Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma

Clinicopathological and immunohistochemical characteristics of pigmented oral squamous cell carcinoma

Pigmented oral squamous cell carcinoma (POSCC) is a rare and underrecognized pathological variant of oral squamous cell carcinoma (OSCC). The current study aimed to evaluate the clinicopathological characteristics, treatment outcomes and prognosis of patients with POSCC and to investigate its oncological properties using immunohistochemical studies. A total of 1,512 patients were pathologically diagnosed with squamous cell carcinoma of the oral cavity, and were treated at the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University between January 2001 and December 2018. A total of 25 patients had POSCC and underwent radical surgery. Of these 25 patients, 23 presented with early T stage disease. Additionally, 22 patients were negative for cervical lymph nodes metastasis. Only one patient had local recurrence. The 5-year disease-free and disease-specific survival rates were 86.6 and 95.8%, respectively. Immunohistochemically, a high percentage of POSCC exhibited low p53 and Ki-67, preserved E-cadherin or negative vimentin expression. The results suggested that POSCC tends to exhibit non-aggressive oncological behavior and demonstrates a good prognosis.

Tumors of the conjunctiva and cornea

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.

Advances in the management of conjunctival melanoma

Malignant melanoma of the conjunctiva is a rare but serious condition. Over the last several years, there have been important advances in the classification, diagnosis, and treatment of this condition. Recent cytogenetic and immunohistochemical studies are increasing understanding of its tumorigenesis. Diagnosis, although still made via histopathology, has been aided with imaging techniques such as ultrasound biomicroscopy and anterior segment optical coherence tomography. Primary treatment consists of surgical excision. But adjuvant treatments with cryotherapy, topical chemotherapy, and radiation therapy have shown increased success. Sentinel lymph node biopsy has shown early promise of detecting micro-metastasis. Long term follow-up of patients with conjunctival melanoma with systemic surveillance is necessary to detect recurrences and metastases.

Pigmented viral-associated conjunctival carcinoma

A 54-year-old African-American woman developed a pigmented papillary squamous cell carcinoma in the palpebral and bulbar conjunctiva of the right eye in areas that received no sun exposure. In situ hybridization performed on the tumor showed human papilloma virus 16. The left eye showed a pedunculated nonpigmented conjunctival dysplasia. The tumors were extirpated by cryosurgery and topical interferon alfa 2b in the right eye and simple surgical excision in the left eye.

Conjunctival malignant melanoma: A rare variant and review of important diagnostic and therapeutic considerations

Malignant melanoma of the conjunctiva is a relatively infrequent neoplasm that can be associated with significant morbidity and cause diagnostic difficulty to both the ophthalmologist and pathologist. We herein describe the first reported case in North American and European databases of a rare variant-signet ring cell melanoma - arising in the background of primary acquired melanosis (PAM) and use this case as a review of important diagnostic and therapeutic considerations when faced with this condition.

Clinicopathologic and immunohistochemical features of pigmented Basal cell carcinomas of the eyelids

PURPOSE

To describe the clinical and microscopic features of pigmented basal cell carcinomas (pBCC) of the eyelid.

DESIGN

Retrospective observational case series collected at one institution.

METHODS

An analysis of clinical records, photographs, and histopathologic characteristics of 257 BCCs with a review of the literature. The frequencies of clinically pigmented, and of microscopically pigmented but clinically nonpigmented, BCCs were determined. Cytochemical stains (Fontana-Masson, Prussian blue) and immunohistochemical probes (S-100, microphthalmia-associated transcription factor [MiTF], HMB-45, MART-1, CK20, synaptophysin, chromogranin, CD1a, Ki-67) were then employed and the findings correlated with the degree of clinical pigmentation.

RESULTS

Histopathologically, 13 of 257 cases (5.06%) were found to have pigment; of these 13, 6 (all white patients) had clinically apparent pigmentation (2.33%), either focal or diffuse. Eight of 13 lesions developed on the lower eyelids. All stained positively for melanin but negatively for iron. MiTF highlighted numerous melanocytic nuclei in the tumor lobules, while MART-1 and HMB-45 revealed the dendritic shapes of the entrapped melanocytes. There was a subtotal blockage of melanin transfer to the surrounding basaloid cells. Intralobular S-100-positive cells included CD1a-positive Langerhans cells, while CK20 did not identify any Merkel cells.

CONCLUSIONS

Only 1 of 6 lesions was uniformly clinically pigmented, whereas the other 5 were only focally brown-black. The clinical pigmentation was imparted by varying densities and distributions of melanocytes with arborizing dendrites, which were present in all BCCs. Melanophages within the stroma and basaloid cell melanization also contributed to pigmentation. No behavioral or biologic differences in pBCC were documented compared with clinically nonpigmented lesions.

Pigmented squamous cell carcinoma in situ of the conjunctiva in 5 cases

PURPOSE

To describe 5 patients with pigmented conjunctival squamous cell carcinoma in situ.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Five patients.

METHODS

Clinical and histopathologic features were reviewed.

MAIN OUTCOME MEASURES

Relationship of clinical and histopathologic features to carcinoma pigmentation.

RESULTS

All 5 patients were male. Two were Hispanic, 2 were Caucasian, and 1 was Asian Indian. Localized racial melanosis was evident in 3 cases and no case showed diffuse racial melanosis. The tumor showed leukoplakia (n = 1) and was at the temporal limbus (n = 4) or nasal limbus (n = 1). The mean tumor basal dimension was 9.2 mm and mean thickness was 3.2 mm. Brown pigment was present deep within the tumor in all 5 cases, involving 50% to 90% of the mass. In each case, pigmented squamous cell carcinoma was suspected; melanoma was a second possibility. Histopathology revealed in situ squamous cell carcinoma (conjunctival intraepithelial neoplasia) with pigmented dendritic melanocytes in all 5 cases. Pigment was also found within neoplastic cells (n = 2). After surgical resection, there was no recurrence over mean follow-up of 23 months.

CONCLUSIONS

Squamous cell carcinoma in situ can manifest as a pigmented tumor, resembling melanoma, in both Caucasians and non-Caucasians, primarily due to intratumoral pigmented dendritic melanocytes.

Survey of 447 patients with conjunctival neoplastic lesions in Farabi Eye Hospital, Tehran, Iran

PURPOSE

The current study was undertaken to determine the frequency of specific primary conjunctival neoplastic lesions in a patient population treated at an ocular service over a 15-year period.

MATERIALS AND METHODS

We analyzed the data of all primary cases of conjunctival neoplasia diagnosed from 1990 to 2004 in the pathology department of Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

RESULTS

Of 3,242 conjunctival specimens, 447 were identified as primary conjunctival neoplasms. The patient group comprised 270 (60.4%) males and 177 (39.6%) females, with an age range of 1 to 90 years. The mean age was 38 years and the median was 32 years. The most common primary conjunctival neoplastic lesion was nevus (38.7%), followed by squamous cell carcinoma, (25.1%), papilloma (7.8%), dysplasia (5.6%), and hemangioma (5.1%), respectively. Of 447 lesions, 261 (58.4%) were benign, 134 (30%) were malignant, and 52 (11.6%) were precancerous.

CONCLUSION

As in previously published studies, benign lesions were the most frequent, but the percent of malignant lesions was much higher than that described in other reports. The high percentage of squamous cell carcinoma that we observed can likely be attributed to elevated sun exposure and ultraviolet light in Iran. The characterization of precancerous lesions in this study emphasizes their potential to transform into malignant lesions and the need for sufficient early management and follow up.

Pigmented squamous cell carcinoma of the conjunctiva of a horse

Abstract A heavily pigmented tumor was removed from the lateral, perilimbal, bulbar conjunctiva of a bay Thoroughbred horse. Excision was incomplete and the base of the tumor was lasered on the assumption that the tumor was a melanoma. No other ophthalmic lesions were seen. Histology showed the mass to be a pigmented squamous cell carcinoma (SCC). The prognosis and recommended treatment protocols are different for SCC and melanoma. This is, to the best of our knowledge, the first report of an ocular, pigmented SCC in the veterinary literature.

Tumors of the conjunctiva and cornea

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.

Pigmented squamous cell carcinoma of the uterine cervix

A 57-year-old female presented with an abnormal Pap smear. Colposcopic examination of the cervix revealed white mucosa with erosion and several areas of black pigmentation. After a colposcopically directed biopsy and loop conization, radical hysterectomy and bilateral salpingo-oophorectomy with pelvic and paraaortic lymphadenectomy were performed. Pathological examination disclosed an invasive squamous cell carcinoma admixed with many dendritic melanocytes. Melanin granules were present within the melanocytes and tumor cells. Although similar tumors have been reported in other sites, this is the first report to our knowledge of a pigmented squamous cell carcinoma of the uterine cervix.