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Background/Aim: Conjunctival malignant melanoma (CMM) is a rare, but very aggressive tumor with a high metastasis rate. Not much is known about the CMM metastasis mechanisms. So far, epidermal growth factor (EGF) and its receptor (EGF-R) as well as macrophages and matrix metalloproteinase 9 (MMP-9) have been reported to lead to metastasis by epithelial-mesenchymal-transition and tumor migration in different solid tumors. Therefore, we evaluated whether EGF and EGF-R, CD68 and MMP-9 are altered in CMM samples in comparison to conjunctival nevi and healthy conjunctiva. Patients and Methods: EGF, EGF-R, the macrophage marker CD68 and MMP-9 expression were analyzed in human conjunctival melanoma (CMM, n=16), human conjunctival nevi (n=13) and disease-free human conjunctiva (controls, n=14) by immunohistology. Staining of each sample was evaluated using a standardized score ranging from negative (0) to triple positive (3). The groups were then compared by ANOVA, followed by Tukey’s post-hoc test. Results: A statistically significant increase of EGF was seen in CMM samples in comparison to conjunctival nevi (p=0.03). In contrast, no statistically significant differences in EGF-R expression were noted between the three groups. A statistically significant increase of CD68 was only seen in conjunctival nevi compared to controls (p=0.04). MMP-9 expression was similar in all groups. Conclusion: In CMM, the study data demonstrated an up-regulation of EGF in comparison to conjunctival nevi. Hence, EGF might promote proliferation of CMM cells and induce the epithelial-mesenchymal transition. Therefore, our data suggest that an interplay between EGF and CMM might have a critical role in the developing CMM tumors and metastasis. [ABSTRACT FROM AUTHOR]

Purpose: To study the efficacy and safety of Interferon (IFN) alpha 2b for Ocular Surface Squamous Neoplasia (OSSN). Study Design: Quasi experimental Study. Place and Duration of Study: Mayo Hospital Lahore, Lahore General Hospital, Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan October 2010 to August 2016. Material and Methods: Patients with suspected conjunctival growth underwent incisional biopsy. Ninety-one eyes of 88 patients were included in the study. The patients with suspected conjunctival growths underwent incisional or excisional Biopsy +/- cryotherapy. After confirming the diagnosis of Ocular Surface Squamous Neoplasia (OSSN), on histopathology, cases were inducted in the study. Intralesional/peri-lesional Interferon (IFN) Alpha-2b was given to the patients weekly along with interferon Alpha-2b topical drops four times daily, for three months. These patients were followed-up in respective hospitals and examined for resolution or recurrence of lesion for atleast three (03) months. Results: Out of 88 patients, 29 were females and 59 were males. The age of the patients was between 52 to 76 years. Eighty eyes tolerated and responded well to the treatment. There was recurrence in 08 eyes, which had advanced squamous cell neoplasia. Three patients were lost to follow up. Mean resolution time of tumor was 3 months and mean follow up time was 12 months with range of 3 months to 5 years. The side effects recorded in our study were filamentary keratitis, conjunctivitis and pyogenic granuloma. Conclusion: For the management of Ocular surface squamous Neoplasia IFN alpha 2 b is safe and effective choice with low recurrence rates. [ABSTRACT FROM AUTHOR]

Purpose Blue nevus is a melanocytic tumor that is commonly found in the skin. Extracutaneous presentations, including the ocular surface, are rare. As such, the purpose of this study was to characterize the clinical features and clinical course of congenital melanocytic tumor (blue nevus) of the conjunctiva. Design Retrospective, noncomparative case series. Participants Twenty-one patients with 23 blue nevi of the ocular surface that were excised surgically between 2000 and 2016. Methods Chart review of patients identified from a database search of the Florida Lions Ocular Pathology Laboratory records. Pathologic diagnoses were confirmed by 2 pathologists (S.R.D. and G.E.). All specimens were bleached and, tissue permitting, stained using SOX10 (MilliporeSigma, Darmstadt, Germany) and CD68 (Leica Biosystems, Nussloch, Germany). Main Outcome Measures Clinical characteristics, pathologic features, and clinical course. Results Mean age of the population was 55±15 years; 71.4% (n = 15) were white and 57.1% (n = 12) were men. One patient had 3 lesions, for a total of 23 lesions examined. Clinically, 13 lesions were on the bulbar conjunctiva, 3 were on the tarsal conjunctiva, 3 were in the fornix, 2 were caruncular, 1 was episcleral, and 1 was at the limbus. Before excision, 8 patients were thought to have primary acquired melanosis, 4 with concern for primary conjunctival melanoma, and 1 thought to have metastatic disease from a plantar melanoma. Five lesions were thought to be benign, and in 8 patients, the lesions were identified incidentally after other ocular surgeries, with no diagnosis of the lesions before excision. Pathologic features were consistent with simple blue nevi in 21 lesions and cellular blue nevus in 2 lesions. No malignant transformations were noted in any patient over the mean 20.2-month follow-up period (range, 2 weeks–103 months). Conclusions Blue nevus is a rare deeply pigmented congenital melanocytic lesion with a benign clinical course that can appear clinically similar to primary acquired melanosis or melanoma. [ABSTRACT FROM AUTHOR]

Purpose: Nevi of the conjunctiva are usually benign pigmented tumorous lesions located in the bulbar conjunctiva. In most conjunctival nevus cases, the patient wants the lesion to be removed for cosmetic reasons, but excisional biopsies are best for lesions suspicious for malignancy. This case report illustrates the intraoperative surgical management, histological findings, and the course of healing in a conjunctival nevus patient. Case report: A 26-year-old man was referred to our eye hospital with a large bulbar conjunctival nevus of the right eye. Upon examination, there was a large pigmented lesion with numerous small cysts present on the superior bulbar conjunctiva. The conjunctival tumor was resected, and an amniotic membrane transplantation was performed for the bulbar conjunctival reconstruction. The histopathological diagnosis suggested a conjunctival nevus. After the resection, a reduction in the inflammation and healing of the conjunctival lesion could be seen. The epithelialization of the bulbar conjunctiva over the amniotic membrane was complete 4 weeks after the resection. At the 6-month follow-up, there was no sign of recurrence or any postoperative complications. Conclusion: A surgical excision combined with reconstruction via amniotic membrane transplantation is effective and economical for the treatment of large conjunctival lesions. [ABSTRACT FROM AUTHOR]

A 2-year-old male ostrich ( Struthio camelus) presented with a rapidly growing soft tissue mass protruding from the ventromedial aspect of the right eye ( OD). The initial physical examination revealed a soft tissue mass attached to the medial inferior conjunctiva. The mass was excised with cryosurgery, and the conjunctival tissue margins were treated with cryoablation. Histopathological examination diagnosed granulomatous inflammation associated with scattered acid-fast bacteria. The ostrich recovered uneventfully and appeared healthy until recurrence of a grossly similar mass 2 months later. Gross examination revealed a botryoid mass attached to the inferior palpebral conjunctiva and extending onto the palpebral aspect of the nictitating membrane. Euthanasia was selected, and the histological diagnosis of the second mass was a mixed mucinous adenocarcinoma; however, no acid-fast bacteria were seen. Granulomatous conjunctival lesions have been previously described in the ostrich, while, to the authors' knowledge, neoplastic conjunctival lesions have not. Neoplasia should be considered as a differential diagnosis for a rapidly recurring, granulomatous conjunctival mass in this species. [ABSTRACT FROM AUTHOR]

Aims Myxomas are benign soft tissue tumours resembling primitive mesenchyme. They rarely involve ocular structures, and have been recognized in the conjunctiva, eyelids, cornea, and orbit. The aim of this study was to investigate the clinicopathological features of seven patients with primary conjunctival myxoma seen at Dr Luis Sánchez Bulnes Hospital, an ophthalmological referral centre in Mexico City. Methods and results We reviewed the clinical, histochemical and immunohistochemical studies of patients with documented myxoma of the conjunctiva diagnosed in our hospital. Seven conjunctival myxomas were retrieved from 5923 conjunctival biopsies (0.1%). The mean age of patients was 40 years, with a range of 27-51 years. Females were more frequently affected, and none of our patients had systemic disease. The left eye was involved in five cases, and most of the lesions were located in the bulbar conjunctiva. Histopathological examination revealed a benign tumour composed of spindle-shaped and stellate-shaped cells immersed within an abundant mucinous matrix with sparse vessels and reticulin fibres. Immunohistochemistry demonstrated positivity for vimentin and negativity for smooth muscle actin, SOX10 and GLUT1 in myxoma cells of all cases. S100 was found to be positive in four cases, and muscle-specific-actin in three cases. Conclusions Conjunctival myxomas are uncommon tumours. For accurate diagnosis, histopathological examination is mandatory. The treatment of choice is surgical removal, and the prognosis is excellent. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether vascular differentiation marker von Willebrand factor (vWf) and proliferation marker KI67 expression correlate with MUC4 localization around stromal tumor vascularization in human conjunctival malignant melanoma (CMM). Materials and methods: For the purposes of this study, we analyzed samples from human CMMs (n = 4), conjunctival compound nevi (n = 7), and samples from healthy conjunctiva (n = 7) for MUC1, 4, and 16 by immunohistochemistry. To test CMM vessel association of MUC4, we investigated the co-localization of MUC4 with vWf or KI67 in human CMM specimens (n = 10) by immunohistochemistry. Also, we investigated the MUC4 localization around vessels of healthy conjunctiva (n = 10). Results: The immunohistochemical analysis demonstrated membrane-associated mucin expression in epithelia of CMM, nevi and healthy conjunctiva, whereas only MUC4 was localized perivascular in CMM tissue in this preliminary analysis. Co-staining analysis with vWf and KI67 demonstrated MUC4 localization around stromal vessels in human CMM specimens. In contrast, no MUC4 localization has been seen around healthy conjunctiva stroma vessels. Conclusions: MUC4 was detected around vWf/KI67-positive CMM stromal vascular tissue, but not around healthy conjunctival stroma vessels. Therefore, we assume that MUC4 might play a role in tumor cell migration toward vessels inducing metastasis. [ABSTRACT FROM PUBLISHER]

The conjunctival tumor associated with Epstein-Barr virus related infectious mononucleosis is a rare ocular manifestation. Only a few cases have been reported in the literature. We reported this rare condition that presented in a 5-year-old boy. [ABSTRACT FROM AUTHOR]

Pigmented squamous ccll carcinomas of conjunctiva arc very rare. Pigmentation is due to an infiltration of apparently normal dendritic melanocytes. Mechanisms of proliferation, migration and colonization of dendritic melanocytes are partially known, although they have not been used for the study of all non melanocytic pigmented lesions and neoplasias. OBJECTIVE: To investigate the pathogenesis of proliferation, migration and colonization of dendritic melanocytes in pigmented squamous cell carcinomas, as a way to challenge the assumed melanocytic migration Cabtropfung) that occurs in the histopathogenesis of intradermal nevi. MATERIAL AND METHOD: In a retrospective and descriptive study, we examined 8 pigmented infiltrating squamous cell carcinomas of the conjunctiva with morphologic, histochemicai and immunohistochemical methods. Statistical analyses were accomplished with nonparametric statistics. Quantitative variables were summarized in ranges and medians. Categorical variables were abbreviated in frequencies and percentages. RESULTS: Numerous dendritic melanocytes decorated with melanin granules infiltrated neoplastic keratinocytes. Cytoplasms of neoplastic keratinocytes displayed powdery melanin, while melanophages exhibited melanin in coarse clusters. Silver stains and immunostains for HMB-45, Mart-1, S-100 protein and vimentin verified the nature of melanin pigment and confirmed the authenticity of dendritic melanocytes. Underexpression of E-cadherin and ß-Catenin most likely promoted proliferation and migration of melanocytes. Ki-67 and PCNA demonstrated significant increased cellular proliferation factors in keratinocytes, despite their good differentiation and low mitotic rate. Upregulated expression of P53 and BCL2 was way out of proportion with low histologic malignancy of these carcinomas. CD1a and vimentin disclosed increase number of Langerhans cells; S-100 and vimentin showed a marked proliferation of both melanocytes and Langerhans cells. CONCLUSION: The pathogenic mechanisms involved in proliferation, migration and colonization of hyperplastic dendritic melanocytes within squamous cell carcinomas, were supported by our results. Further studies need to be clone to elucidate these 3 fascinating phenomena even more. [ABSTRACT FROM AUTHOR]

Ocular Surface Squamous Neoplasm (OSSN) is the neoplasia arising from the conjunctiva, cornea and limbus. OSSN ranges from mild, moderate, severe dysplasia, carcinoma in situ (CIS) to squamous cell carcinoma (SCC). Recent findings on cancer stem cells theory indicate that population of stem-like cell as in neoplasia determines its heterogeneity and complexity leading to varying tumor development of metastatic behavior and recurrence. Cancer stem cell markers are not much explored in the cases of OSSN. In the present study, we aim to evaluate the expression of stem cells using stem cell markers mainly p63, ABCG2, c-KIT (CD117) and CD44 in OSSN tissue, which could have prognostic significance. The present study tries for the first time to explore expression of these stem markers in the cases of OSSN. These cases are subdivided into two groups. One group comprises of carcinoma in situ (n = 6) and the second group comprises of invasive carcinoma (n = 6). The mean age at presentation was 52 years; with 53 years for CIS group and 52 years for SCC group. From each group section from the paraffin block were taken for the IHC staining of p63, c-Kit, ABCG2 and CD44. Our experiments show high expression of P63 and CD44 in the cases of CIN and SCC. Both CIS and SCC displayed positive staining with p63, with more than 80% cells staining positive. However minimal expression of c-kit in both CIN and SCC. But surprisingly we got high expression of ABCG2 in cases of carcinoma in situ as compared to that of invasive squamous cell carcinoma. More than 50% of cells showed CD44 positivity in both CIS and SCC groups. Our results show for the first time that these four stem cells especially the limbal epithelium stem cells play a vital role in the genesis of OSSN but we need to explore more cases before establishing its clinical and biological significance. [ABSTRACT FROM AUTHOR]

Background: The corneal-conjunctival intraepithelial neoplasia (CCIN) is an ocular surface neoplasia commonly found among populations exposed to strong UV light. Although surgical excision is mainstay treatment, topical Mitomycin-C (MMC) 0.02% has been tried as a sole therapeutic treatment of non- invasive Ocular Surface Squamous Neoplasia (OSSN). Aim: The aim of this study was to report the long term outcome of treatment of non invasive ocular surface squamous neoplasia with topical Mitomycin C (0.02%) as primary therapy. Materials and methods: Total six eyes of six patients with CCIN were treated with topical mitomycin C (0.02%) alone as a sole therapy. All patients received topical MMC (0.02%) four times daily as a cycle therapy of two week ON and two week OFF for 12 weeks. The patients were followed up to two years. Results: All patients showed total cure with no recurrence during 2 years follow up period. Ocular irritation and mild conjunctival hyperemia were observed in 4 eyes during treatment with MMC. There were no serious complications noted at the end of the follow-up period. Conclusion: We concluded that Topical Mitomycin C (0.02%) may be used as a sole therapeutic treatment of non invasive Ocular surface squamous neoplasia with close on going follow-up. [ABSTRACT FROM AUTHOR]

Conjunctival malignant melanoma is a rare disease associated with considerable mortality. Most published data have been based on case reports or series of referred patients. In addition, very little is known about the genetic and epigenetic profile of conjunctival melanoma and the resemblance to uveal, cutaneous and mucosal melanoma. The aim was to determine the incidence rate of conjunctival melanoma, and to relate clinicopathological features and treatment to prognosis. A further aim was to determine the prevalence of BRAF mutations in conjunctival melanoma, to determine whether BRAF mutations are early events in pathogenesis, and relate clinicopathological features and prognosis to BRAF-mutation status. Finally, we wanted to identify tumour-specific and prognostic micro RNAs in conjunctival melanoma, and to compare these with the micro RNA expression of other melanoma subtypes. In order to investigate these rare tumours, we studied all the conjunctival melanomas that had been surgically removed in Denmark over a period of 52 years (1960-2012). Tissue samples, clinical files, pathology reports and follow-up data were collected and re-evaluated. Using droplet digital polymerase chain reaction and immunohistochemistry, we investigated BRAF mutations; and using micro RNA expression profiling, we investigated differentially expressed micro RNAs. The overall incidence of conjunctival melanoma was 0.5/1 000 000/year, and it increased in Denmark over 52 years. The increase was mainly caused by an increase in older patients (>65 years) and bulbar lesions. Clinicopathological features significantly associated with a poor prognosis were extrabulbar location, involvement of adjacent tissue structures, tumour thickness exceeding 2 mm and local tumour recurrence. Patients undergoing incisional biopsy and/or treatment involving excision without adjuvant therapy fared worse than patients treated with excision and any type of adjuvant treatment. We found that 35% (39/110) of conjunctival melanomas were BRAF-mutated, and the incidence of BRAF mutations was constant over time. BRAF-mutation status corresponded in conjunctival melanoma and paired premalignant lesions. BRAF mutations were more frequent in males, in young patients, and in tumours with a sun-exposed tumour location (bulbar conjunctiva or caruncle), with a mixed or non-pigmented colour, with absence of primary acquired melanosis, and with origin in a nevus. Immunohistochemistry was able to accurately detect BRAF V600 E mutations. In univariate analysis, distant metastatic disease was associated with BRAF mutations. No prognostic associations with BRAF mutations were identified in multivariate analyses. Micro RNA expression analysis revealed 25 tumour-specific micro RNAs in conjunctival melanoma. Five possibly oncogenic mi RNAs (mi R-20b-5p, mi R-146b-5p, mi R-146a-5p, mi R-506-3p and mi R-509-3p) were up-regulated. Seven micro RNAs (mi R-30d-5p, mi R-138-5p, mi R-146a-5p, mi R-500a-5p, mi R-501-3p, mi R-501-5p and mi R-502-3p) were significantly and simultaneously up-regulated in both stage T1 and stage T2 tumours, and were associated with increased tumour thickness. The expression of the 25 tumour-specific micro RNAs did not differ significantly between conjunctival melanoma and oral or nasal mucosal melanoma. In conclusion, the incidence of conjunctival melanoma increased in the Danish population from 1960 to 2012. From our findings of a distinct pattern of BRAF mutations and differentially expressed micro RNAs, it is evident that conjunctival melanoma is closely related to cutaneous and other mucosal melanomas and bears less resemblance to uveal melanomas. This means that conjunctival melanoma patients may benefit from therapies that are effective for cutaneous and mucosal melanoma. Additionally, the identification of several up-regulated micro RNAs may prove to be useful as prognostic or therapeutic targets in conjunctival melanoma. [ABSTRACT FROM AUTHOR]

Background/Aim. Pterygium is considered to be a degenerative disease of the conjunctiva, however, the presence of tumor markers in pterygium reinforces the hypothesis that this lesion is similar to tumor. Inactivation of p53 function removes an obstacle to increased proliferation. Factors affecting the prevalence of p53 expression in pterygium deserve investigation. The aim of the study was to investigate the expression of p53 and Ki-67 proteins in pterygium and normal conjunctiva, the effects of gender and age on p53 expression, and the relationship between the expression of p53 and Ki-67 proteins. Methods. A total of 34 samples of pterygium and 34 samples of the normal conjunctiva were analyzed. The samples were studied by immunohistochemistry using antibodies against p53 and Ki-67. Results. Totally 15 (44%) samples of pterygia were p53 positive. Correlations between the expression of p53 protein and sex, and age were not established. The number of Ki-67 positive cells in pterygium (9.74%) was significantly higher than the number of Ki-67 positive cells in the normal conjunctiva (1.74%), (p = 0.001). Between the expression of p53 protein and Ki-67 protein in pterygium there was a significant positive correlation (p = 0.000). Conclusion. The prevalence of p53 positive samples of pterygium was 44%. The influence of sex and age on p53 protein expression in pterygium was not found. The increased proliferative acivity was present in the epithelium of pterygium. The expression of Ki-67 protein is associated with the expression of p53 protein in pterygium. The findings of our study support the thesis of pterygium as tissue growth disorder. [ABSTRACT FROM AUTHOR]

Conjunctival melanoma is a rare malignant tumour of the eye. Its diagnosis represents a challenge for general pathologists due to low exposure to ocular biopsies and a broad differential diagnosis. In addition, conjunctival samples are often small and are associated with a high frequency of artefacts due to their processing. Here, we present the first case to date of a traumatic iridial extrusion masquerading as a conjunctival melanocytic neoplasm. An 83-year-old Asian man presented with a conjunctival-pigmented nodule surrounded by an area of diffuse pigmentation. Histopathology revealed in the nodule a well-demarcated lesion composed of spindle shaped melanocytes with thick-walled blood vessels. At higher magnification, the blood vessels were composed of thick walls with collagen fibres in an onion-skin-like arrangement. The histological findings were consistent with extruded iridial tissue. The map biopsies of the flat, pigmented lesion showed melanocytic cell proliferation with dendritic processes restricted to the lamina propria without any epithelial involvement, consistent with ocular melanocytosis. The diagnosis of conjunctival melanocytic lesions is challenging, and non-neoplastic conditions should always be included in the differential diagnosis. Pathologists should correlate clinicopathological findings and be familiar with the normal histology in order to achieve the correct diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ocular malignant tumors are relatively rare compared to other eye lesions, require immediate diagnosis and management. But ignorant care due to unawareness of persons can result into debility, loss of vision, and occasionally 1 life is jeopardized. The aim of the study is to determine the frequency of most common neoplastc lesions of conjunctiva with histopathologically confirmed diagnosis. MATERIAL AND METHODS: It was a retrospective cross-sectional study done in a period of two years (January 2011 December 2012) that included 120 patients who presented with conjunctival lesions to the pathology department of Universal College of Medical Science, Bhairahawa, Nepal. RESULTS: In this study out of 120 biopsies which were histopathologically diagnosed as conjunctival neoplasms were categorized into benign, dysplastic and malignant lesion and was common after second decade of life. Majority of cases (75 cases, 62.5%) were categorized as benign lesion with predominance of squamous papilloma (n=25) and nevus (n=21), followed by malignant lesion (27 cases, 22.5%) and dysplastic lesions (18 cases, 15%). Amongst malignancies, squamous cell carcinoma (SCC) was the most prevalent and a case of malignant melanoma was studied. Dysplastic lesion included conjunctival intraepithelial neoplasia (CIN) with and without squamous papilloma. CONCLUSION: Histopathology plays an important role in diagnosis of conjunctival lesions and rules out different categories of neoplastic lesions on routine basis. In this study Squamous cell carcinoma (SCC) 20.01% is the most common malignant tumor of conjunctiva. The next majority of cases diagnosed as the verrucuous carcinoma 1.66% and malignant melanoma 0.83% maximum case of malignant cases diagnosed in the age group of more than 50 years. [ABSTRACT FROM AUTHOR]

The incidence of squamous cell carcinoma of the conjunctiva is particularly high in sub-Saharan Africa with temporal trends similar to those of Kaposi sarcoma (KS). Human herpesvirus type 8 (HHV8), has not yet been investigated in conjunctiva tumors. In this study biopsies and PBMCs of conjunctiva neoplasia patients along with nonneoplastic conjunctiva tissues have been analyzed for HHV8 sequences by PCR targeting ORF26. All amplimers were subjected to nucleotide sequencing followed by phylogenetic analysis. HHV8 DNA has been identified in 12 out of 48 (25%) HIV-positive, and in 2 out of 24 (8.3%) HIV-negative conjunctiva neoplastic tissues and in 4 out of 33 (12.1%) PBMC samples from conjunctiva neoplasia diseased patients as well as in 4 out of 60 (6.7%) nontumor conjunctiva tissues. The viral load ranged from 1 to 400 copies/10(5) cells. Phylogenetic analysis showed that the majority of HHV8 ORF26 amplimers clustered with subtypes R (n = 11) and B2 (n = 6). This variant distribution is in agreement with that of HHV8 variants previously identified in Ugandan KS cases. The presence of HHV8 in conjunctiva tumors from HIV-positive patients warrants further studies to test whether HHV8 products released by infected cells may have paracrine effects on the growth of conjunctiva lesions. [ABSTRACT FROM AUTHOR]

Purpose: Leiomyosarcoma is a common soft tissue tumor in the body. However, ocular leiomyosarcoma is rather uncommon. Herein, we describe the clinical and histopathological features of two cases of conjunctival leiomyosarcoma. There have only been three previously documented cases of conjunctival leiomyosarcoma. Results: A 34-year-old male presented with a 2-year history of a whitish mass in the right eye. He underwent an incisional biopsy of the mass, which supported the diagnosis of leiomyosarcoma on histopathological examination. Computed tomography showed orbital extension of the mass, following which he underwent an eyelid sparing orbital exenteration of the right side. The second case was that of a 39-year-old male, who had a history of a whitish limbal mass, which had been previously excised elsewhere. The pre-operative clinical photographs and histopathology slides of the excised mass were reviewed. A histopathological diagnosis of conjunctival leiomyosarcoma was established and due to base positivity, he was treated with plaque radiotherapy. Both the cases showed no tumor recurrence or systemic metastasis at one-year follow-up. Conclusion: Primary conjunctival leiomyosarcoma is uncommon. Appropriate treatment of the tumor is associated with good prognosis. [ABSTRACT FROM PUBLISHER]

Capillary hemangioma is the most common benign vascular eyelid tumor in childhood. The periocular lesion appears within the first few weeks after birth and usually has superficial or deep components. Primary conjunctival capillary hemangiomas are rarely reported. We present the case of a 2-day-old child with a pedunculated capillary hemangioma arising from superior palpebral conjunctiva. A complete surgical excision was performed under general anesthesia, and the child was asymptomatic at follow-up of two months. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate whether the handheld in vivo reflectance confocal microscopy that has been recently developed for the study of skin tumors is suitable for the diagnosis of conjunctival tumors. DESIGN: Prospective study, observational case series. METHODS: We prospectively evaluated the reflectance confocal microscopy features of 53 conjunctival lesions clinically suspicious for tumors of 46 patients referred to the University Hospital of Saint-Etienne (France) by using the handheld device. Twenty-three lesions were excised (3 nevi, 10 melanomas, 5 squamous cell carcinoma, 2 lymphomas, and 3 pinguecula/pterygium) while the other 30, presenting no reflectance confocal microscopy malignant features, were under follow-up for at least 1 year. Clinical reflectance confocal microscopy and histologic diagnosis were compared. RESULTS: In vivo reflectance confocal microscopy diagnosis was in agreement with the histologic diagnosis in all cases and none of the lesions that were not excised show any clinical progression under follow-up. CONCLUSION: In vivo reflectance confocal microscopy with a handheld dermatology-dedicated microscope can play a role in the noninvasive diagnosis of conjunctival lesions. Further studies should be performed to better define the diagnostic ability of this technique. [ABSTRACT FROM AUTHOR]

Purpose: To report the outcome of patients with conjunctival squamous cell neoplasia (CSCN)-including conjunctival squamous cell carcinoma (SCC), conjunctival squamous intraepithelial neoplasia (C-SIN) and carcinoma in situ (CIS)-treated at the Liverpool Ocular Oncology Centre (LOOC). Methods: Patients treated between January 1993 and September 2011 were identified and categorised as having 'primary' or 'salvage' treatment, according to whether they had undergone a surgical procedure before referral to our centre. Invasive SCC was treated by excision with adjunctive ruthenium plaque radiotherapy. C-SIN or CIS was treated with topical 5-fluorouracil (5-FU), and in a few cases, cryotherapy. Results: Primary treatment was administered to 20 patients (16 males, four females). Mean age was 62 years (range, 33-85). Histological examination revealed C-SIN/CIS in ten patients and invasive SCC in nine. Median follow-up was 69 months (range, 34-168). Three patients required further topical chemotherapy for persistent/recurrent C-SIN. Salvage therapy was administered to 21 patients (15 males, six females). Mean age was 63 years (range, 26-82). Histology showed C-SIN/CIS in 11 patients and invasive SCC in ten. Median follow-up was 54.5 months (range, 36-120). At the close of this audit, there was no recurrence of invasive or metastatic disease in either the primary or salvage groups. Conclusions: Our established protocol for treatment of CSCN has proven successful in local tumour control, and avoids ocular complications. We advocate adjunctive radiotherapy in patients with invasive SCC and chemotherapy in C-SIN/CIS. For improved patient outcome, prompt referral to a specialist centre is encouraged. [ABSTRACT FROM AUTHOR]

Conjunctival lymphoma is well documented in the medical literature, but veterinary reports are few. We report five cases of canine lymphoma, and three of feline in which the presenting sign was conjunctival involvement. All animals were in apparently good health at the time of presentation, and attended the referring clinic because of conjunctival disease. One dog showed generalized lymphadenopathy at presentation, although the ocular lesion was the reason for consultation, but all other patients were well with no detectable disease beyond the eye. All cats were presented for their ocular disease. All dogs were confirmed to have T-cell tumors, although the histological appearance of these was variable. In contrast, all cats had B-cell tumors. Referring clinicians and owners were contacted for follow-up information. Three dogs had been euthanased within 6 months of diagnosis for deterioration of general health. The remaining two were alive and showed no signs of systemic disease. Two cats had good survival following diagnosis, the other died of lesions that may not be related. [ABSTRACT FROM AUTHOR]

Purpose: To report a case with solitary circumscribed neuroma (SCN) in the palpebral conjunctiva.Methods: This is a retrospective observational case report of a 78-year-old female who showed a yellowish, smooth-surface, dome-shaped mass in the right lower palpebral conjunctiva near the punctum. The mass was completely removed under local anesthesia.Results: Pathological examination revealed that it was composed of benign spindle-shaped cells and tapering nuclei arranged in bundles. Immunocytochemical analyses for the S100, neurofilament, CD34, and epithelial membrane antigens were all positive. These pathological findings were consistent with a SCN. At the 6-month follow-up, there was no evidence of recurrence.Conclusion: This is the first case report of SCN in the palpebral conjunctiva. Although SCN had similar clinicopathological features to other benign peripheral nerve sheath tumors, including neurofibroma and schwannoma, immunocytochemical analyses were helpful for correct diagnosis of this case. [ABSTRACT FROM AUTHOR]

Ocular surface squamous neoplasia is a term that describes neoplastic changes of the cornea and conjunctiva ranging from squamous dysplasia to invasive squamous cell carcinoma (SCC). SCC of the conjunctiva is a rare tumor mainly affecting the elderly age group. Resemblance to common conditions such as pterygium and pinguecula may result in a wrong diagnosis on the part of an ophthalmologist. We present a rare case of SCC of the conjunctiva in a 41-year-old female. [ABSTRACT FROM AUTHOR]

• PURPOSE: To assess the role of androgen receptor detection in diagnosing eyelid sebaceous carcinomas and to compare it with that of adipophilin. • DESIGN: Retrospective, clinicopathologic study. • METHODS: Ten sebaceous carcinomas (8 invasive, 2 intraepithelial only) were stained immunohistochemically for androgen receptors and were compared with adipophilin staining. Receptor staining also was performed on benign sebaceous tumors (a sebaceoma and an adenoma) and as controls on eyelid basal cell carcinomas, eyelid squamous cell carcinomas, conjunctival squamous dysplasias, and conjunctival melanomas. • RESULTS: All 8 patients with an invasive component of sebaceous carcinoma underwent a biopsy in which the tumor cells showed diffusely positive results for androgen receptors (>20% of cells and usually>40%) and positive results for adipophilin. Eight cases displaying an intraepithelial (or pagetoid) component of spread also showed diffusely positive results for androgen receptors and adipophilin in at least 1 of multiple biopsy samples from each patient. However, in 8 of 21 separate conjunctival biopsy specimens with intraepithelial cytologic atypia, adipophilin results were negative. A sebaceoma and a sebaceous adenoma also showed positive results for both of these biomarkers. Among the controls, squamous carcinomas and melanomas showed negative results for androgen receptors and adipophilin. Basal cell carcinomas displayed focal receptor positivity in fewer than 5% of cells and showed negative results for adipophilin. • CONCLUSIONS: Androgen receptors and adipophilin can separate sebaceous tumors immunohistochemically from squamous carcinomas and melanomas, which showed negative results for both, and from basal cell carcinomas, which showed positive receptor results in a distant minority of cells. Regarding intraepithelial (or pagetoid) spread, androgen receptor detection was more sensitive and reliable than adipophilin in highlighting this component of the disease. [ABSTRACT FROM AUTHOR]

Background Even in experienced hands, the classification of some melanocytic lesions of the conjunctiva remains challenging. In skin pathology, the recent application of fluorescence in situ hybridisation (FISH) has been demonstrated to be of use for the analysis and diagnosis of ambiguous melanocytic neoplasms of the skin. This study set out to evaluate this method on seven prospective conjunctival cases that were histologically equivocal. Methods 18 unequivocal retrospective melanocytic controls were exposed to FISH. Commercially available probes assessing copy numbers of RREB1 (6p25), MYB (6q23) and CCND1 (11q13) genes compared with CEP6 (a chromosome six centromeric reference point) were used. After control verification, seven prospective, equivocal cases were identified and exposed to FISH. Results There was complete correlation between FISH result and the control section histopathology report. Control cases of melanoma cases were all positive for FISH and control benign lesions were negative. Of the seven equivocal cases, five were positive and classed as invasive melanoma or melanoma-in situ, one was negative and one tetraploid, classed as negative (these last two cases were classed as naevi with careful clinical observation). Conclusions FISH is very useful in classifying equivocal conjunctival melanocytic lesions, especially those with atypical junctional activity and naevoid melanocytic proliferations of the conjunctiva. [ABSTRACT FROM AUTHOR]

Background/Aims A retrospective service evaluation identified seven patients who developed local conjunctival metastases (LCMs) of the conjunctiva after a primary diagnosis of conjunctival invasive melanoma. The study was conducted to identify the clinicopathological characteristics and implications of these LCMs. Methods Seven patients with primary conjunctival melanoma seen by the ocular oncology service were identified as having also developed LCMs. The clinical history, histopathology, tumour biology, prognostic and staging implications of LCMs were evaluated. Results A total of 15 primary conjunctival melanomas and 19 LCMs were identified. The LCM developed 8-102 months after the first primary melanoma and, in three patients, non-conjunctival metastases developed 8-37 months after the first LCM. The LCMs showed some distinct histopathological features: they were well defined, were separated from the overlying epithelium by a Grenz zone, and were often multiple and associated with vessels and sometimes lymphocytic aggregates. Some appeared within the confines of the vascular drainage territory of the primary melanoma; others did not confine themselves to this distribution. Conclusions LCMs are local metastases of primary conjunctival melanoma that probably develop by dissemination through the local vessels and then becoming extavascular. Their accurate histopathological recognition is important, as it indicates a higher disease stage-indicating 'N' status within the TNM classification and may be a proxy indicator of the presence of nonconjunctival metastases, thus necessitating highresolution radiological imaging modalities or sentinel node biopsy. LCMs may represent an under-recognised lesion and may have been mistaken for primary 'nodular' conjunctival melanomas in the past. [ABSTRACT FROM AUTHOR]

Kaposi's sarcoma (KS) is a malignant vascular tumor, caused by the human herpesvirus 8. It is one of the commonest tumors in human immunodeficiency virus (HIV) patients and not uncommonly the first manifestation of acquired immunodeficiency syndrome (AIDS). Case. We present a case of an isolated bulbar conjunctival KS on a 43-year-old HIV positive male, with no other lesions. Excision and cryotherapy were performed, and the patient remains free of lesions to date. Conclusion. Isolated bulbar conjunctival KP is an unusual site for its initial presentation and must be kept in mind in HIV positive patients. [ABSTRACT FROM AUTHOR]

Purpose: External beam radiotherapy is the only conservative curative approach for Stage I non-Hodgkin lymphomas of the conjunctiva. The target volume is geometrically complex because it includes the eyeball and lid conjunctiva. Furthermore, the target volume is adjacent to radiosensitive structures, including the lens, lacrimal glands, cornea, retina, and papilla. The radiotherapy planning and optimization requires accurate calculation of the dose in these anatomical structures that are much smaller than the structures traditionally considered in radiotherapy. Neither conventional treatment planning systems nor dosimetric measurements can reliably determine the dose distribution in these small irradiated volumes. Methods and Materials: The Monte Carlo simulations of a Varian Clinac 2100 C/D and human eye were performed using the penelope and penEasyLinac codes. Dose distributions and dose volume histograms were calculated for the bulbar conjunctiva, cornea, lens, retina, papilla, lacrimal gland, and anterior and posterior hemispheres. Results: The simulated results allow choosing the most adequate treatment setup configuration, which is an electron beam energy of 6 MeV with additional bolus and collimation by a cerrobend block with a central cylindrical hole of 3.0 cm diameter and central cylindrical rod of 1.0 cm diameter. Conclusions: Monte Carlo simulation is a useful method to calculate the minute dose distribution in ocular tissue and to optimize the electron irradiation technique in highly critical structures. Using a voxelized eye phantom based on patient computed tomography images, the dose distribution can be estimated with a standard statistical uncertainty of less than 2.4% in 3 min using a computing cluster with 30 cores, which makes this planning technique clinically relevant. [Copyright &y& Elsevier]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To describe the clinical, histopathologic, immunohistochemical, and ultrastructural features of a case series of benign stromal tumors in the bulbar conjunctiva. Design: Observational case series. Participants: Four patients with a conjunctival lesion that were classified histologically as low-grade stromal tumors consisting of spindle-shaped cells with occasional pseudonuclear inclusion and multinucleated cells in a partly myxoid matrix. Methods: Four cases of low-grade conjunctival stromal tumors were retrospectively identified in an ophthalmic pathology laboratory database. Patients'' records were analyzed for demographic data, clinical appearance, and the postoperative course. Formalin-fixed, paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin and periodic acid Schiff. Immunohistochemical stains for vimentin, S100, CD34, smooth muscle actin (SMA), CD68, and factor XIIIa were performed. Transmission electron microscopy (TEM) was performed on 3 of the cases. Main Outcome Measures: Histopathologic evaluation (including immunostains and TEM) and clinical correlation. Results: All 4 tumors occurred in the bulbar conjunctiva of patients between 41 to 53 years of age. None of the patients developed recurrence after excisional biopsy. Histologically, all tumors exhibited spindle-shaped cells with pseudonuclear inclusions and occasional multinuclear cells. Mitotic figures were not observed. The stroma seemed to be myxoid to collagenous. Immunohistochemical stains were positive for CD34, vimentin, and focally for CD68, but were negative for S100 and SMA. Conclusions: We propose to classify these benign lesions, which share distinct histopathologic features, as “conjunctival stromal tumors.” A reactive/inflammatory component needs to be considered in the pathogenesis of this lesion. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To evaluate whether tumor-associated lymphangiogenesis contributes to prognosis of conjunctival malignant melanomas and to study its association with other tumor characteristics. Design: Nonrandomized, retrospective case series. Participants: A total of 109 consecutive patients with primary conjunctival malignant melanoma. Methods: Proliferating lymphatic vessels were identified immunohistochemically using lymphatic vascular endothelial hyaluronan receptor-1 and podoplanin as specific lymphatic endothelial markers and Ki-67 as proliferation marker. Baseline tumor characteristics included tumor location, tumor thickness, tumor diameter, tumor origin, and tumor growth pattern. Kaplan–Meier and Cox regression analyses of the risk of local recurrence, lymphatic spread, distant metastasis, and melanoma-related death were performed. Main Outcome Measures: Intratumoral lymphatic vascular density and its association with tumor characteristics and recurrence-free, lymphatic spread-free, distant metastasis-free, and melanoma-specific survival. Results: Intratumoral and peritumoral proliferating lymphatic vessels could be detected in all of the 109 conjunctival melanoma samples. High intratumoral lymphatic density was significantly associated with palpebral tumor location (P<0.001), greater tumor thickness (P<0.001), larger tumor diameter (P = 0.001), tumor origin de novo (P= 0.002), and nodular tumor growth pattern (P = 0.037). Patients with high intratumoral lymphatic density revealed significantly lower recurrence-free, lymphatic spread-free, distant metastasis-free, and melanoma-specific survival rates (P<0.001 for all). By multivariate Cox regression, factors predictive of local recurrence included palpebral tumor location (hazard ratio [HR] 2.66, P = 0.014), large tumor diameter (HR 5.48, P<0.001), and high intratumoral lymphatic density (HR 2.48, P = 0.043); factors predictive of lymphatic spread included palpebral tumor location (HR 4.13, P = 0.009), high tumor thickness (HR 12.17, P<0.001), and high intratumoral lymphatic density (HR 6.79, P = 0.019); factors predictive of distant metastasis included palpebral tumor location (HR 7.63, P<0.001), high tumor thickness (HR 8.60, P<0.001), large tumor diameter (HR 0.30, P = 0.029), and high intratumoral lymphatic density (HR 8.90, P = 0.047); and factors predictive of melanoma-related death included palpebral tumor location (HR 7.74, P<0.001), high tumor thickness (HR 10.88, P<0.001), large tumor diameter (HR 0.28, P = 0.018), and, with borderline significance, high intratumoral lymphatic density (HR 8.46, P = 0.052). Conclusions: Tumor-associated lymphangiogenesis seems to be associated with an increased risk of local recurrence, lymphatic spread, distant metastasis, and melanoma-related death in patients with conjunctival malignant melanomas. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To evaluate conjunctival nevi using anterior segment optical coherence tomography (AS-OCT). Design: Retrospective interventional case series. Participants: There were 22 eyes of 21 patients with conjunctival nevus imaged with AS-OCT for evaluation and detection of cysts within conjunctival nevi. Intervention: Anterior segment OCT. Main Outcome Measures: Evaluation and detection of intralesional cysts. Results: All margins of the nevus, including the deep margin, could be visualized on AS-OCT with high resolution of the anterior margin in 100% of cases, posterior margin in 82% of cases, and lateral margin in 86% of cases. The nevus was optically dense with homogeneous pattern in all cases. Some degree of deep optical shadowing, mostly from pigmented nevi, was noted in 86%. Intrinsic cysts within the nevus were detected by slit-lamp biomicroscopy in 18 cases (82%) and by AS-OCT in 17 cases (77%). In comparison with histopathologic findings, AS-OCT detected intrinsic cysts with a sensitivity of 80%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 60%. Slit-lamp biomicroscopy (by experienced observers) compared with histopathology revealed detection of cysts with a sensitivity of 100%, a specificity of 100%, a PPV of 100%, and an NPV of 100%. Conclusions: Anterior segment OCT provides high-resolution imaging of conjunctival nevi with the ability to demonstrate all margins and to provide information on the presence of intralesional cysts, which are important in the diagnosis. The main drawback is optical shadowing of deeper structures from pigment within nevi. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

To describe signalment, clinical presentation, treatment, recurrence rate, and outcome of canine conjunctival mast cell tumors (MCTs). Retrospective study. Canine cases were selected from the Comparative Ocular Pathology Laboratory of Wisconsin, Eye Path Lab of the UK, and California Eye Care for Animals. Thirty-two canine patients were identified as having a MCT presumed to be arising primarily from the conjunctiva. Data were collected from pathology submission request forms; additional information was collected by means of a questionnaire distributed to the veterinary ophthalmologist or veterinarian who performed the surgery. Data collected included age, gender, breed, location of tumor, dimensions of tumor, duration and growth rate, additional diagnostics, surgical descriptions, adjunctive treatment, histologic description, special stains, number of recurrences, and final outcome. Thirty-two dogs with 33 conjunctival MCTs meeting search criteria were identified. All dogs underwent surgical excision as the primary treatment. Surgical margins were evaluated for 30 tumors and were reported as: incomplete margins in 25 cases, narrow in four cases and complete in one case. Histologic grade was provided for 33 of 33 MCTs and included 10 low (30%), 18 intermediate (55%) and five high-grade (15%) tumors. Follow up information was received for 25 dogs. Four died of unrelated causes, two had local recurrence, 15 were currently disease free (mean 21.4 months postoperatively) and four were reported to be disease free at the reported rechecks but were lost to long term follow up (mean 13 months postoperatively). No dogs in the study were identified that died of MCT related disease. [ABSTRACT FROM AUTHOR]

Objective: The tolerability and activity of the intralesional administration of rituximab, a chimeric monoclonal antibody that targets the CD20 antigen, was assessed in patients with conjunctival B-cell lymphoma. The systemic administration of rituximab has varying response rates with different types of lymphoma, generally with a mild toxicity level. Intralesional administration of this drug has increased local disease control in cases of cutaneous mucosa-associated lymphoid tissue (MALT) lymphoma. Design: This was an interventional pilot study of 3 patients with relapsed CD20+ conjunctival lymphomas treated with intralesional injections of rituximab. Participants: Two patients with conjunctival MALT lymphoma refractory to previous systemic treatment with rituximab and 1 patient with relapsed follicular lymphoma of the eyelid were included in the study. Methods: Patients received 4 weekly intralesional injections followed by 6 monthly injections of undiluted rituximab together with xylocaine 2%. Main Outcome Measures: Side effects and tumor response were assessed before each intralesional injection and at 3-month intervals after treatment conclusion. Results: The 2 conjunctival MALT lymphoma patients achieved complete remission after intraconjunctival rituximab treatment, which shows that this method of administration can overcome the primary resistance to this monoclonal antibody. The patient with the eyelid follicular lymphoma did not achieve tumor regression after the first intralesional injections of rituximab. In this patient, the addition of autologous serum resulted in lymphoma remission at the end of treatment, suggesting that drug inefficacy can be related to the low bioavailability of effectors in the tumor tissue. Conclusions: Although follow-up is still short, these preliminary findings suggest that intralesional rituximab is a well-tolerated strategy in marginal-zone and follicular lymphomas of the conjunctiva. An increased bioavailability of effectors in the tumor tissue, by means of the addition of autologous serum, may improve rituximab activity. This strategy could be used in other extranodal CD20+ indolent lymphomas to improve local control, even in patients who are initially refractory to systemic rituximab treatment. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: Conjunctival Squamous Cell Carcinoma (CSCC) is one of the important ocular surface tumors. It is thought to be more advanced in this part of the world such as in Saudi Arabia. The Squamous Spindle Cell Carcinoma (SSCC) is a more aggressive variant. A single case of spindle squamous cell carcinoma tumor-related death due to bone and lung metastasis has been reported in Sweden in 1995. We are reporting a similar case of SSCC of the conjunctiva with eventual death because of bilateral lung metastasis in our area. Proper identification of this type of tumor by ocular pathologists and the need for future detailed clinicopathologic studies on CSCC in Saudi Arabia is emphasized. [Copyright &y& Elsevier]

We describe a patient who developed an isolated brain metastasis four years after his right eye was treated for conjunctivalmelanoma by excision and local chemotherapy. He had a history of ipsilateral ocular trauma by coal stuff while working in a mining industry. Conjunctival melanoma represents only 1.6% of all non-cutaneous melanoma. Metastasis of this kind of neoplasm to brain is a rare event, especially without evidence of prior or concurrent regional lymph node involvement. [ABSTRACT FROM AUTHOR]

To investigate the expression of matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of matrix metalloproteinase (TIMP)-1 in conjunctival melanomas and their correlations with clinicopathologic parameters and prognosis. Fourteen conjunctival melanoma tissue samples and nine conjunctival nevus tissue samples were stained immunohistochemically for MMP-2, MMP-9, and TIMP-1. Association of MMP-2, MMP-9, and TIMP-1 expression in melanoma tissues with clinical progression in terms of metastasis, recurrence, mitotic index, thickness, base diameter, and invasion depth was analyzed. In the melanoma group, 78.6% of samples showed a positive reaction for MMP-2, 85.7% for MMP-9, and 100% for TIMP-1. In the nevus group, 11.1% showed a positive reaction for MMP-2, 66.7% for MMP-9, and 100% for TIMP-1. MMP-2 expression was significantly more induced in conjunctival melanoma than in benign nevi ( P = 0.002). In conjunctival melanoma, MMP-9 expression was higher in tumors >1.5 mm thick ( P = 0.026) and TIMP-1 expression was higher in recurrent cases ( P = 0.03). There was no significant correlation between the expression and metastasis during the follow-up period (mean, 5 years). MMP-2, MMP-9, and TIMP-1 were expressed in the majority of conjunctival melanomas, and MMP-2 might play a role in the development and clinical behavior of conjunctival melanoma. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical and immunopathologic features of patients with 2 different types of paraneoplastic conjunctival cicatrization. Design: Retrospective observational case analyses with a review of the literature. Participants: One patient with paraneoplastic ocular cicatricial pemphigoid (POCP) and 1 patient with paraneoplastic pemphigus (PNP) with ocular involvement. Methods: Critical review of clinical history, diagnostic studies, and immunopathologic results of biopsies in the 2 cases, together with a review of the literature. Main Outcome Measures: Ability to recognize paraneoplastic conjunctival cicatrization and to diagnose the conditions accurately. Results: The first patient, 46 years of age, presented with conjunctival scarring and symblephara, cough, oral lesions, and chest rash. Concurrently, a diagnosis of pulmonary squamous cell carcinoma was made. Conjunctival biopsy revealed a subepithelial bulla, an inflammatory infiltrate of T and B lymphocytes, and basement membrane zone deposition of immunoglobulin (Ig)-G and C3 consistent with POCP. The second patient, 54 years of age, had a recently diagnosed B-cell chronic lymphocytic leukemia, followed 1 month later with ocular irritation and bilateral extensive symblephara. Extensive oral lesions and skin involvement of the lower half of the body were seen. Skin biopsy disclosed subepidermal bullae and mostly T cells with virtually no B cells in the dermal infiltrate (the patient was being treated with rituximab). Linear subepithelial deposition of IgG and C3 and deposition within the epidermis were consistent with PNP. Further indirect immunofluorescence and immunoprecipitation studies with the patient''s serum-derived antibodies established PNP as the definitive diagnosis. Conclusions: Underlying malignancy is an important consideration in younger patients with puzzling bilateral cicatrizing conjunctivitis, and a paraneoplastic condition can be established from either a conjunctival or a skin biopsy. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To analyze whether tumor-associated lymphangiogenesis accompanies the development from premalignant conjunctival intraepithelial neoplasia (CIN) into invasive squamous cell carcinoma (SCC) of the conjunctiva and to study its association with prognosis and other tumor characteristics. Design: Case-controlled, matched-pair cohort study. Participants: Twenty patients with invasive SCC were closely matched with 20 patients with high-grade CIN and 20 patients with low-grade CIN regarding tumor size, tumor location, tumor extension, and patients'' age. Methods: Proliferating lymphatic vessels were identified using lymphatic vascular endothelial hyaluronan receptor-1 and podoplanin as specific lymphatic endothelial markers and Ki-67 as proliferation marker. Baseline tumor characteristics included tumor size, tumor-to-limbus distance, tumor-to-fornix distance, 2009 TNM classification, tumor cell type, mitotic rate, and Ki-67 proliferation index. Kaplan–Meier and Cox regression analyses of recurrence-free survival were performed. Main Outcome Measures: Lymphatic vascular density (LVD) and relative lymphatic vascular area (RLVA) of proliferating lymphatic vessels within the tumor mass (intratumoral) and within an area ≤500 μm from the tumor border (peritumoral), and its association with tumor characteristics and recurrence-free survival. Results: Intratumoral and peritumoral proliferating lymphatic vessels could be detected in all of the 60 conjunctival tumor samples. Invasive SCC revealed significantly higher values of intratumoral and peritumoral LVD and RLVA of proliferating lymphatics than high-grade or low-grade CIN (P≤0.001). Higher intratumoral lymphatic densities were significantly associated with larger tumor size (P=0.001), lower tumor-to-limbus distance (P=0.002), lower tumor-to-fornix distance (P=0.003), and higher TNM categories (P<0.001). Recurrence-free survival rates decreased significantly with higher intratumoral lymphatic densities (P<0.001). By multivariate Cox regression, large tumor size (hazard ratio 1.68, P=0.002) and high intratumoral lymphatic density (hazard ratio 1.10, P=0.046) were significant prognostic predictors of local recurrence. Conclusions: Development of conjunctival SCC from premalignant lesions is accompanied by the outgrowth of new conjunctival lymphatic vessels. This active tumor-associated lymphangiogenesis seems to be associated with an increased risk of local recurrence in patients with CIN and conjunctival invasive SCC. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: Eyelids and conjunctiva, which are composed of cutaneous, mucosal and stromal tissues, may develop various pathologies. Histopathological diagnosis of the lesions located in these anatomical regions is crucial for determining the optimal therapeutic modality and protection of ocular functions. Material and Methods: In this retrospective study, the clinical and histopathological features of neoplastic lesions located on the eyelids and the conjunctiva diagnosed at the Department of Pathology in Karaelmas University Faculty of Medicine between the years of 2003 and 2008 were reviewed and evaluated. Results: A total of 127 cases were included to the study. 84,2% of the lesions in our case series were located on the eyelids. 69,1% and 30,9% of these eyelid lesions were benign and malignant, respectively. 15,8% of the lesions were conjunctival. 95% of the conjunctival lesions were benign, while 5% were malignant. The most common benign lesions of the eyelids were squamous papillomas (20,3%), while the most commonly observed malignant neoplasm was basal cell carcinoma (57,6%). Most of the benign conjunctival lesions were melanocytic nevi (57,9%), while only one case was diagnosed as in situ squamous cell carcinoma. Conclusion: Basic histopathological analyses of the periorbital lesions were performed in this study. The most commonly encountered malignant lesions of the eyelids and conjunctiva were basal and squamous cell carcinomas. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate treatment of conjunctival melanomas at the Ocular Oncology Service in Liverpool.MethodsWe included 40 patients initially treated at our centre for invasive conjunctival melanoma and 36 patients referred for salvage therapy after surgery elsewhere. Patients underwent local excision or radiotherapy. Adjunctive cryotherapy for invasive and intra-epithelial neoplasia was abandoned in favour of ruthenium brachytherapy and mitomycin C chemotherapy, respectively. Tumours were staged according to circumferential spread, basal diameter, and histological thickness.ResultsThe 40 previously-untreated tumours were confined to bulbar conjunctiva in 31 patients and involved extrabulbar conjunctiva in 9, affecting caruncle in 6 of these. All eyes were conserved, most retaining initial visual acuity. Invasive conjunctival recurrence, which occurred in six patients, was more likely with medial tumours (Log-rank, P=0.004) and if treatment did not include radiotherapy (Log-rank, P=0.03). Four patients died of metastases, all with caruncular involvement. Of the 36 patients referred for salvage therapy after previous surgery, 11 had no visible tumour, 9 had only intra-epithelial neoplasia, and 16 had invasive melanoma, which was recurrent in seven. After salvage therapy, five patients died, all of whom were referred with recurrent invasive tumour and only one of whom had caruncular involvement.ConclusionsExcision of invasive melanoma with adjunctive brachytherapy and topical chemotherapy achieved high rates of local tumour control with little ocular morbidity. Without caruncular involvement, disease-specific mortality was rare unless the patient was referred after a surgical procedure. Our results suggest that inadequate surgical intervention increases risks of local recurrence and metastatic death.Eye (2009) 23, 801–809; doi:10.1038/eye.2008.154; published online 6 June 2008 [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To develop a system for clinically mapping conjunctival melanomas, taking into account the tumours stage of development, location and extent. Methods: Baseline clinical features of 40 patients with conjunctival melanoma, first treated at our centre between 1993 and 2006, were studied. Maps showing sectorial location and circumferential spread in all areas of conjunctiva were digitally generated from numerical data. Results: The patients (18 female; 22 male) had a median age of 59 years. Three had multiple tumours and 20 had mixed, invasive and intraepithelial disease. The Tumour Node and Metastasis (TNM) T stage was I in 11 patients, II in 20, III in eight and IV in one. The tumour was medial in 19% of eyes with T stages I and II as compared with 67% of eyes with stages III and IV (Mann-Whitney, <0.001). Within each T stage of the TNM system, there was considerable variation in tumour dimensions, circumferential spread and longitudinal extent. Conclusions: A system for clinically mapping conjunctival tumour location and extent has been developed. This revealed tumour variation within TNM T stages and may facilitate better collection of data for multicentre trials. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 10-year-old female sprayed domestic cat suffering from a protruding nictitating membrane of the right eye. Diagnostic examinations showed conjunctival lymphoma. The cat was put under surgery because of severe ocular lesion and bleeding. A discussion about conjunctival lymphoma in domestic cats, the diagnosis, surgery, management and treatment of the tumor is offered.

Ocular adnexal tumors are relatively rare but require unique diagnostic and treatment considerations given the functional importance of the eye and periocular structures and their unique metastatic behavior. In the following paper, we review the major malignant tumors of the ocular adnexa including the eyelid, conjunctiva and orbit. Frozen section control of the margins and, in selected cases, Mohs microsurgery have decreased the recurrence rate in malignant eyelid tumors. Intraoperative cryotherapy and postoperative topical mitomycin C have similarly contributed to better surgical outcomes in conjunctival malignant tumors including squamous cell carcinoma and malignant melanoma. Immunotherapy with CD20 antibodies is a developing treatment in ocular adnexal lymphomas. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma is the most common ocular tumor of horses. To demonstrate that carbon dioxide laser is a useful method to successfully induce ablation of superficial squamous cell carcinoma of the cornea and conjunctiva, two horses affected with superficial ocular squamous cell carcinoma were operated, under general anesthesia, by this technique delivering continuous pulses over the affected tissue. Tumors were completely removed, with minimal or no postoperative inflammation nor discomfort to horses. Ablation using carbon dioxide laser represents a promising new surgery option in the treatment of squamous cell carcinoma in horses. [ABSTRACT FROM AUTHOR]

Presents a medical case of a 65-year-old Hispanic man with a history of a large, multi-lobulated conjunctival tumor on the lateral epubulbar surface of the left eye. Indication of histopathological examination of the conjunctival tissue revealed a large, multilobular tumor in the susbtantia propia that focally infiltrated the superficial epithelium; Observation of sqaumous cells that showed intracytoplasmic periodic acid-Schiff-positive granules that were sensitive to diastase; Infiltration of the superficial epithelium by the neoplastic cells.