Aim: To examine conjunctival papilloma and normal conjunctival tissue for the presence of human papillomavirus (HPV). Methods: Archival paraffin wax-embedded tissue from 165 conjunctival papillomas and from 20 histological normal conjunctival biopsy specimens was analysed for the presence of HPV by PCR. Specimens considered HPV positive using consensus primers, but with a negative or uncertain PCR result using typespecific HPV probes, were analysed with DNA sequencing. Results: HPV was present in 86 of 106 (81%) b-globin-positive papillomas. HPV type 6 was positive in 80 cases, HPV type 11 was identified in 5 cases and HPV type 45 was present in a single papilloma. All the 20 normal conjunctival biopsy specimens were b-globin positive and HPV negative. Conclusion: There is a strong association between HPV and conjunctival papilloma. The study presents the largest material of conjunctival papilloma investigated for HPV and the first investigation of HPV in normal conjunctival tissue. HPV types 6 and 11 are the most common HPV types in conjunctival papilloma. This also is the first report of HPV type 45 in conjunctival papilloma.H uman papillomavirus (HPV) is associated with the occurrence of conjunctival papilloma. 1 The individual HPV types are trophic for cutaneous or mucosal epithelium and have different oncogenic potentials. 2 So far, low-risk HPV types 6 and 11 and high-risk HPV types 16 and 33 have been identified in conjunctival papilloma. 1 3-6 To our knowledge, similar studies on normal conjunctiva have not been reported to date. Therefore, it is still unclear whether HPV plays a crucial role in the development of conjunctival papilloma.The purpose of this study was to analyse the largest material of conjunctival papilloma to date (fig 1) and normal conjunctival tissue for the presence of various HPV types. The aim was also to investigate for HPV types not described previously in conjunctival papilloma, and to determine whether HPV is a common pathogen on the normal ocular surface. MATERIALS AND METHODSWe studied 165 cases of conjunctival papilloma from the files of the Eye Pathology Institute, Copenhagen, Denmark. The formalin-fixed, paraffin wax-embedded specimens were registered during the period 1988-97. A histological review of the diagnosis was made in each case. The material did not include our previous series of 55 conjunctival papillomas. 1

Aim-To examine conjunctival papillomas for the presence of human papillomavirus (HPV) and koilocytosis. Methods-Archival paraYn embedded tissue from 55 conjunctival papillomas was analysed for the presence of HPV by polymerase chain reaction and subsequent filter hybridisation. Histological sections of the 55 papillomas were evaluated for the presence of koilocytosis. Results-HPV was present in 48 of 52 (92%) globin positive papillomas. HPV type 6/11 were found in 40 of 47 investigated papillomas and a double infection with HPV 6/11 and 16 was identified in a single papilloma. In six papillomas the HPV type could not be identified. Koilocytosis was present in 22 of 55 papillomas (40%). Conclusion-There is a strong association between HPV and conjunctival papillomas. HPV type 6/11 is the most common HPV type in conjunctival papilloma. The sensitivity of koilocytosis as an indicator of HPV in conjunctival papilloma is low. (Br J Ophthalmol 2001;85:785-787)

ABSTRACT.Purpose: To determine morphological and clinical characteristics of conjunctival papilloma. Methods: Specimens of conjunctival papilloma registered during the period 1983-1997 were collected. For each case the patient's sex and age, number of papillomas/patient, seasonal debut, duration, number of recurrences, localisation and presence of dysplasia and/or inflammation in the papilloma were registered. Results: A total of 245 papillomas in 219 patients were found. 132 (60.3%) of the patients were males. The age distribution showed skewness to the left with a peak in the age groups 20-29 years and 30-39 years. No variation of seasonal debut was found. 14 patients (6%) had more than one papilloma concurrently. 24 (11%) of the patients had recurrence. Most of the papillomas were located medially and inferiorly. 98 (40%) of the papillomas were inflamed. 14 (6%) of the papillomas were dysplastic. Conclusion:The conjunctival papilloma is a common tumour. More males than females develop conjunctival papillomas and the incidence is highest among patients aged 20-39 years. The conjunctival papilloma is primarily located medially and inferiorly.Key words: papilloma -conjunctiva -localisation -dysplasia -sex -age -distribution. T he squamous cell papilloma of the conjunctiva is a benign and common epithelial tumour.Conjunctival papillomas may have an exophytic, mixed or inverted growth pattern (Conlon et al. 1994;Streeten et al. 1979). The exophytic configuration may be sessile or pedunculated. Inverted papillomas of the conjunctiva are very rare (Streeten et al. 1979).Dysplasia may be observed, but carcinoma rarely develops in a conjunctival papilloma (Zimmerman 1980).In a study of 1016 epibulbar lesions (Ash 1950) the conjunctival papilloma was found to be the second most frequent epithelial lesion and the conjunctival papilloma is an equally frequent lesion of the caruncle (Santos & Gó mez-Leal 1994).The aetiology of the conjunctival papilloma is not known, but it has been associated with human papillomavirus (HPV) types 6,11 and 16 (McDonnell et al. 1987;Saegusa et al. 1995). HPV types 16 and 18 have in addition been found in normal conjunctival tissue (Karcioglu 1997). Material and MethodsThe files at the Eye Pathology Institute, University of Copenhagen, Denmark were reviewed for the period 1983 to 1997, included. Specimens diagnosed as a conjunctival papilloma were identified.The following data were registered from the pathology referral forms: the patient's sex and age, number of papillomas/patient, seasonal debut of the papilloma, duration, number of recurrences, the affected eye (right or left), localisation and presence of dysplasia and/or inflammation in the papilloma.A chi-squared test was used in order to test for associations between the following parameters: sex and localisation of the papilloma, localisation and affected eye and sex and age-distribution. A probability level of pϽ0.05 was considered significant. ResultsA total number of 245 papillomas in 219 patients were registered. The chi-squared...

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Aim: To define the clinical and histopathological characteristics of primary lacrimal sac lymphoma in a predominantly white population. Methods: Specimens of lacrimal sac lymphoma and follow up data were solicited from members of the Ophthalmic Oncology Task Force of the European Organization for Research and Treatment of Cancer (EORTC) and the European Ophthalmic Pathology Society (EOPS). Specimens were stained with haematoxylin and eosin and an immunohistochemical panel against leucocyte antigens was applied. Diagnosis was reached by consensus of five experienced pathologists according to the World Health Organization classification system. The histopathological findings were correlated with the clinical data. Results: Of 15 primary lacrimal sac lymphomas, five (33%) were diffuse large B cell lymphoma (DLBCL), five (33%) were extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma), three were classified as ''transitional MALT lymphoma,'' being in transition from MALT lymphoma to DLBCL, and two were unclassified B cell lymphomas. Nine of the patients were female, and the median age at the time of diagnosis was 71 years (range 45-95 years). The most frequent presenting symptoms were epiphora (85%), swelling in the region of the lacrimal sac (79%), and dacryocystitis (21%). All but one patient presented in stage I. Systemic spread occurred in three of nine patients (33%). The 5 year overall survival was 65%. Conclusions: DLBCL and MALT lymphoma are equally common in the lacrimal sac in contrast with the remaining periorbital and/or orbital region where MALT lymphoma predominates.