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PubMed2007

Role of Helicobacter pylori in conjunctival mucosa-associated lymphoid tissue lymphoma.

OBJECTIVE: Conjunctiva-associated lymphoid tissue is the conjunctival equivalent to mucosa-associated lymphoid tissue (MALT). Mucosa-associated lymphoid tissue lymphoma has been shown to be associated with Helicobacter pylori. In this study, the prevalence and possible role of H. pylori infection in conjunctival MALT lymphoma were evaluated. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirteen cases of conjunctival MALT lymphoma were investigated. Five samples of conjunctival lymphoid hyperplasia and 20 biopsies of normal conjunctiva served as controls. METHODS: The specimens were investigated for the presence of H. pylori with immunohistochemistry (IHC) and nested polymerase chain reaction (PCR) techniques. For each case of conjunctival MALT lymphoma, information regarding gender, age at presentation, conjunctival localization, and information of generalized MALT lymphoma were collected. MAIN OUTCOME MEASURES: Detection of H. pylori and patient characteristics. RESULTS: The 13 conjunctival MALT lymphomas originated from 8 women and 5 men with an average age of 62 years (range, 25-87). Only 1 patient had evidence of systemic MALT lymphoma. H. pylori could not be identified in any of the conjunctival MALT lymphomas, in conjunctival lymphoid hyperplasia, or in normal conjunctival biopsies using IHC and PCR techniques. CONCLUSIONS: An association between H. pylori and localized conjunctival MALT lymphoma could not be verified. Antigens other than H. pylori may take part in the development of conjunctival MALT lymphoma.

Adult↗
PubMedDate not supplied

Tumors of the conjunctiva and cornea.

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.

Conjunctival Neoplasms↗
PubMed2006

Chapter 1: HPV in the etiology of human cancer.

The causal role of human papillomavirus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. Most cancers of the vagina and anus are likewise caused by HPV, as are a fraction of cancers of the vulva, penis, and oropharynx. HPV-16 and -18 account for about 70% of cancers of the cervix, vagina, and anus and for about 30-40% of cancers of the vulva, penis, and oropharynx. Other cancers causally linked to HPV are non-melanoma skin cancer and cancer of the conjunctiva. Although HPV is a necessary cause of cervical cancer, it is not a sufficient cause. Thus, other cofactors are necessary for progression from cervical HPV infection to cancer. Long-term use of hormonal contraceptives, high parity, tobacco smoking, and co-infection with HIV have been identified as established cofactors; co-infection with Chlamydia trachomatis (CT) and herpes simplex virus type-2 (HSV-2), immunosuppression, and certain dietary deficiencies are other probable cofactors. Genetic and immunological host factors and viral factors other than type, such as variants of type, viral load and viral integration, are likely to be important but have not been clearly identified.

Conjunctival Neoplasms↗
PubMed2000

Tarsal fibroma.

PURPOSE: To report a case of an isolated tarsal fibroma. METHODS: Case report. Excisional biopsy and histopathological evaluation were performed on a solid lesion originating from the tarsal conjunctival surface of an upper eyelid. RESULTS: Histopathological evaluation, including positive trichrome stains, was consistent with fibroma of the left upper tarsus. No recurrence has developed after a follow-up interval of a year. CONCLUSION: Tarsal fibroma is a rare condition that should be considered in the differential diagnosis of tarsal lesions.

Aged↗
PubMed2001

Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma.

PURPOSE: To report a pigmented conjunctival squamous cell carcinoma that clinically simulated a conjunctival melanoma. DESIGN: Interventional case report. METHODS: Ocular examination, surgical excision, and clinicopathologic correlation. RESULTS: A 78-year-old white man developed a lightly pigmented mass at the temporal limbus of his right eye. The differential diagnosis included pigmented squamous cell carcinoma and malignant melanoma. Histopathologic examination revealed a malignant squamous cell tumor that contained foci of melanin pigment. The final diagnosis was pigmented conjunctival squamous cell carcinoma. CONCLUSION: Conjunctival squamous cell carcinoma may rarely be pigmented and simulate a conjunctival melanoma.

Aged↗
PubMed2001

Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy.

PURPOSE: To illustrate a novel method of management for extensive conjunctival and corneal melanoma. METHODS: Interventional case report. A 40-year-old Caucasian woman presented with a large, diffuse conjunctival melanoma involving 6 clock hours of the limbus. The remaining bulbar conjunctiva and the entire corneal epithelium were affected by diffuse, flat melanosis. RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was treated with double freeze-thaw cryotherapy. The extensive conjunctival defect, involving one-half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treated with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 20/20 visual acuity. CONCLUSION: Preliminary evidence suggests that combined therapeutic approaches, consisting of extensive tumor removal, cryotherapy, amniotic membrane allograft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired melanosis.

Adult↗
PubMed2001

Efficacy of (123)N-isopropyl-p-[(123)I]-iodoamphetamine single photon emission computed tomography for the diagnosis of uveal malignant melanoma.

PURPOSE: To evaluate the efficacy of single photon emission computed tomography (SPECT) images with N-isopropyl-p-[(123)I]-iodoamphetamine ([(123)I]-IMP) as a radiopharmaceutical for the diagnosis of uveal melanoma. METHODS: Consecutive interventional case series. Single photon emission computed tomography images were obtained after intravenous injection of [(123)I]-IMP in 20 patients with clinically suspected uveal melanoma (16 eyes of 16 patients) or ocular adnexal melanoma (four adnexal tumors of four patients). Histologic findings in seven eyes enucleated for uveal melanoma were analyzed with the SPECT images semiquantitatively evaluated. RESULTS: Eight of 20 eyes with suspected uveal melanoma showed high accumulation of [(123)I]-IMP in the late phase in the area corresponding to the uveal tumor, and the diagnosis of uveal melanoma was confirmed histologically in seven enucleated eyes. Tumor size and histologic features did not reflect the intensity of scintillation counts of [(123)I]-IMP. Twelve patients with no accumulation on the SPECT images were found to have clinically or histologically iris nevus, choroidal nevus, and other intraocular and adnexal conditions. CONCLUSION: N-isopropyl p-[(123)I]-iodoamphetamine SPECT may serve as a sensitive and specific examination for the diagnosis of uveal melanoma.

Adult↗
PubMed2002

Topical mitomycin C for extensive, recurrent conjunctival-corneal squamous cell carcinoma.

PURPOSE: To evaluate the efficacy of topical mitomycin C for extensive recurrent conjunctival and corneal squamous cell carcinoma (SCC). DESIGN: Interventional case series. METHODS: A prospective study was conducted in a single institution. Ten patients (ten eyes) with extensive recurrent conjunctival and corneal SCC were studied. The patients received topical mitomycin C 0.04% one drop four times daily in the eye with SCC. Treatment cycles were defined as 1 week using medication followed by 1 week without medication. Such treatment cycles were repeated until resolution of the conjunctival malignancy was clinically evident. The main outcome measures were tumor response and medication-related complications. RESULTS: Of the ten patients, the median age was 66 years (range 33-77 years). Before referral, the patients had undergone a median of two previous conjunctival tumor resections revealing the diagnosis of in situ SCC in three cases and locally invasive SCC in six cases. At presentation, the tumor involved the limbus and cornea in all ten eyes, forniceal conjunctiva in three eyes, and tarsal conjunctiva in one eye. The extensive tumor affected a median of 10 clock hours of limbal conjunctiva and 10 clock hours of cornea, with corneal epithelial invasion for a median of 50% (range 20%-100%) of its surface. Mitomycin C 0.04% four times daily was applied for a median of three cycles (range 1-4 cycles). Complete tumor regression was documented in all ten cases (100%). There was no recurrence over a mean follow up of 22 months (range 6-50 months). Mitomycin C caused moderate temporary local irritation and conjunctival erythema and chemosis, but no long-term intraocular or extraocular complications. CONCLUSIONS: Based on this small series, topical mitomycin C 0.04% appears to be a safe and effective therapy for conjunctival or corneal SCC, even when there is extensive recurrent tumor.

Administration, Topical↗
PubMed2002

Conjunctival mycosis masquerading as melanoma.

PURPOSE: To report a patient with a melanotic lesion of the conjunctiva that mimicked melanoma but proved to be a fungal infection on biopsy. DESIGN: Interventional case report. METHODS: A 75-year-old white man was examined for a 3-month history of a deeply pigmented lesion of the conjunctiva at the limbus of the right eye that closely resembled conjunctival melanoma. The lesion was completely excised. RESULTS: Histologic examination revealed fungal elements without evidence of tumor. CONCLUSION: Although rare, fungi should be included in the differential diagnosis of pigmented lesions of the conjunctiva.

Aged↗
PubMed2002

Treatment of conjunctival papillomata with topical interferon Alfa-2b.

PURPOSE: Two patients with biopsy-proven conjunctival papillomata exhibited complete resolution after treatment with topical Interferon Alfa-2b (IFNalpha2b). DESIGN: Interventional case reports. METHODS: Two patients with monocular biopsy-confirmed conjunctival papillomata were treated with IFNalpha2b, 1 million units/cc, one drop four times daily until clinical resolution was achieved. RESULTS: (Patient 1) The lesion's size was significantly reduced at 1 month. Complete resolution was noted at the 3-month visit. No recurrences were seen 40 months post-treatment. (Patient 2) The lesion completely resolved after 6 weeks of treatment. No recurrence has occurred 18 months post-treatment. No systemic or local side effect of treatment was noted. CONCLUSIONS: Two sizable conjunctival papillomata resolved using topical IFNalpha2b alone. Interferon is usually not considered effective for large solid tumors without surgical debulking. We realize that this is a limited case series, but these cases may serve as a basis for further investigation.

Administration, Topical↗
PubMed2002

Treatment of conjunctival squamous cell carcinoma with topical cidofovir.

PURPOSE: To describe a case of conjunctival squamous cell carcinoma in situ that was successfully treated with adjunctive topical cidofovir. DESIGN: Interventional case report. METHODS: A 52-year-old woman presented with a diagnosis of diffuse conjunctival papillomatosis in the right eye. She underwent conjunctival biopsy followed by a 6-week course of cidofovir eyedrops (2.5 mg/ml). RESULTS: The biopsy specimen demonstrated squamous cell carcinoma in situ. After this biopsy and treatment with cidofovir, the mass regressed into a small vascular tuft, which was excised and treated with cryotherapy. Six months after cidofovir treatment, the patient developed cicatricial changes of the inferior punctum. No recurrence of the squamous cell carcinoma has occurred in 24 months of follow-up. CONCLUSION: Cidofovir has shown effectiveness in the treatment of neoplastic lesions involving various mucus membrane sites. This antiviral drug may be a valuable addition to our treatment armamentarium for patients with squamous cell carcinoma in situ of the conjunctiva. The possible relationship between topical cidofovir and cicatricial changes of the lacrimal system cannot be determined from this isolated report, but further investigation is indicated.

Antineoplastic Agents↗
PubMed2002

Caruncle tumor as the first sign of metastatic lung carcinoma.

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.

Aged↗
PubMed2003

Conjunctival melanoma: is it increasing in the United States?

PURPOSE: While the incidence of cutaneous melanoma has been found to have increased over time, the evidence for conjunctival melanoma is not as clear. We applied a large cancer registry database to determine whether any changes had occurred in the incidence of conjunctival melanoma. DESIGN: Descriptive epidemiologic analysis. METHOD: Using population-based registry data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), we identified 206 newly diagnosed patients with conjunctival melanoma from 1973 to 1999. For analysis purposes, we calculated age-adjusted incidence rates and described temporal changes, using joinpoint regression model. RESULTS: Overall estimated biannual percent change (EBAPC) was 5.5 (95% confidence interval [CI] = 2.3, 8.8; P <.001). The significant elevated trend was observed for white men (EBAPC = 11.2; 95% CI = 6.3, 16.3; P <.001) but not for white women (EBAPC = 0.3; 95% CI = -4.1, 4.9; P >.05). In white men, the incidence rate increased 295% within the 27 years. Our analysis also showed a significant upward trend in the age group aged 60 years or more (EBAPC = 7.6; 95% CI = 3.9, 11.3; P <.001). Incidence tended to rise in the group aged 40 to 59 years, but it was not statistically significant (EBAPC = 4.4; 95% CI = -2.3, 11.6; P =.1536). CONCLUSIONS: Substantial temporal changes in the incidence of conjunctival melanoma have occurred in the United States in recent years. The changing incidence patterns coincide with those seen in cutaneous melanoma, suggesting a possible link to a sunlight-related etiology.

Adult↗
PubMed2003

Diagnosis of conjunctival B-cell lymphoma by polymerase chain reaction heteroduplex analysis.

PURPOSE: To report a case initially assessed as giant papillary conjunctivitis and subsequently as B-cell lymphoma by the molecular technique of polymerase chain reaction heteroduplex analysis. DESIGN: Observational case report. METHODS: Clinical, histologic, immunohistochemical, and polymerase chain reaction heteroduplex analysis findings are presented. RESULTS: A 32-year-old man developed unilateral blepharoptosis secondary to an extensive palpebral conjunctival follicular-like process. Excisional biopsy showed a dense small lymphocyte infiltrate consistent with benign lymphoid hyperplasia by histology and immunohistologic marker studies. Polymerase chain reaction heteroduplex analysis revealed low-grade B-cell lymphoma, however. Systemic examination was negative. Focal radiation therapy was performed, and preliminary results show no signs of lymphoma. CONCLUSIONS: Polymerase chain reaction heteroduplex analysis established a diagnosis of conjunctival B-cell lymphoma in the absence of supporting histology and immunohistochemistry studies. This technique may provide independent, diagnostic distinction between benign lymphoid hyperplasia and low-grade B-cell lymphoma of the ocular adnexa.

Adult↗
PubMed2003

Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma.

PURPOSE: To present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia. DESIGN: Observational case report; follow-up at 30 months. METHODS: In a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month. RESULTS: After MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. Cataract surgery was performed uneventfully. The patient was followed up for 30 months. CONCLUSIONS: In selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.

Administration, Topical↗
PubMed2003

A conjunctival leiomyoma.

PURPOSE: To report a conjunctival leiomyoma. DESIGN: Observational case report. METHODS: A 35-year-old man was referred to us for evaluation of a lesion in his left eye. The lesion had been present for 1 year but had recently caused irritation. Ophthalmologic examination revealed an elevated mass in the episclera. There was no associated conjunctival/episcleral injection. Ocular examination was otherwise entirely normal. An excisional biopsy was performed. RESULTS: The histopathologic and immunohistochemistry examinations established the diagnosis of a conjunctival leiomyoma. CONCLUSION: This case represents the first report, known to date, describing the occurrence of a conjunctival leiomyoma.

Adult↗
PubMed1997

Female genital tract papillomavirus in conjunctival papillomas of infancy.

PURPOSE: To show the association between conjunctival papillomas present during infancy and maternal infection with human papillomavirus. METHOD: Case report of conjunctival papillomas occurring in an infant born to a mother with a human papillomavirus infection of the vulva during pregnancy. RESULT: The infant developed conjunctival papillomas caused by human papillomavirus of the female genital tract. CONCLUSIONS: Conjunctival papillomas present during infancy may be caused by vertical transmission of the human papillomavirus from mother to infant during delivery. Mothers of infants with conjunctival papillomas should be examined for diseases associated with human papillomavirus.

Adult↗