Balloon cell nevi of the conjunctiva: Clinicopathologic correlation and literature review

Thompson, Jordan M.; Bermudez-Magner, Jose Antonio; Barker, Nigel H.; Payne, Darren; Meghpara, Beeran; Dubovy, Sander R.

doi:10.1016/j.survophthal.2014.12.001

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…These kinds of cells are described not only in benign nevi including Spitz, combined halo, dysplastic, nodal, and blue nevi, [12][13][14][15][16] but also in malignant lesions, such as in melanoma of the skin, choroid, or conjunctiva. 3,[17][18][19] No clinical features are suspect to the diagnosis, and single case reports are described in the literature showing different In our cases, each BCN was a smooth brownish macular lesion, confirming the aspect of common nevus reported in the literature. The most common location reported is the head and neck area.…”

Section: Discussionsupporting

confidence: 83%

“…Ballooning cell changes would be caused by an arrest of biosynthesis of melanin and would reflect an intrinsic cellular degenerative process, resulting in less pigmented than typical melanocytes. These kinds of cells are described not only in benign nevi including Spitz, combined halo, dysplastic, nodal, and blue nevi, 12–16 but also in malignant lesions, such as in melanoma of the skin, choroid, or conjunctiva 3,17–19 …”

Section: Discussionmentioning

confidence: 99%

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Dermoscopy and reflectance confocal microscopy of balloon cell nevi: a series of 10 cases

Fusano¹,

Soglia

Gianotti

et al. 2021

Int J Dermatology

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Background Balloon cell nevus (BCN) is a rare histopathological entity. It is usually represented by an asymptomatic brown smooth or polypoid lesion, but no clinical features allow differentiation from other melanocytic nevi. Moreover, dermoscopy and reflectance confocal microscopy (RCM) aspects of BCN have been described in a few single cases. This study aims to describe a wider BCN series with dermoscopic and RCM features to assess the most frequent patterns. Methods Ten patients who underwent a BCN surgical excision with histological diagnosis were included in this study. Dermatoscopy and RCM were performed for each lesion, searching for the features described in literature. Results Each nevus presented as an asymptomatic, smooth brownish lesion. Regarding dermoscopy, four balloon cell nevi showed yellow globules, eight white globules, eight a light‐brown network at the periphery, and eight a structureless central area; moreover, we found a hyperpigmented central blotch in four cases. RCM examination highlighted aggregates of dense nests at superficial dermis level in all BCNs, characterized by the presence of a dark nucleus surrounded by vacuolized cytoplasm. Moreover, multiple melanophages were seen at the dermal–epidermal junction in one case and superficial epidermal dendritic cells in one case. Conclusions This series of 10 BCNs improves the dermoscopic and confocal microscopic knowledge of this rare entity. We also reported a new dermoscopic aspect represented by central hyperpigmented blotch. A correct identification of BCN with noninvasive techniques allows to avoid unnecessary surgical excision.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Dermoscopy and reflectance confocal microscopy of balloon cell nevi: a series of 10 cases

Fusano¹,

Soglia

Gianotti

et al. 2021

Int J Dermatology

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“…Growth of nevi during puberty, presumably due to hormonally induced changes in pigmentation, inflammation, and enlargement of cysts is a well-recognized phenomenon that can be prominent in juvenile (inflamed) conjunctival nevi and balloon cell nevi, which share clinical and histopathologic characteristics with granular cell nevi. 2,[4][5][6] Documented growth since infancy was particularly striking in 2 of our patients. Clinical-pathologic correlation suggests that the granular cell change in nevocellular nevi with an accompanying cell volume expansion and intracytoplasmic pigmentation, melanophagic infiltrate, and lymphocytic infiltrate may all contribute to the apparent change in size of these tumors.…”

Section: Discussionmentioning

confidence: 99%

“…5,7 Immunohistochemically, nevocellular nevi, juvenile nevi, and balloon cell nevi are either diffusely negative for HMB-45, a marker of ''activated'' melanocytes, or express HMB-45 in a stratified fashion, with typically weak expression limited to the junctional and the immediate subjunctional region. 2,[5][6][7] In the nevi with granular cell change, architectural features concerning for melanoma included extension of junctional nevus nests beyond the subepithelial nevoid component and unifocal or multifocal asymmetric nodules of large epithelioid melanocytes with granular cell change in the stroma, leading to appearance of ''reverse maturation'' or ''pushing margin.'' Cytomorphologically, nuclear pleomorphism and nuclear enlargement within the granular cell change when compared with the conventional nevocellular component raised concern for melanoma.…”

Section: Discussionmentioning

confidence: 99%

Conjunctival Melanocytic Nevi With Granular Cell Change

Eiger-Moscovich

Eagle

Lally

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Granular cell change in melanocytic nevus is underrepresented in the literature with only 4 well-documented cases, 1 described in the conjunctiva. Unfamiliarity with the clinical and pathologic features of these lesions contributes to the diagnostic difficulty. Objective.— To delineate the clinical and histopathologic features of conjunctival nevi with granular cell change. Design.— In a retrospective observational case series, the medical records of all patients with conjunctival nevi and granular cell change diagnosed between December 2016 and October 2018 were reviewed. Data collected included age, sex, clinical presentation, pathologic findings, and follow-up. Results.— Twelve patients, 6 males and 6 females, with a median age of 14 years (range, 8–82 years) were identified. The nevus manifested as a pigmented, well-circumscribed nodule (7 of 9; 78%) or patch (2 of 9; 22%) in the bulbar and limbal conjunctiva (7 of 9; 78%) or in the plica semilunaris/caruncle (2 of 9; 22%). Cysts were noted in 7 of 9 lesions (78%). Features prompting surgical excision included atypical pigmentation (8 of 9; 89%), growth (7 of 9; 78%), and atypical vascularity (4 of 9; 44%). Microscopically, all lesions comprised a conventional melanocytic nevus with focal granular cell change and immunoreactivity for Melan-A, SOX10, and HMB-45, with Ki-67 proliferative index of less than 2%. Of the 9 lesions with follow-up information, there were no recurrences over mean follow-up of 11.2 months (range, 1–23 months). Conclusions.— Granular cell change in melanocytic nevi is an underrecognized finding that can simulate melanoma clinically and histopathologically. Young age at diagnosis, lack of associated conjunctival melanosis, bulbar location, cysts, and the absence of mitotic figures with a low Ki-67 proliferative index are helpful clinical and pathologic diagnostic clues.

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“…It has been described in melanoma of the skin, choroid, and conjunctiva. [6][7][8] Multiple BCN are frequently associated with dysplastic or malignant lesions. 2 However, there has been no definitive evidence that balloon cell change marks an increased risk of malignant progression.…”

mentioning

confidence: 99%