Inflamed juvenile conjunctival naevus: clinicopathological characterisation

Abstract

Aim: Inflamed juvenile conjunctival naevi (IJCN) are often erroneously suspected to be malignant because of rapid growth. Their clinical and histopathological features have not been characterised in series of patients. The aim of the study is to characterise IJCN clinically and histopathologically. Methods: This is a retrospective non-randomised clinicopathological study. All patients younger than 20 years with conjunctival naevi which were excised between 1990 and 2000 were included. The clinical signs of the affected patients and the histopathological findings of the excised lesions were characterised. Results: A total of 63 conjunctival naevi were resected. 25% of the patients had simple compound conjunctival naevi and 75% had compound naevi with prominent inflammatory histological features (discrete lymphocyte aggregates, plasma cells, and eosinophils). Epithelial cysts and solid epithelial islands were common in the IJCN. The IJCN were all located at or near the limbus, and characterised by recurrent periods of congestion and growth. 75% of the IJCN patients with complete medical records had a history of allergic disease. Marked conjunctival papillary reaction was present in all of the patients, indicating a possible conjunctival allergy. Conclusions: IJCN is a unique entity, different from simple compound conjunctival naevus. Its association with allergic conjunctivitis is suggestive, and despite periods of alarmingly rapid growth, is histologically benign. C onjunctival naevi are common lesions of the conjunctival epithelium and substantia propria. They are classified as either congenital or acquired, and usually develop during the first decade of life. Acquired naevi are typically located near the limbus, and may drape over the peripheral cornea.1 They rarely require excision, except where rapid growth or irritative symptoms are present."Inflamed naevi of puberty and young adulthood," as termed by Folberg and colleagues in their review of benign conjunctival melanocytic lesions, 1 are conjunctival naevi that seem to be enlarging and are histologically associated with extensive inflammatory infiltrate. It is our impression that these rapidly enlarging naevi are often approached with undue concern by patients and clinicians, usually suspecting malignancy. Our aim was to study the clinical and histological characteristics of this entity. METHODSWe retrospectively reviewed the clinical charts of patients under the age of 20 years who underwent surgical removal of conjunctival lesions between 1990 and 2000. Patients whose specimens were processed in our ocular pathology laboratory, and who had a histopathological diagnosis of conjunctival naevus, were selected. Pertinent ocular and, when available, systemic history was summarised. We then reviewed the histopathological sections (formalin fixed, paraffin embedded, 5 µm sections, haematoxylin and eosin and periodic acid Schiff stains). The diagnosis of inflamed conjunctival naevus was made in cases of compound naevi that had prominent inflammatory cellular infi...

Immunohistochemical Studies of Conjunctival Nevi and Melanomas

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Long-Term Safety and Efficacy of Topical Cyclosporine in 156 Children with Vernal Keratoconjunctivitis

“…Data on the efficacy of the treatment are reported in Fig. 1 and Table II; the results on the drug safety are reported in Table III. In 4 patients (2.5%) an inflamed juvenile conjunctiva naevus was diagnosed (10 an autoimmune liver disease. Elevated ALT and AST values (in 2 cases BTS and in 1 case DTS) were related to a concomitant EBV infection in 3 patients.…”

Unusual ocular presentations of ocular phaeohyphomycosis

“…It was this depigmentation that lead to the clinical interpretation of an inflamed naevus, well known to undergo pigmentary alterations. 10 Such clinical depigmentation of phaeohyphomycosis has not been documented before in the literature. The patient was a soft contact lens wearer, which could have transmitted the fungus, (illustrated in a previous case of invasion of a soft contact lens by phaeohyphomycosis species Exophiala jeanselmei 11 ), although subsequent microbiological investigations were negative.…”