control were immunoreactive for p16INK4a. There were statistically significant differences in overexpression of p16INK4a between the CINs and SILs CONCLUSIONS The Ki-67 proliferative index may be a sensitive marker for CIN lesions and these results, with significant differences in overexpression of p16INK4a between CINs and SILs, may provide new evidence that HPV related mucosal dysplasia in different anatomical locations may lead to dissimilar molecular pathways.
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Affiliation(s)
- K-T Kuo
- Department of Ophthalmology, Taipei Hospital, Department of Health, Taiwan
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Affiliation(s)
- Alice Song
- Department of Ophthalmology, Loma Linda University Health Care, 11370 Anderson St, Suite 1800, Loma Linda, CA 92354, USA.
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Polito E, Pichierri P, Loffredo A, Lasorella G. A case of primary botryoid conjunctival rhabdomyosarcoma. Graefes Arch Clin Exp Ophthalmol 2005; 244:517-9. [PMID: 16151784 DOI: 10.1007/s00417-005-0085-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 06/09/2005] [Accepted: 07/06/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rhabdomyosarcoma is the most common childhood primary orbital malignancy, but the occurrence of this tumour in the conjunctiva is rare. METHODS A 14-year-old girl presented with a visible case of conjunctival mass in the left eye. The year before, the patient was referred to another hospital for a biopsy of a conjunctival mesenchymal tumour in the same site, which was periodically checked after the excision. We intervened by partially removing the conjunctival mass. RESULTS The histopathology revealed a botryoid rhabdomyosarcoma. The patient underwent chemotherapy and fractionated radiotherapy. The follow-up after three years revealed that the patient remained clinically tumor-free, with no ocular complication from the radiotherapy. CONCLUSION It is evident that by not excising the tumour in its entirety it is therefore possible to preserve the underlying rectus muscles and not interfere with ocular motility. Subsequent radiotherapy and chemotherapy helped to destroy any residual tumour. Alternatively, surgical excision of the mass alone could lead to recurrence of the tumour after some months or years.
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Affiliation(s)
- Ennio Polito
- Department of Ophthalmology and Neurosurgery, University of Siena, via A. De Gasperi 3, Sienna, Italy.
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Abstract
PURPOSE To study the sebaceous tumors of eyelid/conjunctiva associated with Muir-Torre syndrome (MTS) and to determine the role of immunohistochemical markers (MSH2, mismatch repair gene) in the diagnosis of patients with MTS. METHODS A retrospective, noncomparative case series of 5 patients diagnosed with MTS from our laboratory. We also reviewed all previously reported cases of sebaceous eyelid tumors with a visceral malignancy. RESULTS Four of the 5 patients were men, with a mean age of 55 years (range, 41 to 76 years). Four of the 5 patients had gastrointestinal carcinoma. On histopathological examination, 4 of the 5 tumors were classified as sebaceous adenomas that exhibited a distinct lobular pattern with prominent basaloid cells at the periphery of the lobules. One tumor was classified as a well-differentiated sebaceous gland adenocarcinoma. The diagnosis of MTS in all 5 patients was made after the diagnosis of the eyelid lesions. Immunohistochemical stains showed a lack of MSH2 expression in two tumors, which is highly consistent with MTS. CONCLUSIONS Muir-Torre syndrome should be considered in patients who develop sebaceous tumors of the ocular adnexa. Immunohistochemistry for MSH2 is a practical initial approach for screening MTS in patients with sebaceous tumors.
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Affiliation(s)
- Kirtee Rishi
- Department of Ophthalmology, The Methodist Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
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Affiliation(s)
- Charlotte Akor
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
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Kiratli H, Ruacan S. [Fibrous histiocytoma of the conjunctiva ]. Can J Ophthalmol 2003; 38:504-6. [PMID: 14620040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Hayyam Kiratli
- Clinique ophtalmologique universitaire, Faculté de médecine, Université de Hacettepe, Ankara, Turquie.
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Abstract
PURPOSE To highlight the recognition and diagnosis of Muir-Torre syndrome (MTS) in patients with sebaceous tumors of the eyelid/conjunctiva and to determine the role of immunohistochemical markers as a screening test in patients with Muir-Torre syndrome. DESIGN Single interventional case report. METHODS The clinical and family history was reviewed from the records of a 41-year-old man who had a sebaceous gland adenoma of the tarsal conjunctiva of the left upper eyelid. The lesion was completely excised and submitted for histopathologic examination. Immunohistochemical stains using an antibody to MSH2 were performed on the paraffin-embedded sections of the tumor. RESULTS Histopathologic examination of the tumor showed a lobular pattern with basaloid cells at the periphery of the lobules with central areas of sebaceous differentiation. Immunohistochemical stains showed a lack of MSH2 expression in the tumor, which is highly consistent with MTS. CONCLUSIONS Muir-Torre syndrome should be considered in patients initially seen with sebaceous tumors of the eyelid. Immunohistochemistry for MSH2 is a practical initial approach to screen for MTS in patients with sebaceous tumors.
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Affiliation(s)
- Ramon L Font
- Department of Ophthalmology, Cullen Eye Institute, The Methodist Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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Schmid K, Wild T, Bolz M, Horvat R, Jurecka W, Zehetmayer M. Kaposi's sarcoma of the conjunctiva leads to a diagnosis of acquired immunodeficiency syndrome. Acta Ophthalmol Scand 2003; 81:411-3. [PMID: 12859274 DOI: 10.1034/j.1600-0420.2003.00105.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Clarke B, Legodi E, Chrystal V, Govender D. Systemic anaplastic large cell lymphoma presenting with conjunctival involvement. Arch Ophthalmol 2003; 121:568-70. [PMID: 12695256 DOI: 10.1001/archopht.121.4.568] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Blaise Clarke
- Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of Natal, Congella, Durban, South Africa.
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Iwamoto S, Burrows RC, Grossniklaus HE, Orcutt J, Kalina RE, Boehm M, Bothwell MA, Schmidt R. Immunophenotype of conjunctival melanomas: comparisons with uveal and cutaneous melanomas. Arch Ophthalmol 2002; 120:1625-9. [PMID: 12470134 DOI: 10.1001/archopht.120.12.1625] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To characterize the immunophenotypic expression pattern of conjunctival melanomas, with the use of standard melanoma markers as well as microphthalmia transcription factor and p75 neurotrophin receptor. DESIGN Eleven conjunctival melanomas, including 1 caruncular melanoma, were immunolabeled with a panel of antibodies that included S100, tyrosinase, melan-A, HMB-45 and HMB-50 combination, microphthalmia transcription factor, and p75 neurotrophin receptor. The results were tabulated on the basis of intensity and pervasiveness of labeling and compared with a previous study of uveal melanomas. RESULTS Immunolabeling with S100 was at significantly higher levels in conjunctival melanomas than in uveal melanomas. Tyrosinase, HMB-45 and HMB-50 combination, melan-A, and microphthalmia transcription factor were expressed at high levels in conjunctival melanomas, whereas p75 neurotrophin receptor was not expressed. CONCLUSIONS Melanomas of the conjunctiva, including the caruncle, expressed S100, tyrosinase, melan-A, HMB-45 and HMB-50 combination, and microphthalmia transcription factor at high levels, suggesting that these are good markers for this melanoma subtype. Expression of S100 was significantly higher in conjunctival melanomas than in uveal melanomas. The immunophenotypic pattern of conjunctival melanomas is most similar to the epithelioid subtype of cutaneous melanomas.
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Affiliation(s)
- Satori Iwamoto
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Box 356524, Seattle, WA 98195-6524, USA.
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Abstract
The ocular adnexal lymphomas represent the malignant end of the spectrum of lymphoproliferative lesions that occur in these locations. The Revised European and American Lymphoma (REAL) Classification and the new World Health Organization Classification of Tumors of Hemopoietic and Lymphoid Tissues are the most suitable for subdividing the ocular adnexal lymphomas, whereby the extranodal marginal zone B-cell lymphoma represents the most common lymphoma subtype. This review is based on five cases subtyped according to the above classifications-three "typical" lymphomas (an extranodal marginal zone B-cell lymphoma, a diffuse large cell B-cell lymphoma arising from an extranodal marginal zone B-cell lymphoma, and a follicular lymphoma) and two "atypical" lymphomas (a non-endemic Burkitt lymphoma in an immune competent elderly patient, and a primary Hodgkin lymphoma of the eyelid) of the ocular adnexa. Management of patients with ocular adnexal lymphomas includes a thorough systemic medical examination to establish the clinical stage of the disease. The majority of patients with ocular adnexal lymphoma have stage IE disease. Current recommended therapy in stage IE tumors is radiotherapy, while disseminated disease is treated with chemotherapy. Despite usually demonstrating an indolent course, extranodal marginal zone B-cell lymphomas are renowned for recurrence in extranodal sites, including other ocular adnexal sites. Long-term follow-up with 6-month examinations are therefore recommended. Major prognostic criteria for the ocular adnexal lymphomas include anatomic location of the tumor; stage of disease at first presentation; lymphoma subtype as determined using the REAL classification; immunohistochemical markers determining factors such as tumor growth rate; and the serum lactate dehydrogenase level.
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Affiliation(s)
- Sarah E Coupland
- Department of Pathology, University Hospital Benjamin Franklin, Free University, Berlin, Germany
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Abstract
PURPOSE Report of a neuroendocrine carcinoma of the caruncle as the first sign of a metastatic lung carcinoma. DESIGN Interventional case report. METHODS Excision of a rapidly growing caruncular tumor in a 76-year-old woman with a history of breast cancer. RESULTS Pathology revealed a large cell neuroendocrine carcinoma, consistent with metastatic lung carcinoma. Computerized tomography of chest, abdomen, and a bone scan disclosed signs of malignancy in the lungs, liver, and bones, originally considered as metastatic breast cancer. However, this diagnosis was excluded on the basis of histopathological findings and clonality analysis. A primary neuroendocrine (Merkel cell) carcinoma was ruled out on morphologic and immunohistochemical grounds. CONCLUSION We present a unique case of a metastatic large cell neuroendocrine carcinoma of the caruncle.
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Affiliation(s)
- Angela Lie
- Rotterdam Eye Hospital, Oculoplastic Service & Pathology Service, The Netherlands
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Shields CL, Shields JA, Eagle RC. Clinicopathologic reports, case reports, and small case series: rapidly progressive T-cell lymphoma of the conjunctiva. Arch Ophthalmol 2002; 120:508-9. [PMID: 11934328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107, USA
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Scott RAH, Dua HS, Joseph A, Haynes R, Snead D, Hand NM. E-Cadherin distribution in normal and dysplastic conjunctival epithelium. Eye (Lond) 2002; 16:198-200. [PMID: 11988826 DOI: 10.1038/sj.eye.6700032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Honavar SG, Shields CL, Maus M, Shields JA, Demirci H, Eagle RC. Primary intraepithelial sebaceous gland carcinoma of the palpebral conjunctiva. Arch Ophthalmol 2001; 119:764-7. [PMID: 11346408 DOI: 10.1001/archopht.119.5.764] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sebaceous gland carcinoma usually arises from meibomian or Zeis glands deep within the eyelid, but it can rarely arise within the conjunctival epithelium without a deep component. We describe a woman with a history of chronic blepharoconjunctivitis unresponsive to topical medications. Examination disclosed confluent papillary hypertrophy of the upper palpebral conjunctiva and deposits of white flaky material. Tarsoconjunctival punch biopsy revealed intraepithelial sebaceous gland carcinoma. Management consisted of frozen section-controlled complete tumor excision with removal of the entire posterior lamella of the right upper eyelid, cryotherapy to the margins, and reconstruction. Histopathologic analysis confirmed primary sebaceous gland carcinoma localized to the conjunctival epithelium without involvement of underlying meibomian or Zeis glands or the caruncle. Patients with unexplained chronic unilateral blepharoconjunctivitis or papillary hypertrophy of the palpebral conjunctiva should be considered for biopsy to rule out neoplasia, even when there is no sign of an underlying eyelid mass.
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Affiliation(s)
- S G Honavar
- Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
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Heegaard S, Jensen OA, Prause JU. Immunohistochemical diagnosis of malignant melanoma of the conjunctiva and uvea: comparison of the novel antibody against melan-A with S100 protein and HMB-45. Melanoma Res 2000; 10:350-4. [PMID: 10985669 DOI: 10.1097/00008390-200008000-00006] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A novel antibody A103, which recognizes melan-A/MART-1, has been found to be more sensitive than the antibody HMB-45, which recognizes gp100, in melanocytic lesions of the skin and might therefore also be useful in the diagnosis of uveal and conjunctival melanocytic lesions. In this study we compared the staining characteristics of anti-melan-A, anti-S100 protein and HMB-45 in 13 conjunctival, 11 iris and 37 ciliary and choroidal malignant melanomas. The ciliary and choroidal melanomas comprised 13 spindle cell (10 spindle B and three spindle A), 14 mixed cell and 10 epithelioid cell tumours. In the conjunctival melanomas the diagnostic sensitivity was 100% for anti-S100 and anti-melan-A and 85% for HMB-45. In the iris melanomas the sensitivity was 100% for anti-S100 and anti-melan-A and 55% for HMB-45. A high staining intensity of anti-melan-A was particularly noticed in iris melanomas. In the choroidal malignant melanomas, the spindle cell and mixed cell types showed a sensitivity of only 69-79% with all three antibodies. In the epithelioid cell type the sensitivity was 80% for anti-S100 and 100% for HMB-45 and anti-melan-A. In conclusion, anti-melan-A was found to be a useful addition to antibody panels for ocular melanocytic lesions. Anti-melan-A has a higher sensitivity than HMB-45 in conjunctival and iris melanomas, but the sensitivity is similar to HMB-45 in choroidal melanomas. Anti-melan-A stains in a very similar pattern to anti-S100, but the staining intensity of anti-melan-A is higher than that of anti-S100 in iris melanoma.
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Affiliation(s)
- S Heegaard
- Eye Pathology Institute, University of Copenhagen, Denmark
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Lachapelle KR, Rathee R, Kratky V, Dexter DF. Treatment of conjunctival mucosa-associated lymphoid tissue lymphoma with intralesional injection of interferon alfa-2b. Arch Ophthalmol 2000; 118:284-5. [PMID: 10676800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- K R Lachapelle
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
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Abstract
Loss of nm23 gene expression is believed to enhance metastatic spread in diverse human tumors, including skin melanoma. The purpose of this work was to determine the pattern and prognostic relevance of nm23 protein immunoexpression in conjunctival melanoma and potential precursor lesion. Formaldehyde-fixed, paraffin-embedded conjunctival specimens comprising 85 melanocytic lesions (nevi, primary aquired melanosis with and without atypia and primary and locally recurrent malignant melanomas) from 73 patients were used. Sections from all specimens were examined by light microscopy to assess diverse prognostic parameters. Additional sections were then immunostained for nm23 H-1 protein and the immunoreactivity was assessed semi-quantitatively. Survival data for all patients were retrieved from the National Causes of Death Registry of Sweden.Nm23 H-1 protein was differentially expressed in conjunctival melanocytic lesions, however loss of immunoexpression was not more common in melanocytic lesions asociated with a high risk of malignant transformation. Also, primary and recurrent conjunctival melanomas showed an essentially similar nm23 expression pattern and we could not associate the pattern of nm23 immunoexpression with an increased risk for malignant transformation or locally recurrent disease. While there was a tentative separation between cause-specific survival curves after excision for low and high nm23 expression conjunctival melanoma, there was no statistically significant association with metastatic death of patients. However, loss of nm23 protein immunoexpression may still be of some importance as a marker for prognosis in conjunctival melanoma because the present study could only detect large differences in survival. Our results suggest that any potential prognostic value of nm23 immunoexpression would be independent of other markers, underlining the importance of further studies.
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Affiliation(s)
- S Seregard
- Ophthalmic Pathology and Oncology Service, St Eriks Eye Hospital, Polhemsgatan 50, Stockholm, SE-112 82, Sweden
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Abstract
BACKGROUND Diagnosis of sebaceous carcinoma of the periorbital region is often delayed. Clinically, this lesion can mimic several inflammatory disorders. Histopathologically, it can mimic either squamous cell or basal cell carcinoma. OBJECTIVE To identify an immunohistochemical approach to assist in the diagnosis of periorbital sebaceous carcinoma. METHOD The immunohistochemical profiles of several cases of periorbital sebaceous, basal cell, and squamous cell carcinoma were examined. RESULTS Although at least focal epithelial membrane antigen (EMA) staining can effectively distinguish sebaceous carcinoma (10 of 11 were positive) from basal cell carcinoma (1 of 16 were positive), most squamous cell carcinomas examined were also focally EMA positive (11 of 14). However, Cam 5.2 reactivity was seen in most sebaceous carcinomas (8 of 11) but no squamous cell carcinomas (0 of 14). In addition, at least focal BRST-1 reactivity was also seen in most sebaceous carcinomas (7 of 11) but no basal cell carcinomas (0 of 16). CONCLUSIONS Periorbital sebaceous, basal cell, and squamous cell carcinomas have different immunohistochemical staining profiles; a panel of commonly available antibodies, including anti-EMA, BRST-1, and Cam 5.2, may help distinguish these diseases from each other when that distinction cannot be clearly made by light microscopy alone.
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MESH Headings
- Adenocarcinoma, Sebaceous/chemistry
- Adenocarcinoma, Sebaceous/diagnosis
- Adenocarcinoma, Sebaceous/pathology
- Adult
- Aged
- Aged, 80 and over
- Antigens, Neoplasm/analysis
- Biomarkers, Tumor/analysis
- Carcinoma, Basal Cell/chemistry
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/pathology
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/pathology
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/diagnosis
- Conjunctival Neoplasms/pathology
- Diagnosis, Differential
- Eyelid Neoplasms/chemistry
- Eyelid Neoplasms/diagnosis
- Eyelid Neoplasms/pathology
- Female
- Glycoproteins/analysis
- Humans
- Immunoenzyme Techniques
- Keratins/analysis
- Male
- Middle Aged
- Mucin-1/analysis
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Affiliation(s)
- J H Sinard
- Department of Pathology, Yale University School of Medicine, New Haven, Conn 06520-8023, USA.
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Abstract
A 43-year-old Caucasian male, presented with a swelling of the left caruncle which had persisted for more than ten years. Clinical examination showed a small, smooth, not painful 2x2x2 mm tumor located at the caruncle. There were no signs of orbital involvement. Histologically, the tumor was composed of interlacing fascicles of spindle-shaped cells with bright eosinophilic cytoplasm and cigar-shaped nuclei. Mitotic activity was not observed and the tumor showed no atypia or pleomorphism. The tumor cells reacted with the reticulum stain and Masson trichrome. Immunohistochemically, the tumor cells were positive for vimentin, SMA, MSA, CD34, laminin and a scattered number for S-100. The tumor was classified as a leiomyoma of the caruncle and is the first described in this localisation. The origin of the tumor is discussed.
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Affiliation(s)
- S Heegaard
- Eye Pathology Institute, University of Copenhagen, Denmark
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46
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Abstract
Melanoma of the conjunctiva is a rare, unilateral malignancy primarily affecting middle-aged whites; the annual average age-adjusted incidence rate is 0.012 per 100,000 population. Although conjunctival melanoma in the black population is extremely rare, cases have been reported. Melanoma of skin in blacks has a predilection for nonsun-exposed, nonpigmented sites such as mucous membranes, palms, and soles. Primary acquired melanosis may lead to the development of melanoma even in blacks. Primary acquired melanosis in the black population may be difficult to differentiate from racial melanosis clinically and histopathologically. Early diagnosis through awareness and education can help improve the survival of black patients with conjunctival melanoma.
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Affiliation(s)
- A D Singh
- Department of Ophthalmology, University of Florida, Gainesville 32610, USA
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Abstract
PURPOSE To report a rare case of T-cell malignant lymphoma involving the conjunctiva. METHODS A 63-year-old woman had rapid onset of bilateral perilimbal congestion and chemosis. Perilimbal thickening with corneal infiltration developed 20 days later. Computed tomography incidentally disclosed a right maxillary sinus mass. Biopsy specimens from the maxillary sinus mass and the left limbus were subjected to histopathologic examination and immunohistochemical study. RESULTS T-cell malignant lymphoma of diffuse large cell type, stage IV, was diagnosed. The patient was treated with combination chemotherapy plus 13-cis-retinoic acid and remained in remission 1 1/2 years after diagnosis. CONCLUSION Conjunctival involvement with T-cell lymphoma may present as episcleritis and chemosis.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/drug therapy
- Conjunctival Neoplasms/pathology
- Female
- Humans
- Immunohistochemistry
- Immunophenotyping
- Isotretinoin/therapeutic use
- Leukocyte Common Antigens/analysis
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell/chemistry
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/pathology
- Maxillary Sinus Neoplasms/chemistry
- Maxillary Sinus Neoplasms/drug therapy
- Maxillary Sinus Neoplasms/pathology
- Middle Aged
- Neoplasm Staging
- Tomography, X-Ray Computed
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Affiliation(s)
- F R Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei.
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48
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Abstract
BACKGROUND The authors describe an amelanotic malignant melanoma of the conjunctiva in association with primary acquired melanosis (PAM) sine pigmento, and highlight the clinical and pathologic features of this rare entity. METHODS Histopathologic and immunohistochemical studies were performed on a conjunctival tumor in a 54-year-old white woman. STUDY DESIGN Case report. RESULTS Histopathologic examination revealed an invasive amelanotic melanoma of the conjunctiva, with anterior orbital extension arising from intraepithelial dysplastic melanocytes that lacked melanin pigment (PAM sine pigmento). Both the malignant melanoma cells and the intraepithelial dysplastic melanocytes in the areas of PAM exhibited S-100 and HMB-45 positivity. The patient underwent an orbital exenteration that disclosed tumor within the anterior orbit inferiorly. CONCLUSIONS Amelanotic invasive malignant melanoma can arise in association with PAM sine pigmento, as seen in our patient who had orbital invasion necessitating exenteration. This aggressive form of conjunctival melanoma is often associated with a poor prognosis and risk of metastatic disease. Absence of conjunctival pigmentation in PAM sine pigmento prevents early clinical detection of this variant of PAM. This lack of pigmentation also makes clinical diagnosis virtually impossible, and diagnosis can only be established histopathologically. Awareness of this nonpigmented variety of PAM is crucial for early recognition and appropriate management of the associated melanoma.
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Affiliation(s)
- V Jay
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA
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49
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Abstract
BACKGROUND The granular cell tumor (GCT) is a common, usually benign, neoplasm of uncertain histogenesis that may affect any organ in the body. It occurs rarely in ophthalmic sites, where orbital location is most frequent. The purpose of this report is to describe a unique case of an epibulbar, subconjunctival GCT in a child. METHOD Histopathologic examination of the excised tumor included standard and immunohistochemical staining of formaldehyde-fixed, paraffin-embedded tissue. RESULTS Histopathologic study showed the characteristic morphology of GCT. Immunohistochemistry was strongly positive for vimentin, weakly and partly positive for neuron-specific enolase, and negative for S-100 and HAM-56. CONCLUSIONS Granular cell tumor must be added to the differential diagnosis of epibulbar masses. Immunohistochemistry of the tumor in this case suggests an uncommitted mesenchymal cell origin.
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Affiliation(s)
- N C Charles
- Department of Ophthalmology, New York University Medical Center, New York 10016, USA
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50
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White VA, Gascoyne RD, McNeil BK, Chang WY, Brewer LV, Rootman J. Histopathologic findings and frequency of clonality detected by the polymerase chain reaction in ocular adnexal lymphoproliferative lesions. Mod Pathol 1996; 9:1052-61. [PMID: 8933515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the reclassification according to recently described histologic categories of 48 patients with ocular adnexal lymphoproliferative lesions with long-term follow-up (mean, 8.1 yr). We used available formalin-fixed, paraffin-embedded, and frozen tissues to assess the frequency of immunoglobulin heavy chain gene rearrangement detectable by polymerase chain reaction in these lesions. We reviewed patient records, obtained follow-up data, and examined hematoxylin- and eosin-stained slides. DNA extracted from tissues was amplified with consensus V- and J-region primers to detect immunoglobulin heavy chain gene rearrangement. We examined 28 orbital, 10 lacrimal, and 10 conjunctival lesions, of which 2 lesions were lymphoid hyperplasias, 3 were indeterminate, and 43 were lymphomas. Of the 44 patients with follow-up, systemic lymphoma developed in 24 (55%), of whom 11 died of the disease, and 6 are alive with disease. Thirty-one patients had sufficient DNA for polymerase chain reaction analysis; 9 specimens were nonclonal, 21 were clonal, and 1 failed to amplify. The nonclonal lesions included one hyperplasia, one indeterminate lesion, and seven lymphomas; two of these patients died of the disease, and one is alive with disease. The clonal lesions included 1 indeterminate lesion and 20 lymphomas. Systemic lymphomas developed in 16 patients; 8 died of the disease, and 4 are alive with disease. Of the lesions histologically classified as lymphoma, 74% were clonal. We conclude that most ocular adnexal lymphoproliferative lesions can be histologically classified as lymphomas, that systemic lymphoma will develop in at least 50% of these patients if they are followed for sufficient time, and that most lesions classified as lymphomas will be clonal using polymerase chain reaction techniques. Lack of amplification using a consensus primer strategy may account for the inability to detect clonality by polymerase chain reaction in some histologically identified lymphomas.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Clone Cells
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/classification
- Conjunctival Neoplasms/pathology
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Humans
- Lacrimal Apparatus Diseases/classification
- Lacrimal Apparatus Diseases/pathology
- Lymphoma/chemistry
- Lymphoma/classification
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/chemistry
- Lymphoma, B-Cell, Marginal Zone/classification
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Orbital Neoplasms/chemistry
- Orbital Neoplasms/classification
- Orbital Neoplasms/pathology
- Polymerase Chain Reaction
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Affiliation(s)
- V A White
- Department of Pathology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada
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