Conjunctival papilloma is a benign growth arising from the stratified squamous epithelium of the conjunctiva 1. Aim to examine conjunctival papillomas for the presence of human papillomavirus hpv and koilocytosis. Papillomas are one of the most common benign eyelid lesions, and there is no race or sex predilection. Clin hpv type 16 junctional papilloma, dysplasia, and. Premalignant primary acquired melanosis pam intraepithelial neoplasia carcinoma in situ 3. The pedunculated type is synonymous with infectious conjunctival papilloma and squamous cell papilloma. Although toluidine blue has been used as a vital stain of conjunctival lesions, in this case, it was unable to distinguish between an infective and neoplastic cause.
A case report of recurrent conjunctival squamous cell. Pacific university college of optometry eye on pacific. Squamous cell dysplasia and carcinoma of the conjunctiva. The aetiological role of human papilloma virus hpv has been an object of massive investigation, due to the well. In the menu at the top, select view make sure thumbnails is checked in the dropdown menu. Ocular involvement in pemphigus vulgaris pv ranges from mild conjuctivits to conjunctival blisters and rarely prominent erosions of the bulbar and palpebral conjunctiva which may be found at the eyelid margin. Bruce ostler, california despite topical treatment of the left eye with triethylenethiophosphoramide thiotepa. The current procedural terminology cpt code range for surgical procedures on the conjunctiva 6802068899 is a medical code set maintained by the american medical association. A sessile conjunctival tumor involving the limbus was observed. Human papillomavirus in conjunctival papilloma british. Papillomas are tumors that grow from epithelial tissue and form outward fingerlike fronds. Because of its gross appearance, limbal papillomas are typed as. As in the skin, conjunctival papillomas can occur as branchingpediculate tumors or as broadbased lesions on the surface of the conjunctiva fig. Sixteen cases of papilloma, 12 of basal cell epithelioma, four of dysplasia, and four of squamous cell carcinomas surgically removed fromthe eyelid area, includingthe tunica conjunctiva palpebrum conjunctiva, its junction to eyelids epidermis junction, andthe eyelid skin, were selected from patient files of the kitasato university hospital.
Squamous cell papilloma of the conjunctiva due to human. Benign conjunctival tumors of stromal origin are described in chap. A appearance of the papilloma and sebaceous gland hyperplasia regions. Methods archival paraffin embedded tissue from 55 conjunctival papillomas was analysed for the presence of hpv by polymerase chain reaction and subsequent filter hybridisation. Frequency of eyelid papillomas increases with age, usually more often seen after age 30. There is a strong association between hpv and conjunctival papilloma. Benign tumors of the conjunctiva are much more common than malignant tumors of the conjunctiva. Conjunctival papilloma is a benign neoplastic lesion of epithelial origin, with a minim. Fifty five conjunctival papillomas were collected from the files of the eye pathology institute 33 males, 22 females, age range 1884 years, mean age 41 years. It was a small red nodule in the four oclock position near the corneal limbus of the left temporal bulbar conjunctiva characterized as having no. Full text papilloma and sebaceous gland hyperplasia of. Ocular rhinosporidiosis mimicking conjunctival squamous. The code is valid for the year 2020 for the submission of hipaacovered transactions.
Conjunctival papilloma is an acquired benign squamous cell tumor that can present at any age, but most frequently in the third and fourth. If your open pdf has more than a single page, select a thumbnail in the lefthand side where you want to insert another pdf file. Squamous cell papillomas are typically associated with human papillomavirus hpv while for others the cause is unknown. Pdf to text batch convert multiple files software please purchase personal license. Histological sections of the 55 papillomas were evaluated for the presence. Nodular squamous conjunctival carcinoma nodular squamous conjunctival carcinoma this squamous carcinoma exhibits a few corkscrew vessels on its surface arrow. In this chapter, benign tumors of epithelial and melanocytic origin, which comprise the majority of the conjunctival tumors, are described. Both clinically and histopathologically, the tumours show distinct features compared with exophytic conjunctival papillomas. Human papillomavirus 6a lesions of the lower eyelid and genitalia. Papillomas produce a permanent foreignbody sensation that is annoying to the patient, and the entire lesion should be surgically removed. Multiple conjunctival papillomas of eyelid margins in.
Common, benign acquired papillary lesion emedicine. Detection of human papillomavirus dna sequences in. They are thought to represent noninfectious squamous neoplasias that develop in middleaged to older. Figure 1 a inverted papilloma of the conjunctiva on the medial bulbar conjunctiva in a 77yearold woman, clinically mistaken for a nevus due to the pigmented appearance arrows. Exophytic growth of papillary, well differentiated, acanthotic nonkeratinized squamous epithelial cells with variable goblet cells supported by prominent, branching fibrovascular core. A severe case of conjunctival papilloma in a five year old. Pdf a 31yearold black man presented with two oval masses in his right conjunctiva.
Conjunctival lesions present commonly in primary care. Malignant melanoma squamous cell carcinoma kaposi sarcoma lymphoma conjunctival tumours 2. Treatment of conjunctival papilloma with topical interferon. Review of the patient journals and pathology files revealed a range of age at. Follow up examination one year later showed no recurrence. The limbal conjunctival papilloma often is referred to as noninfectious conjunctival papilloma because it is believed that limbal papillomas arise from uv radiation exposure. Objective to determine the prevalence of a broad spectrum of human papillomavirus hpv types in conjunctival papillomas and a possible difference in clinical and histopathological presentation of hpvpositive and hpvnegative papillomas. They are known to occur in both children and adults but they are most common in the age group 2039 years. The study presents the largest material of conjunctival papilloma investigated for hpv and the first investigation of hpv in normal conjunctival tissue. J f olivier, mb chb, mrcophth uk, mmed ophth department of ophthalmology, university of limpopo, medunsa campus, dr. Methods formalinfixed, paraffinembedded papilloma tissue specimens obtained from 25 patients were analysed. Recurrence and malignant transformation occurred in 2 of the 11 cases described.
Infectious squamous conjunctival papillomas have a strong association with human papillomavirus hpv types 6 and 11 minchiotti et al. Fifty five conjunctival papillomas were col lected from the files of the eye pathology insti tute 33 males, 22 females, age range 1884 years. Figure 1 intra oral view of the lesion present on anterior part of hard palate figure 2 lesion seen on the finger figure 3 histopathological picture showing confirmation of squamous papilloma discussion. In this article, we describe our experience regarding the difference in the clinical features and outcomes of conjunctival papilloma based on age at initial examination. With the advent of nasal endoscope it has made the radical surgical procedures like lateral rhinotomy and other external approaches redundant. Ocular details included laterality of conjunctival papilloma unilateral or bilateral, eye affected right or left, and number of tumors per eye. Update on diagnosis and management of conjunctival papilloma. Rearrange individual pages or entire files in the desired order. Importance conjunctival papilloma is a benign epithelial tumor occurring in both children and adults with varying clinical features and outcomes. Hpv types 6 and 11 are the most common hpv types in conjunctival papilloma. Subscribe to aapc coder and get the code details in a flash. Benign naevus papilloma epibulbar dermoid lipodermoid 2. Conjunctival papilloma is an acquired benign squamous cell tumor that can present at any age, but most frequently in the third and fourth decades of life. Pdf purpose the purpose of the study was to evaluate the clinical features, treatment, and outcome of patients with conjunctival papilloma.
Conjunctival papillomas caused by human papillomavirus. Human papillomavirus in normal conjunctival tissue and in. We report two unusual cases of pv patients presenting with multiple conjunctival papillomatous lesions of the eyelids margins. Provencher, md a conjunctival papilloma is a benign squamous epithelial tumor. Four cases of conjunctival inverted papillomas were retrieved from our files. The apical portion of the tumor resembled a conjunctival papilloma and papillary proliferation of the epithelium was seen. Shields, md, speaking on saturday at the cornea subspecialty day. Inverted papilloma of nose is a surgically manageable condition. Pdf multiple conjunctival papillomas of eyelid margins. Squamous conjunctival papilloma squamous conjunctival papilloma note the atypical hyperpigmentation, fine vasculature and parse tumor stroma. Case report a yearold male who lived in the tableland of tibet first noticed the tumor 2 years ago. Topical interferon alpha2b can be utilized as an adjunctive therapy for recurring conjunctival papilloma. Different types of conjunctival papilloma presenting in. Morphological characteristics of conjunctival squamous.
Hpv is transmitted via direct human contact and typically produces benign tumor growths with minimal risk for malignancy. Conclusion here we present four cases of conjunctival inverted papilloma, which is an exceedingly rare tumour with only 11 previously reported cases in the literature. The patients history disclosed that the possibility of growth retardation had been investigated but with negative results. Inverted papilloma of the conjunctiva bmj open ophthalmology. In children, the lesions are typically manifestations of an infection acquired during delivery. Nine months after excision, there was no sign of recurrence. Pdf different types of conjunctival papilloma presenting in the. A inverted papilloma of the conjunctiva on the medial bulbar conjunctiva in a 77yearold woman, clinically mistaken for a nevus due to the pigmented appearance arrows. A squamous cell papilloma is a generally benign papilloma that arises from the stratified squamous epithelium of the skin, lip, oral cavity, tongue, pharynx, larynx, esophagus, cervix, vagina or anal canal. Pdf update on diagnosis and management of conjunctival. At the base of the tumor, sebaceous gland hyperplasia was observed.
Conjunctival papilloma visual acuity alpf medical research. Furthermore, this is the first description of highrisk hpv 58 in a conjunctival tumour. More recently, topical alpha2b interferons have shown to be successful in treating not only primary conjunctival papilloma but also conjunctival intraepithelial neoplasia. Human papillomavirus in normal conjunctival tissue. Cpt code surgical procedures on the conjunctiva 68020. Individual fronds are surrounded by connective tissue, each having a central vascularized core. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Human papillomavirus in conjunctival papilloma british journal of.
Mitomycinc is an adjunct therapy to surgical excision. Conjunctival papilloma american academy of ophthalmology. Conjunctival papilloma removal by direct excision using topical anesthesia. Squamous cell papillomas eg, infectious papilloma, viral conjunctival papilloma are composed of multiple branching fronds emanating from a narrow pedunculated base. Conjunctival papillomas located in the inferior fornix are often pedunculated with a multilobulated appearance. The pathology revealed papilloma with severe intraepithelial dysplasia. Acute and chronic inflammatory cells are found within these fronds. The human papillomavirus hpv currently affects 79 million americans, and an additional 14 million new infections occur each year, said carol l. These benign neoplasms are initiated after infection by.
A healthy 9yearold boy had a 1year history of an itchy right eye with frequent tearing. Pdf documents are often used because they help preserve the original content of the document, but this can make splitting the file up a little more difficult than other document formats. Screening for human papilloma virus done icd10cm diagnosis code z11. Ocular motility and slitlamp examination were otherwise unremarkable. How to combine pdf files into one document lifewire. Conjunctival papilloma accessed 23 april 2018 probably lacks malignant potential, even if dysplasia present.