Conjunctival Lesions: When Should We Perform Biopsy?

Abstract

Introduction: The conjunctiva is a thin and flexible mucus membrane that provides a protective barrier for the eye. Very few histopathologic studies have been conducted on biopsies from conjunctival lesions (CL) in central India. Objective: To study the spectrum of CL and define those lesions that need attention with regard to need of biopsy in order to prevent grave sequelae and ocular morbidity. Results: Degenerative conditions such as pterygium followed by pinguicula were the commonest lesions seen in conjunctiva. Out of 129 subjects, youngest in the series was 3 years old while oldest patient was 72 years of age. Commonest age interval for involvement was 35 to 50 years. In children below 8 years, cystic lesions (infective or inclusion), limbal dermoid and choristoma were seen. Vascular lesions were noticed by patients for the first time between mid-teens to 25 years age. Premalignant lesions were dysplasia, actinic keratosis and PAM with or without XP. Malignant lesions in this series were squamous cell carcinoma, basal cell carcinoma and sebaceous carcinoma; which were observed in the age interval 25 to 75 years. In none of the malignant conditions there was deeper penetration into the globe or orbit. Though diagnosed within two weeks duration (by incisional biopsy) from appearance of nodule, unfavourable outcome was seen only in one malignant CL; a case having sebaceous carcinoma. In all pediatric cases outcome was good, except in child having choristoma, where amblyopia ensued before a diagnosis was made. Response to sclerotherapy was excellent as all the epibulbar vascular malformations regressed. All degenerative lesions regressed except one recurrence in a recurred pterygium. Case diagnosed as large B cell lymphoma recurred after one year. Dysplastic changes were seen to occur at limbus on followup in one XP, but in all cases of naevi, neither cellular atypia was seen nor melanoma developed. Conclusion: An overview of various CL disclosed that clinician has to differentiate benign from premalignant and malignant lesions. Early diagnosis, proper histological study and patient education, all are equally important for achieving good outcome.

Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital

“…The most common overall lesions among both categories of lesions were fibrodegenerative lesions (53.6%), followed by melanocytic lesions (13.6%). This result is quite similar to what Khan found (55.03% and 12.40%, respectively) [ 12 ]. Similarly, Aliakbar-Navahi et al reported that the most common lesion among all their cases was pterygia, accounting for 69.2%, followed by melanocytic lesions, accounting for 15.3% [ 11 ].…”

“…Most of the cases in Khan et al’s study involved limbal and perilimbal lesions in 71.10% and bulbar lesions in 3.13% [ 12 ]. In our study, 68.2% of all lesions involved the bulbar conjunctiva nasally and temporally, whereas the superior and inferior conjunctiva were involved in 11.9%.…”

“…In our study, 68.2% of all lesions involved the bulbar conjunctiva nasally and temporally, whereas the superior and inferior conjunctiva were involved in 11.9%. As the exact locations of limbal and perilimbal lesions were not defined in our data, we were only able to compare the collective bulbar conjunctival lesions in all four quadrants (80.1%) to Khan’s combined limbal, perilimbal, and bulbar lesions (74.23%), which were almost similar [ 12 ]. This location is of particular importance in regard to the analysis of benign lesions alone because almost all the nasal bulbar conjunctival lesions in our study were benign (54 out of 56 nasal lesions), whereas the most common location of malignant lesions was the lower palpebral conjunctiva.…”

“…It is also worth mentioning that in terms of age, no epithelial or inflammatory lesions or pterygia were seen in children. Melanocytic lesions in the form of nevi tend to show some growth related to puberty and/or inflammation; hence, those lesions are usually removed at adolescence [ 12 , 17 , 18 ]. However, in adults, malignant transformation has been found to be very low and does not warrant excision solely to avoid this risk [ 19 ].…”

Successful surgical management of large conjunctival nevus in a 10-year-old child with resection and amniotic membrane transplantation

“…If the lesion encroaches onto the cornea, as was the case in our patient, it may lead to amblyopia in children or progress to malignancy. 4 Local excision of the conjunctival lesion is recommended if there are suspicions of malignant changes, persistent ocular irritation, or cosmetic concerns; the latter was the case for our patient and his parents. The entire conjunctival lesion was removed via the no-touch technique with a tumor safety margin of 3.0 mm.…”