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PubMed1999

Orbital malignancy in Papua New Guinea: a 21 year review.

BACKGROUND: Information about orbital malignancies in Papua New Guinea (PNG) is limited to reports published 20 years ago. The present retrospective study was performed to establish the pattern of malignant orbital lesions occurring in PNG and to see whether the pattern is any different from that reported in the earlier series and in other countries. Papua New Guinea is special in that it has a large and relatively homogenous population unaffected,to a large extent, by contact with the'outside world'. METHODS: The records of 176 proven cases of orbital malignancy treated between 1975 and 1996 were studied with respect to type of tumour, age, gender; mode of presentation and, where possible, treatment and its outcome. RESULTS: Orbital tumours were found to be uncommon relative to other malignancies. The most common orbital tumour encountered in the present study was orbital extension of retinoblastoma (40.3%). These tumours were all unilateral and were associated with a very high mortality. No bilateral or familial cases were seen. Squamous cell carcinomas were the second most common tumours (25.6%) and were seen in young adults (average age 36.6 years). Basal cell carcinomas (9.1%) occurred later (average age 54 years) and were more common in the lighter-skinned Southern Highlanders and expatriates. The other malignancies seen included lacrimal gland tumours (3.4%), malignant melanomas (4.5%), lymphomas (3.4%), rhabdomyosarcomas (1.7%), meibomian cell carcinomas (1.7%) and soft tissue sarcomas. CONCLUSIONS: Most patients presented late and the mortality rate was high. This could also reflect the relative paucity of ophthalmic and oncological services in the country as well as psychosocial attitudes to disease. Many patients live far from medical services and may be treated by traditional healers before coming to a hospital.

Adolescent↗
PubMed2001

Prostaglandin E2 signalling pathway in human T lymphocytes from healthy and conjunctiva basal cell carcinoma-bearing subjects.

Prostaglandin E-induced signal transduction pathways in human T cells from healthy and uveal melanoma-bearing subjects were studied. Transfection experiments showed that PGE2 was able to phosphorylate and activate the fusion trans-activator of the cAMP responsive element-binding protein (CREB). Phosphorylation was at least partially mediated by protein kinase A, as evidenced by the effects of specific kinase inhibitors. Western blotting experiments, which were performed to identify the CREB/ATF2 family members involved in the response to PGE2, revealed a modulation of proteins CREB1, CREB2 and ATF2 and phosphorylation of the 43 kDa form of CREB. Experiments of immunoprecipitation with CREB-binding protein (CBP) demonstrated that, after PGE2 treatment, all of the CREB/ATF isoforms studied, as well as the phosphorylated form of CREB (p-CREB), interacted with CBP. In basal conditions, T cells from patients with conjunctiva basal cell carcinoma showed the presence of p-CREB, which coimmunoprecipitated with CBP. CREB phosphorylation did not modify after PGE2 treatment whereas the p-CREB fraction bound to CBP increased in a delayed manner compared to normal subjects.

Activating Transcription Factor 2↗
PubMed2002

Clinical aspects of conjunctival melanoma.

Conjunctival melanoma is a rare but important condition encountered in ophthalmology. This paper reviews conjunctival melanoma as a clinical entity, with particular emphasis on differential diagnosis, management and prognostic factors. Relevant references were located through a comprehensive search of articles published between 1980 and early 2001 on Medline, using both the WinSpirs and PubMed platforms. The references of these articles were then checked for further articles of relevance. The condition is uncommon and its presentation variable; therefore, relevant studies were found to suffer from small numbers of subjects. This may be the cause of the confusion that still surrounds the condition and its management.

Conjunctival Neoplasms↗
PubMed2002

Use of mitomycin C in the treatment of corneal conjunctival intraepithelial neoplasia.

PURPOSE: To evaluate the efficacy of topical mitomycin C as a treatment of corneal conjunctival intraepithelial neoplasia. METHODS: An open prospective analysis of 20 cases of corneal conjunctival intraepithelial neoplasia with recurrent disease (17 patients) or refusing surgery (three patients) were treated with topical mitomycin C. Treatment was with mitomycin C eye drops, either 0.02% or 0.04%, four times daily for 1 week followed by a week off the cycle then repeated for a second week. Patients were examined weekly until the lesions were eradicated. RESULTS: Clinical resolution of disease occurred in 18/20 cases. The mean time to resolution was 4.5 weeks, the mean number of cycles of treatment was two. Average follow up was 13 months with four cases of recurrent disease. These four cases were retreated with complete resolution in two cases. Epithelial toxicity occurred in 10/20 eyes and lid toxicity in two cases. There were no long-term complications on discontinuing mitomycin C. CONCLUSIONS: Mitomycin C is effective in inducing regression of corneal conjunctival intraepithelial neoplasia. Complications are common but self-limiting. An optimal regimen is still to be established.

Administration, Topical↗
PubMed2001

Ocular adnexal lymphoproliferative disease: a series of 73 cases.

BACKGROUND: This study involved 73 patients with lymphoproliferative lesions of the ocular adnexa. The lesions were categorized using the Revised European American Lymphoma classification of lymphoid tissues and analysed to determine the frequency and prognostic impact of tumour type, location, stage and patient's age and sex. METHODS: The clinical, histopathological, immunohistochemical and phenotypic analysis by flow cytometry and follow-up data were studied. RESULTS: The ocular adnexal lymphoproliferative lesions included 70 lymphomas and six reactive lymphoid hyperplasia. Seventy-nine per cent had stage IE disease, 4% stage II, 1.5% stage III and 15.5% stage IV. Five patients (7%) had a past history of systemic lymphoma. Major histological types were extranodal marginal zone lymphoma (MZL) in 44 (63%), follicular (FL) in 12 (17%), diffuse large B-cell (DLBCL) in eight (11%), mantle cell (MCL) in two (3%), B-cell chronic lymphocytic leukaemia (CLL)/small lymphocytic lymphoma in two (3%), peripheral T-cell lymphoma (PTCL) one (1.5%) and natural killer cell lymphoma (NKCL) in one (1.5%). Longest survival was seen in those with low-grade lymphomas (MZL and FL) and worst in PTCL and NKCL. Lymphoma-related mortality was 2% for MZL, 33% for FL, 38% for DLBCL, and 100% for MCL, PTCL and NKCL. Systemic lymphoma was present prior to, at presentation or at subsequent follow up in 26/68 (39%) of all lymphoma patients, 17% for MZL, 38% for DLBCL, 83% for FL, and 100% for MCL, CLL, PTCL and NKCL. CONCLUSION: The majority of ocular adnexal lymphomas were low-grade B-cell lymphomas (MZL). Multivariate analysis showed that the only significant independent predictors of all causes of mortality were the histological type of lymphoma and the stage of disease at presentation.

Adult↗
PubMed2001

Lipogranulomatous conjunctivitis: clinical findings from 21 eyes in 13 cats.

OBJECTIVE: The clinical and, where available, histologic features of lesions fitting a previous description of lipogranulomatous conjunctivitis were reviewed retrospectively from a series of cats. ANIMALS STUDIES: Thirteen cats (21 eyes) with lesions consistent with a diagnosis of lipogranulomatous conjunctivitis were seen over a 4-year period in a referral practice in southern Australia. Affected cats ranged in age from 6 to 16 years (mean 11.2 +/- 3.6 years). RESULTS: Twelve cats were domestic shorthair or longhair cats and one was a British shorthair cat. Five cats were white, four were bicolor, two were orange tabby and two were dilute orange tabby. Lesions were always found in the palpebral conjunctiva, adjacent to the eyelid margin. They affected upper eyelids only in five cases, and upper plus lower eyelids in eight cases. Lesions were bilateral in eight cases. Lesions were excised in eight cases, with resolution of associated irritation and no signs of lesion recurrence during a 4- to 21-month follow-up period. SUMMARY: Histologic features of tissues excised from surgically treated cases were consistent with a previous report of lipogranulomatous conjunctivitis and with descriptions of chalazia. A possible role of actinic radiation in the etiopathogenesis of lesions is discussed.

Animals↗
PubMed2002

Conjunctival dermoid in two guinea pigs: a case report.

Clinical and histologic findings of conjunctival dermoids in two unrelated guinea pigs are described. The dermoids were treated surgically by resection with superficial lamellar keratectomy and corneal epithelial debridement. Histologically the dermis underneath a stratified squamous keratinized and variably pigmented epithelium consisted of multiple hair follicles, with clearly visible arrectores pilorum muscles, sebaceous glands and loose vascularized fatty tissue.

Animals↗
PubMed2003

Intravascular papillary endothelial hyperplasia of the conjunctiva in a horse.

OBJECTIVE: Vascular tumors of the conjunctiva in the horse are rare. We present a unique case of an intravascular papillary endothelial hyperplasia of the conjunctiva. ANIMAL STUDIED: Horse. PROCEDURES: Case report. A 6-year-old-mare presented with a red mass in the conjunctiva of the left eye. After complete ophthalmologic examination the lesion was excised. The tissue was processed for light microscopy and studied histopathologically. RESULTS: Pathologic examination revealed a nonencapsulated vascular lesion composed of confluent vascular spaces filled by multiple papillary structures composed of a central collagenous core lined by hyperplastic endothelial cells. There was neither atypical endothelial cell nor mitotic activity. CONCLUSIONS: Intravascular papillary endothelial hyperplasia is a benign proliferative lesion that should be differentiated from malignant vascular tumors.

Animals↗
PubMed2002

Treatment of conjunctival lymphomas by beta-ray brachytherapy using a strontium-90-yttrium-90 applicator.

We reviewed the outcome of the 10 patients (13 eyes) with localized, biopsy-proven, low-grade lymphoma of the conjunctiva treated at our Department between 1988 and 1997. All patients were treated by beta-ray brachytherapy using a bidirectional 90Sr-90Y ophthalmic applicator (Applicator SIA 2, Amersham plc). Total doses, prescribed at the surface of the applicator, varied between 40 Gy and 80 Gy. With a median follow-up of 78 months (range: 14 to 146 months), seven patients remained with no evidence of relapse (67.5% 10 year disease free survival). Local control was achieved in 10 out of 13 eyes (76.9%). Two of the three local relapses were marginal. One of these three patients also developed a metachronous lymphoma in the contralateral conjunctiva. These three patients underwent a second course of brachytherapy with 90Sr/90Y and remained free of second relapse 109, 68 and 33 months after salvage therapy. No cases of systemic relapse were observed. Late (LENT-SOMA) complications were of grade 2 in five eyes, of grade 3 in one eye and of grade 4 in one eye. Late complications of grade 2 or higher were observed in one out of five patients (20%) treated with doses lower or equal to 50 Gy and in six out of eight patients (75%) treated with doses higher than 50 Gy (P=0.086). Our data indicates that beta-ray brachytherapy was ultimately able to control most conjunctival lymphomas but carried a risk of late complications and marginal relapses that was possibly higher than the rates reported for other radiotherapy techniques.

Adult↗
PubMed2001

[Conjunctival balloon cell nevi--light- and electronmicroscopic findings in 2 patients].

CASE REPORTS: Two 19-year-old patients presented with small nasal conjunctival tumors. Histologic examination revealed subepithelial tumors consisting of large cells with deeply basophilic, small, centrally-placed nuclei and abundant, slightly eosinophilic cytoplasm with microvesicles. Electron microscopy showed premelanosomes in some of the balloon cells. CONCLUSION: The balloon cell nevus is a rare variant of the conjunctival nevi. The characteristic intracellular microvesicles are probably degenerative remnants of premelanosomes.

Adult↗
PubMed2001

[Treatment of 9 squamous epithelial carcinoma in situ lesions of the conjunctiva (CIN) with mitomycin C eyedrops in cytological and DNA image cytometric control].

BACKGROUND: Conjunctival intraepithelial neoplasia (CIN) is a frequent conjunctival tumor. Following excision alone recurrences are frequent. An effective postsurgical recurrence prevention is therefore highly desirable. In this study we aimed to evaluate the effectivity of postsurgical chemotherapy of conjunctival squamous cell carcinoma in situ (CIN) with mitomycin C eyedrops. We introduced the otherwise established diagnostic tools of cytology and DNA-image-cytometry to the diagnosis and therapy-monitoring of CIN. PATIENTS AND METHODS: We treated 9 patients with CIN. For diagnosis the results of cytology and cytometry of presurgically obtained brush smears were compared with the histologic evaluation of the excised tissue. After surgery, we administered topical chemotherapy with mitomycin C eye drops 0.02% (MMC). Conjunctival brush smears were again evaluated by cytology and DNA-image-cytometry for postsurgical therapy monitoring. RESULTS: The clinical diagnosis of CIN was fully confirmed by cytology, DNA-image-cytometry and histology respectively in 7 patients. In one patient, the results of the applied diagnostic methods differed in results: Histologic evaluation indicated a moderate dysplasia but DNA-image-cytometry showed significant DNA-aneuploidy unequivocally indicating neoplasia like squamous cell carcinoma. In another patient the preoperatively obtained conjunctival brush smears could not properly analyzed by cytometry but clinical diagnosis was confirmed by histology. MMC-therapy was well tolerated except for a self-limited conjunctivitis. A complete remission of CIN was obtained in 8 of 9 patients (89%) who were free of CIN recurrences during a follow-up period of 27.2 months (11-48). Only one patient suffered from a recurrence 14 months after surgery and after 2 MMC-cycles. CONCLUSION: Adjuvant topical mitomycin C appears to be effective in the prevention of recurrences of conjunctival CIN after surgical removal. Our results indicate that at least 4 cycles of topical MMC are required to prevent local recurrences in the long term. Cytology and DNA-image cytometry are highly sensitive and specific methods for diagnosis and therapy monitoring of conjunctival squamous cell carcinoma in situ (CIN).

Adult↗
PubMed2001

[Conjunctival neuromas and prominent corneal nerve fibers as diagnostic indication of multiple endocrine disease].

BACKGROUND: Multiple endocrine neoplasias (MEN-syndromes) represent diverse, mostly autosomal-dominant inherited, seldom sporadic diseases. MEN 2B-syndrome comprises medullary thyroid carcinoma, pheochromocytoma and mucosal neuromas. PATIENT: A 30 year old male patient presented with bilateral chronic irritation of the ocular surface. The biomicroscopy revealed intraconjunctival worm-like alterations, prominent corneal nerves and nodules on the upper lid margins. HISTOLOGY: The performed conjunctival biopsy showed nearly no goblet cells, but prominent intrastromal, immunohistochemical S100-positive neuromas. RESULTS: The initiated investigations revealed bilateral multifocal medullary thyroid carcinoma and a left sited pheochromocytoma. CONCLUSION: Conjunctival neuromas and prominent corneal nerves can be diagnostic for the MEN 2B-syndrom. Early diagnosis and prophylactic thyroidectomy are expected to improve the life expectancy even in asymptomatic gene-carriers.

Adult↗
PubMed2001

[Massive intraocular invasion of conjunctiva by squamous cell carcinoma--a case report].

BACKGROUND: Squamous cell carcinoma of the conjunctiva is a mostly solitary growing tumor located at the limbus region, which seldom invades the eye. We present an unusual case of conjunctival carcinoma with marked intraocular involvement, which appeared primarily as a chronic inflammation with corneal ulcer. CASE REPORT: A 89-year-old female patient was referred to our institution with a suspected ulcus rodens of the cornea. Since one year a refractory conjunctivitis persisted despite of different local treatment. At first presentation, a marked bacterial keratoconjunctivitis with circular necrosis of the conjunctiva, corneal infiltration and perforation was seen. Visual acuity of the right eye was light perception. The left eye was unremarkable. Enucleation of the right eye was performed. Histopathologic examination revealed the diagnosis of squamous cell carcinoma of the conjunctiva with intraocular involvement. There was a marked infiltration of the choroid even behind the equator. No metastases were found. CONCLUSION: Advanced squamous cell carcinoma associated with superinfection may present as a primary inflammatory process. There may be extensive involvement of the choroid. Metastases are probably rare even in advanced cases of this type of carcinoma.

Aged↗
PubMed2001

[The treatment of a primary acquired melanosis of the conjunctiva with atypia by low dose of Mitomycin C 0.02 % - case report with follow up of 2 years].

BACKGROUND: About 70 % of the melanomas of the conjunctiva develop from an primary acquired melanosis (PAM) with atypia. This is the reason why excision, radiation, cryotherapy or a combination of them are proposed for therapy. But, if the acquired melanosis is very large, serious complications will be found with that treatment. PATIENT AND METHOD: A 65-year-old woman has shown a large melanosis of the conjunctiva of her left eye. Biopsies, taken from different sites of the conjunctiva, have confirmed the diagnosis of an acquired melanosis of the conjunctiva with atypia. This has been the reason for our Mitomycin C 0.02 % therapy for one week. It has been repeated once again after half a year. RESULTS: Atypia of the cells was shown in the upper cell layer of the conjunctiva after the first therapy. But after the second therapy no atypia of the cells was present within two years after the last treatment, examining several biopses. CONCLUSION: Looking for an effective treatment without complications, a new therapy with Mitomycin C has been introduced in the last years. As it is not yet clearly known how to use Mitomycin to have maximal effectiveness with minimal complications, the reports about doses and frequency are differing a lot in the literature and are more often considerably lying over the introduced effective dose of our case. If Mitomycin is used in that low dosage and in that special application as shown, it could be a very efficient therapy with less complications.

Administration, Topical↗
PubMed2002

[Malignant conjunctival melanoma. Clinical review with recommendations for diagnosis, therapy and follow-up].

BACKGROUND: Malignant conjunctival melanoma is a rare disease with an incidence of 0.03 - 0.08. This tumour is potentially lethal, even after prompt and proper treatment, especially after delayed onset of therapy. Conjunctival melanoma arises from primary acquired melanosis (PAM), from a preexisting nevus or "de novo" without any precursor at all. In contrast to uveal melanomas, conjunctival melanoma metastasizes via the ipsilateral lymph nodes and in rare cases through the lacrimal duct into the nasal cavities. RESULTS: Removing the local tumour with preservation of visual functions and avoidance of metastases is the therapy of choice. Excision alone is followed by a high rate of recurrence. To minimize local recurrence rate surgical excision should be combined with an additional procedure such as cryotherapy, irradiation, or local chemotherapy with MMC. Surgical technique is characterized by a so-called "no-touch" method avoiding any direct manipulation of the tumour to prevent tumour cell seeding into a new area. The behaviour of conjunctival melanomas is individually unpredictable. Prognostic factors are tumour size and tumour location. Tumours growing extralimbal especially at the fornix, plica and caruncle have a significantly poorer prognosis than limbal tumours. In our own patients the 5-year, 10-year, and 15-year cumulative melanoma-specific survival rate was 84.4 %, 77.7 %, and 75.0 %, respectively. Up to now there is no effective treatment of the metastatic disease. CONCLUSION: In all cases with pigmented lesions of the conjunctiva exclusion of a malignant melanoma has to be the first aim. A patient suffering from a conjunctival melanoma should be referred to an ophthalmo-oncological center for proper treatment. An indefinite follow-up including photodocumentation is necessary since the rate of recurrence is high. An international prospective study would be worthwhile to answer open questions and to develop new kinds of treatment of this potentially fatal tumour.

Combined Modality Therapy↗
PubMedDate not supplied

[Ultrasound biomicroscopy of conjunctival lesions].

BACKGROUND: The value of ultrasound biomicroscopy in the diagnosis of conjunctival lesions is not well established. PATIENTS AND METHODS: For the examination of conjunctival lesions, we used an ultrasound biomicroscope (Humphrey, Zeiss, Oberkochen) with a high frequency transducer (30 MHz). Between January 2000 and August 2001, 28 patients (16 female, 12-male) with conjunctival lesions, aged 9 to 81 years, were available for this study. RESULTS: Histological examination of the excised tissue displayed the presence of a compound naevus (8/28), cysts (6/28), inflammatory processes (3/28), granulomatous processes (2/28), lymphomas (2/28), foreign bodies (2/28), a pterygium (2/28), a malignant melanoma (1/28), a primary acquired melanosis (1/28), and a conjunctival amyloidosis (1/28). Using ultrasound biomicroscopy we were able to demonstrate a cystic tumour in the six patients (21 %) with a cyst of the conjunctiva. In patients suffering from solid tumours of the conjunctiva the definite diagnosis could not be made with ultrasound biomicroscopy alone. The eight patients with compound naevus displayed a somewhat heterogeneous sonographic structure within the tumour. In the patient with a foreign body we were able to demonstrate posterior shadowing of the underlying tissue. CONCLUSION: For evaluation of conjunctival lesions caused by a cyst or a solid tumour, ultrasound biomicroscopy may be an additional diagnostic tool, e. g. for assessing the margins of the tumour. However, up to now it is not possible to differentiate between different lesions solely by means of ultrasonography.

Adolescent↗