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      A Clinicopathologic Study of Excised Conjunctival Lesions

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          Abstract

          Purpose:

          This study was aimed at to determine the frequency of excised conjunctival lesions in a patient population treated over a 10-year period.

          Materials and Methods:

          The data of all excised conjunctival lesions with tissue diagnoses from 1998 to 2008 in the pathology department were analyzed.

          Results:

          The patient group comprised 192 conjunctival specimens; 106 (55.2%) obtained from male patients and 86 (44.8 %) from female patients. The age range was 75 years with a mean age of 27.07 ± 17 years. The most frequent excised lesions were pyogenic granulomas, which represented 30.7% (59 cases). Pigmented epithelial tumors were the second most common benign conjunctival lesions (44 cases, 22.9%). Out of these cases, compound nevus represented 86.4% (38 cases) and junctional nevus represented 6.8% (3 cases). Primary acquired melanosis and subepithelial nevus were reported in two cases (4.5%) and one case (2.3%), respectively. Cystic lesions represented 12% (23 cases). These were mostly ductal retention cysts in 16 cases (70%), occupying the fornix in eight cases. Ocular surface squamous neoplasia (OSSN) was detected in 21 cases (10.9%) significantly affecting an older age group as compared to other lesions (mean age 45.9 ± 16.7). Other less frequent lesions included papilloma (10 cases, 2.5%), dermolipoma (8 cases, 4.2%), solid dermoid (3 cases, 1.6%), hemangioma (15 cases, 7.8%), and benign reactive lymphoid hyperplasia (four cases, 2.1%).

          Conclusion:

          Benign lesions were the most frequent histologically diagnosed conjunctival lesions. The true malignant lesions were lower than what has been described in many reports. The significant proportion of precancerous OSSN can be attributed to sun exposure and ultraviolet light in Egypt.

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          Most cited references24

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          Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors.

          To report the spectrum and frequency of melanocytic and nonmelanocytic conjunctival tumors in an ocular oncology practice. Retrospective noninterventional case series. One thousand six hundred forty-three consecutive patients with a conjunctival mass evaluated at an ocular oncology department. A chart review was conducted to obtain the clinical features of the patient and tumor and to tabulate and categorize the diagnoses. Tumor diagnosis overall and relative to patient age, race, and gender and relative to tumor location and laterality. In 1643 consecutive patients, the tumor was classified as melanocytic in 872 cases (53%) and nonmelanocytic in 771 cases (47%). The nonmelanocytic categories included congenital choristomatous (n = 40 [2%]), epithelial (n = 219 [13%]), vascular (n = 63 [4%]), fibrous (n = 7 [ 60. Of the 219 patients with epithelial tumors, 80% occurred in males, whereas the incidence of melanocytic lesions was equal in males and females. African-American patients represented only 7% of epithelial tumors, <1% of melanomas, and 8% of lymphoid tumors. Conjunctival tumors were of melanocytic origin in 53% of cases and nonmelanocytic origin in 47%. Overall, melanocytic tumors, epithelial tumors, and lymphoid tumors accounted for 74% of all cases. These tumors were far more common in Caucasian patients, and epithelial tumors were found more frequently in men.
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            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.
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              Ocular surface squamous neoplasia: a review.

              Even though ocular surface squamous neoplasia (OSSN) has been recognized for well over a century, the past decade has witnessed advances that have helped rewrite many of the paradigms for the diagnosis and management of these lesions. OSSN occurs predominantly in the elderly for whom they are the third most common oculoorbital tumors after melanoma and lymphoma. In addition to advanced age and male sex, other major risk factors linked to its pathogenesis are ultraviolet light, cigarette smoking, and the human papilloma virus. Although the latter has been linked to OSSN for nearly 4 decades, its identification and role in the pathogenesis of these tumors has been elucidated recently and is addressed in detail in this review. Newer techniques of impression cytology represent a noninvasive and reliable method of diagnosing OSSN and monitoring treated cases. The efficacy of chemotherapeutic agents such as mitomycin C and 5-fluorouracil have been proven in the recent past, making them a clear alternative to the time-tested treatment of surgical excision and cryotherapy. Early reports on the efficacy of topical Iterferon alpha 2b indicate significant promise in providing another alternative for the treatment of some of these neoplasms. These advances thus represent a minimally invasive and highly successful approach to the diagnosis and treatment of OSSN.
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                Author and article information

                Journal
                Middle East Afr J Ophthalmol
                MEAJO
                Middle East African Journal of Ophthalmology
                Medknow Publications (India )
                0974-9233
                0975-1599
                Jan-Mar 2011
                : 18
                : 1
                : 48-54
                Affiliations
                Department of Ocular and Pathology, Memorial Institute of Ophthalmology, Cairo, Egypt
                Author notes
                Corresponding Author: Laila Hassan Mohamad Elshazly, Ocular and Pathology Departments, Memorial Institute of Ophthalmology, 5-Alahram Street, Giza, Cairo, Egypt. E-mail: laihasan@ 123456gmail.com
                Article
                MEAJO-18-48
                10.4103/0974-9233.75886
                3085152
                21572734
                8fa9b1ea-4e95-496b-9595-90cd6821a739
                © Middle East African Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Ophthalmology & Optometry
                conjunctiva,ocular surface squamous neoplasia,papilloma,hemangioma,nevus
                Ophthalmology & Optometry
                conjunctiva, ocular surface squamous neoplasia, papilloma, hemangioma, nevus

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