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Purpose: To document a case of actinic granuloma (AG) of the conjunctiva, provide an extensive histopathologic and immunohistochemical description, review previously reported cases, and supply a differential diagnosis. Methods: Both a retrospective chart review and comprehensive literature review were performed. The distinctive histopathologic pattern of the current case was defined with histochemical and immunohistochemical stains (CD163, p63, and a Verhoeff–Van Gieson elastic stain). Clinical follow up was obtained. Results: A granulomatous process composed of CD163-positive mononuclear epithelioid cells and multinucleated giant cells was characterized by displaced extracellular actinic-related elastic fibers to the base of the lesion. Small elastic fibers were phagocytosed in epithelioid cells. Pseudoepitheliomatous hyperplasia of the overlying squamous epithelium was present; p63 assisted in defining the squamous proliferation and highlighted its noninvasive nature. Conjunctival AGs, according to the literature review, occur almost exclusively in young females, clinically manifest as nodular foci with painless injection over the course of weeks, and histologically featured granulomatous inflammation and elastophagocytosis. The etiology of this entity is likely multifactorial, but its genesis revolves around actinic injury. Conclusion: AGs of the conjunctiva have likely been an underreported entity in the past. The authors’ review underscores the importance of including conjunctival AGs in the differential diagnosis of painless, subacute injected masses of the perilimbal conjunctiva. While it is benign, histopathologically separating AGs from neoplasia and other mimickers such pinguecula, foreign body granulomas, allergic, or rheumatoid nodules is essential for optimal management.

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In 1944 1 revisited Greece. Some of my friends I could not find; the others were prematurely aged and looked ill. A distinguished medical professor limped badly from a knee injury incurred when a Nazi soldier kicked him off a moving tram. Venereal disease was extremely prevalent. The Germans had kept open the 'venereal diseases hospital (under the care of Professor Photinos), but they would permit the use of medicaments and food only for the treatment of these diseases in young women. Outside the. cities no treatment of venereal diseases had been given. In the cities syphilis had increased at least five-fold and it was difficult to compute the increased incidence of gonorrhoea and chancroid. I do not know whether or not the Germans suffered to the same extent from venereal diseases as did our troops-it was difficult to obtain reliable data on this subject-*but the German regime certainly fostered conditions which produced a high incidence. Professor Photinos had collected a very fine set of wax casts and models of skin and venereal cases, some of them very unusual, and a very profitable hour could be spent in his museum. ConclusionsLooking back on the war years after a short interval, certain strong impressions remain.(1) Venerologists abroad had a tremendous volume and variety of experience, the value of which can scarcely be measured.(2) Contact with other peoples, with different standards and codes, different medical views and practices, was very stimulating.(3) Our policy regarding venereal diseases was evolved gradually, on the spot, by trial and error and after much delay. It would have been extremely valuable if the War Office--and not the medical branch-had set out clearly the principles of prevention of venereal disease. For example, a bold directive was required on the exclusion of troops from brothels and on the provision of prophylactic centres, as well as a strongly formed public opinion on the subject of prevention. Army discipline regarding venereal diseases could have been made a very powerful factor in safeguarding health and efficiency.

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