Update on Diagnosis and Management of Conjunctival Papilloma

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Abstract

Conjunctival papilloma is an acquired benign squamous cell tumor that can present at any age, but most frequently in the third and fourth decades of life. Papillomas have been associated with human papilloma virus (HPV) infection, usually types 6 and 11.

Although histopathological diagnosis remains the gold standard, the advent of newer non-invasive imaging modalities such as optical coherence tomography (OCT) is transforming the way we diagnose and treat ocular surface tumors, including conjunctival papilloma. Management of these lesions can prove a challenge to the treating physician since not all lesions respond to medical and/or surgical therapy and in fact may worsen after surgical manipulation.

In this review, the epidemiology, pathophysiology, clinical characteristics, and diagnosis of conjunctival papilloma including the use of OCT are discussed. Indications, efficacy, and side effects of currently available management options are also reviewed to guide the selection of the best treatment approach.

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Most cited references 133

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Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).

Lauri E. Markowitz, Eileen Dunne, Mona Saraiya … (2014)

This report summarizes the epidemiology of human papillomavirus (HPV) and associated diseases, describes the licensed HPV vaccines, provides updated data from clinical trials and postlicensure safety studies, and compiles recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of HPV vaccines. Persistent infection with oncogenic HPV types can cause cervical cancer in women as well as other anogenital and oropharyngeal cancers in women and men. HPV also causes genital warts. Two HPV vaccines are licensed in the United States. Both are composed of type-specific HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein using recombinant DNA technology produces noninfectious virus-like particles (VLPs). Quadrivalent HPV vaccine (HPV4) contains four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18. Bivalent HPV vaccine (HPV2) contains two HPV type-specific VLPs prepared from the L1 proteins of HPV 16 and 18. Both vaccines are administered in a 3-dose series. ACIP recommends routine vaccination with HPV4 or HPV2 for females aged 11 or 12 years and with HPV4 for males aged 11 or 12 years. Vaccination also is recommended for females aged 13 through 26 years and for males aged 13 through 21 years who were not vaccinated previously. Males aged 22 through 26 years may be vaccinated. ACIP recommends vaccination of men who have sex with men and immunocompromised persons (including those with HIV infection) through age 26 years if not previously vaccinated. As a compendium of all current recommendations for use of HPV vaccines, information in this report is intended for use by clinicians, vaccination providers, public health officials, and immunization program personnel as a resource. ACIP recommendations are reviewed periodically and are revised as indicated when new information and data become available.

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Papillomavirus infections--a major cause of human cancers.

H zur Hausen (1996)

The papillomavirus family represents a remarkably heterogeneous group of viruses. At present, 77 distinct genotypes have been identified in humans and partial sequences have been obtained from more than 30 putative novel genotypes. Geographic differences in base composition of individual genotypes are generally small and suggest a low mutation rate and thus an ancient origin of today's prototypes. The relatively small size of the genome permitted an analysis of individual gene functions and of interactions of viral proteins with host cell components. Proliferating cells contain the viral genome in a latent form, large scale viral DNA replication, as well as translation and functional activity of late viral proteins, and viral particle assembly are restricted to differentiating layers of skin and mucosa. In humans papillomavirus infections cause a variety of benign proliferations: warts, epithelial cysts, intraepithelial neoplasias, anogenital, oro-laryngeal and -pharyngeal papillomas, keratoacanthomas and other types of hyperkeratoses. Their involvement in the etiology of some major human cancers is of particular interest: specific types (HPV 16, 18 and several others) have been identified as causative agents of at least 90% of cancers of the cervix and are also linked to more than 50% of other anogenital cancers. These HPV types are considered as 'high risk' infections. Their E6/E7 oncoproteins stimulate cell proliferation by activating cyclins E and A, and interfere with the functions of the cellular proteins RB and p53. The latter interaction appears to be responsible for their mutagenic and aneuploidizing activity as an underlying principle for the progression of these HPV-containing lesions and the role of high risk HPV types as solitary carcinogens. In non-transformed human keratinocytes transcription and function of viral oncoproteins is controlled by intercellular and intracellular signalling cascades, their interruption emerges as a precondition for immortalization and malignant growth. Recently, novel and known HPV types have also been identified in a high percentage of non-melanoma skin cancers (basal and squamous cell carcinomas). Similar to observations in patients with a rare hereditary condition, epidermodysplasia verruciformis, characterized by an extensive verrucosis and development of skin cancer, basal and squamous cell carcinomas develop preferentially in light-exposed sites. This could suggest an interaction between a physical carcinogen (UV-part of the sunlight) and a 'low risk' (non-mutagenic) papillomavirus infection. Reports on the presence of HPV infections in cancers of the oral cavity, the larynx, and the esophagus further emphasize the importance of this virus group as proven and suspected human carcinogens.

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How does photodynamic therapy work?

B Henderson, T J Dougherty (1992)

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Author and article information

Contributors

Carol L. Karp: ckarp@med.miami.edu

Journal

Journal ID (nlm-ta): Eye Vis (Lond)

Journal ID (iso-abbrev): Eye Vis (Lond)

Title: Eye and Vision

Publisher: BioMed Central (London )

ISSN (Electronic): 2326-0254

Publication date (Electronic): 18 June 2019

Publication date PMC-release: 18 June 2019

Publication date Collection: 2019

Volume: 6

Electronic Location Identifier: 18

Affiliations

[1 ]ISNI 0000 0004 1936 8606, GRID grid.26790.3a, Department of Ophthalmology, , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, ; 900 NW 17th Street, Miami, FL 33136 USA

[2 ]GRID grid.484420.e, Miami Veterans Administration Medical Center, ; 1201 NW 16th Street, Miami, 33125 FL USA

Article

Publisher ID: 142

DOI: 10.1186/s40662-019-0142-5

PMC ID: 6580461

PubMed ID: 31236424

SO-VID: 194c8f1a-85e9-493d-a02e-a99165b479d6

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 March 2019

Date accepted : 24 May 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: P30EY014801

Funded by: FundRef http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;

Award ID: Unrestricted Award and Career Development Awards

Funded by: FundRef http://dx.doi.org/10.13039/100000005, U.S. Department of Defense;

Award ID: W81XWH-09-1-0675

Award Recipient : Anat Galor

Custom metadata

Keywords: conjunctival papilloma,squamous cell papilloma,optical coherence tomography,treatment,interferon,mitomycin,surgery,cryotherapy,human papilloma virus

Data availability:

Keywords: conjunctival papilloma, squamous cell papilloma, optical coherence tomography, treatment, interferon, mitomycin, surgery, cryotherapy, human papilloma virus

Update on Diagnosis and Management of Conjunctival Papilloma

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Abstract

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Karger: Ophthalmology

Most cited references 133

Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).

Papillomavirus infections--a major cause of human cancers.

How does photodynamic therapy work?

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