Table of Contents /Previous Topic/Next Topic / Index

Preliminary Report

Histopathological Study of Conjunctival Lesions

Santosh Kumar Mondal*, Arijit Banerjee**, Asit Ghosh***

.

Key words : Histopathology, conjunctival lesion.

A variety of neoplastic lesions (tumours), both benign and malignant, can occur apart from many non-neoplastic lesions simulating tumours1. Both epithelial and melanocytic lesions can include malignant and potentially life-threatening tumours. But fortunately these malignancies are uncommon among the cancers occurring in patients.
There have been only few large published series on conjunctival lesions. A large review of conjunctival biopsied specimens in adults in the US showed inflammatory/degenerative lesions(41%), acquired epithelial (26%), pigmented (13%), miscellaneous (12%), acquired subepithelial (6%) and congenital lesions(2%)2. Histopathological examination of conjunctival lesions over a period of two years in a tertiary care eye hospital in Kolkata, India is being reported in this study.

Material and Method

Fifty cases with conjunctival lesions were studied from March, 2003 to February, 2005 at Regional Institute of Ophthalmology, Medical College, Kolkata. Biopsied specimens of the conjunctival lesions were received in the department of pathology for histopathological examination. Among the 50 patients, 34 were males and remaining females. Most of the patients were adults (>15 years); only 4 patients were in paediatric age group (<14 years). The biopsied specimens received in pathology department were grossed properly when needed and macroscopic features were noted. After that, tissues were processed routinely, paraffin sections cut at 5 µm thickness, stained with haematoxylin and eosin (H&E). Wherever necessary special stains such as periodic acid schiff (PAS), Verhoeff-Van Gieson, reticulin stain were done according to the standard procedures. Sections were studied histologically for tissue response.
Different findings from microscopic examination were analysed.

Observations

Premalignant and malignant epithelial lesions occurred in elderly patient at a median age> 65 years. We received an unequal representation of male and female patients (34 versus 16). Premalignant and malignant epithelial lesions were more common in males (n=12) than in females (n=2).
Table 1 revealed the anatomic location of each category of lesion. Bulbar conjunctiva (limbal and extralimbal) was commonest location for conjunctival lesion (n=38) followed by palpebral conjunctiva and fornix. Diffuse involvement of conjunctiva was uncommon and there was only one patient (later diagnosed as non-Hodgkin’s lymphoma). Malignant epithelial neoplasms were located at the bulbar conjunctiva. Melanocytic tumours were also located at the bulbar conjunctiva. Of the 4 patients with palpebral conjunctival lesion, the diagnoses were chronic non-specific inflammation, pyogenic granuloma and granulations. The only patient of rhinosporidiosis involved the bulbar conjunctiva which is an uncommon site for this infection. Histopathological classification of each category of conjunctival lesion with specific diagnosis of each lesion is shown in Table 2. Most common lesion was of epithelial origin (n=23). There were 10 cases of squamous cell carcinoma (Fig 1, H&E, x 400). Miscellaneous group (n=11) followed epithelial origin group. Others were degenerative lesions(n=7), melanocytic lesions(n=6) and lymphoid tumours (n=3).

Discussion

In an epidemic review of all eye cancers from the Singapore Cancer Registry, conjunctival tumours represented 13% among 125 patients3. Small series studies of epibulbar tumours from Australia4 and India5 have been published.
In this series, 46% proved to be of epithelial origin (benign, premalignant and malignant neoplasm). Remaining lesions included miscellaneous lesions (22%), degenerative lesions (14%), melanocytic tumours (12%) and lymphoid tumours (6%). Commonest specific diagnosis was squamous cell carcinoma (20%) followed by chronic non-specific inflammation (12%), squamous papilloma (8%) and pterygium (10%). In most of the cases, our findings in this study corroborated with the findings published by Yoon and Grossniklaus6.
Squamous cell carcinoma and premalignant epithelial neoplasm was found in elderly at a mean age of 65 years and predominantly in men (86%).This tumour was commonly located at limbal region in the temporal (45%) or nasal (30%) conjunctiva7. They appeared as a papillary exophytic mass and derived from the conjunctiva’s non-keratinising stratified squamous epithelium. Malignant melanoma also occurred commonly at limbal region8,9. In contrast, lymphoid tumours were located more commonly in fornix or extralimbal bulbar conjunctiva10. It presented as a salmon coloured mass and spawned by conjunctiva’s resident population of lymphocytes. The type of lymphoma was mucosa associated lymphoid tissue (MALT) lymphoma11.

Reference

.

Home
Copyright : JIMA