Conjunctival squamous intraepithelial neoplasia and its differential diagnosis

Reese, Alexander; Margo, Curtis E.

doi:10.1136/jclinpath-2020-207302

Cited by 3 publications

(3 citation statements)

References 18 publications

(28 reference statements)

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“…Their distinction can be challenging when typical pagetoid cells of intraepithelial sebaceous neoplasia are not present and greater reliance on immunohistochemical stains is required. 3 Clinicians have traditionally divided the inflammatory pattern of the conjunctiva into papillary and follicular (i.e., papillary and follicular conjunctivitis). Large or "giant" ( > 1 mm) papillae are useful in diagnosing vernal, atopic, and contact-lens-associated conjunctivitis.…”

Section: Clinical Contextmentioning

confidence: 99%

“…The 2 offenders in this regard are intraepithelial squamous neoplasia and intraepithelial sebaceous neoplasia, both of which are diagnosed based on the presence of cellular atypia and loss of normal cellular maturation. Their distinction can be challenging when typical pagetoid cells of intraepithelial sebaceous neoplasia are not present and greater reliance on immunohistochemical stains is required 3 …”

Section: Clinical Contextmentioning

confidence: 99%

“…It is 76 pages in length and cites 280 references 2 . Relatively few cases of conjunctivitis require biopsy and when biopsy is performed it is often to exclude conditions than mimic chronic conjunctival inflammation like ocular surface neoplasia 3 . There are, however, several inflammatory diseases of conjunctiva such as ocular mucous membrane pemphigoid that benefit from timely diagnostic biopsy and immunofluorescent studies.…”

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confidence: 99%

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Conjunctivitis: A Primer on Conjunctival Biopsy and Approach to Histopathologic Diagnosis

Margo

Harman

2023

Advances in Anatomic Pathology

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Conjunctivitis, or inflammation of the mucosal covering the anterior third of sclera and inner eyelid, is a common clinical condition of varied causation. Most cases are self-limited due to infection or allergy and rarely necessitate biopsy. Inflammation of the conjunctiva, however, is one of the most common principal histopathologic diagnoses rendered when the tissue is biopsied. In the context of conjunctivitis, biopsy is usually performed when inflammation is chronic and recalcitrant to therapy, has clinically atypical features, or requires an etiologic diagnosis when one cannot be reached through other laboratory methods. The exclusion of ocular surface neoplasia in a chronically inflamed conjunctiva is a common justification for biopsy. When inflammation is the principal histopathology finding, it is desirable—whenever feasible—to establish the cause. This brief review provides a guide in how histologic findings of an inflamed conjunctiva can direct the clinical evaluation towards an etiologic diagnosis.

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Section: Clinical Contextmentioning

confidence: 99%

Section: Clinical Contextmentioning

confidence: 99%

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confidence: 99%

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Conjunctivitis: A Primer on Conjunctival Biopsy and Approach to Histopathologic Diagnosis

Margo

Harman

2023

Advances in Anatomic Pathology

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Complex clinical and cytological diagnosis of eye adnexa epithelial tumors

Saakyan,

Zhiltsova,

Borodin

et al. 2024

Rossijskij oftalʹmologičeskij žurnal

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Purpose. Studying clinical and cytological signs of malignant epithelial genesis tumors of eye adnexa. Material and methods. In 2015–2020, 308 patients aged from 23 to 87 (58.0 ± 6.7) years with suspected malignant neoplasms of eyelid skin and conjunctiva were cytologically examined. The material for cytological examination was obtained by scraping (n = 271; 88 %), imprinting (n = 27; 8.8 %), and fine needle aspiration biopsy (n = 10; 3.2 %) if the neoplasm was more than 10 mm thick. Preparations were processed and fixed according to the standard technique using panchromic Pappenheim staining. Results. The cytological analysis confirmed the clinical diagnosis and the epithelial genesis of the malignant neoplasm in 273 (88.7 %) patients. The benign nature of the tumor was confirmed in 17 patients (5.5 %) and the non-tumor nature of the process was confirmed in 11 patients (3.6 %). In the group of malignant tumors, basal cell cancer prevailed, affecting 240 patients (87.9 % of all malignant tumors). 27 patients (9.9% ) had squamous cell cancer, 4 patients had meibomian gland cancer in 4 patients, and 2 patients had undifferentiated cancer. Benign tumors included papillomas (n = 11), while tumor-like lesions included atheromas (n = 3) and granulation polyps (n = 3). Non-tumor lesions involved productive inflammation of the chalazion type (n = 7), or chronic inflammation of a reactive nature (n = 4). 22 patients had histological examination to check the diagnosis, in all cases the histological outcome coincided with the cytological diagnosis. Conclusion. The comprehensive clinical and cytological study allowed us to specify cytomorphological characteristics of epithelial tumors of the eye adnexa: the basal cell cancer and its varieties according to the clinical forms of the tumor, squamous cell cancer and meibomian gland cancer, and papilloma. The complex clinical and cytological method of diagnostics is easily applicable in out-patient conditions, allowing us to specify the diagnosis during the initial visit, which considerably reduces the time required for full patient’s examination.

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Conjunctival epithelial hyperplasia in a patient with a nodular lesion in the palpebral conjunctiva: A case report

et al. 2022

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The conjunctiva is a thin and delicate mucous membrane lining the inner eyelid and the anterior surface of the eyeball. Although hyperplastic changes can occur due to nonspecific chronic inflammation, 'conjunctival epithelial hyperplasia' has not been sufficiently established as a pathological entity. Additionally, the immunohistochemical (IHC) features of both the intact conjunctiva epithelium and conjunctival epithelial hyperplasia have not been sufficiently evaluated. The present report describes the case of an 86-year-old man who consulted with an ophthalmologist for a 6-month-old nodular lesion on his left eye. Located in the medial aspect of the left lower palpebral conjunctiva, the lesion was slightly erythematous and smooth. An excisional biopsy of the lesion was performed to obtain a pathological diagnosis. The hematoxylin and eosin sections revealed a thickened conjunctival epithelium composed of hyperplastic cuboidal epithelial cells and goblet cells, indicating conjunctival epithelial hyperplasia. Atypia, increased mitosis and a papillomatous architecture, indicative of neoplastic changes, were not observed. This resulted in conjunctival squamous intraepithelial neoplasia and squamous cell papilloma being ruled out. IHC analysis was performed to further characterize the lesion as well as the intact conjunctival epithelium. The thick conjunctival epithelium was composed of epithelial cells that stained positive for cytokeratin [AE1/AE3 (intensity: +), CK5/6 (intensity: ++), and CK7 (intensity: +)] and p63-positive basal cells (intensity: +) whose presence in the conjunctiva has received insufficient recognition. Moreover, squamous metaplasia was found in a segment of the thick conjunctiva, which exhibited IHC features similar to those of hyperplasia. CK5/6 was positive, indicating endogenous squamous differentiation of the conjunctival epithelial hyperplasia. These findings led to the diagnosis of conjunctival epithelial hyperplasia as a pathological entity. Further collection and analysis of several cases of conjunctival epithelial hyperplasia may lead the development of preventative methods and drug treatments for this lesion, and additional prognostic data, such as the recurrence rate.

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Conjunctival squamous intraepithelial neoplasia and its differential diagnosis

Cited by 3 publications

References 18 publications

Conjunctivitis: A Primer on Conjunctival Biopsy and Approach to Histopathologic Diagnosis

Conjunctivitis: A Primer on Conjunctival Biopsy and Approach to Histopathologic Diagnosis

Complex clinical and cytological diagnosis of eye adnexa epithelial tumors

Conjunctival epithelial hyperplasia in a patient with a nodular lesion in the palpebral conjunctiva: A case report

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