Case History
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Transcript of Case History
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Case History
• 67 yo F Progressive visual loss in the SO associated with corneal degeneration and a limbal tumor
• Gross description– Opaque white tissue measures 13x12mm – Extends from the limbus to the edge of cornea
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• Diagnosis• Dysplasia/CIN, limbal conjunctiva
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Conjunctival intraepithelial neoplasm (CIN)
• Definition: CIN includes a wide range of neoplastic intraepithelial changes ranging from dysplasia to full-thickness epithelial neoplasia or carcinoma in situ
• Synonyms include mild, moderate, and severe dysplasia, carcinoma in situ, ocular surface squamous neoplasia, intraepithelioma and bowenoid dyskeratosis
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CIN
• Clinically, lesions are sharply demarcated and arise at the limbus, where corneal stem cells are located, with either or both conjunctival and corneal involvement.
• Most lesions are pink, nonkeratinized, well- vascularized and have a raspberry-like configuration.
• Rarely, these changes spontaneously regress.
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CIN
• Microscopic findings–Keratinization and dyskeratosis are not a
common feature of CIN. –Atypical mitosis are frequent and may be
located at all levels of the epithelium. – The intraepithelium dysplastic changes are
graded as mild, moderate, or severe based on the thickness of intraepithelial involvement.
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CIN
• Differential diagnosis.– UV-related epithelial hyperplasia– Intraepithelial sebaceous gland carcinoma– Inraepithelial invasion by adenocarcinoma
originating from aprocrine glands of moll– Primary acquired melanosis
(HMB45, S-100, Melan A)
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Case 2
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Case History
• 50 yo F• 2Y/H progressively enlarging pigmented area
involving the conjunctiva and cornea of the left eye.
• 3X3.5 mm. pigmented limbal nodule appeared in this area of heavily pigmented conjunctiva, which had been previously biopsied and diagnosed as “primary acquired melanosis”
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Case History (Cont.)
• The left eye and a broad zone of bulbar conjunctiva were excised because of the clinical diagnosis of malignant melanoma of the conjunctiva.
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• Diagnosis– Malignant melanoma of limbus arising from
primary acquired melanosis.
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Melanocytic tumors of the conjunctiva
• Ephelis(Freckle)• Lentigo• Nevus• Primary Acquired Melanosis(PAM) • Malignant Melanoma
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PAM
• Clinical Characteristics– The melanosis of unilateral, diffuse, brown
pigmentation that moves with the conjunctiva over the sclera (analogous to lentigo maligna of the skin).
– Age of onset is 40 to 50 years of age.– No clinical differentiation in PAM with or without
atypia
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Corneal Cases
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Case 3
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Case History
• 60 yo M• H/O Pseudophakic bullous keratopathy• Waxing and waning corneal edema• Decreased vision in his left eye• Penetrating keratoplasty