Part 3a

Papillomatous CCIN
Diffuse CCIN
Is
a raised discrete lesion with
surface corkscrew-like blood
vessels
Is uncommon and is characterized by
indistinct conjunctival thickening
Note: All three types may be
associated with grey white hyperplastic
epithelium that can extend into cornea
Case MT- 38 Year old female
CC: Red bump & ache on left eye x 4 mos and
is slowly getting worse.
General health is good & no history of cancer
BVA: 20/20 OD, OS
Pupils, IOPs, visual fields normal
See slide
Referral for excisional biopsy
1
Lab Report
Atypical squamous proliferative lesion. In
dysplastic areas changes approach squamous
cell carcinoma in situ.
No evidence of stromal invasion
Lesion is called dysplastic if only partial
thickness of epithelial layer is replaced by
atypical cells & CIN if there is total
replacement of the epithelial layer, basement
membrane is intact
Commonly Misdiagnosed as
Chronic conjunctivitis, papilloma, ptyerguim,
inflamed pinguecula
Sometimes difficult or impossible to distinguish
clinically
Histopathological evaluation is critical
If dysplastic cells breach the basement
membrane, then this is invasive squamous cell
carcinoma
2
Squamous Cell Carcinoma
General characteristics
Rare condition, in late life, which develops at the limbus in the
intrapalpebral zone
Signs
Starts as a small fleshy, pink, gray nodule, becomes almond
shaped as it extends around the limbus, large
feeder vessels develop giving rise to the suspicion
of malignancy, characterized by deep invasion of the
stroma
Treatment
Excision & cryotherapy, Mitomycin C, enucleation
Dyskeratosis
General characteristics
Due to a variety of chronic irritative factors, i.e.
radiation and topical drug therapy
Signs
Dry white plaque on the surface of the globe
Treatment
Surgical removal if concern
Hemangioma
General characteristics
Usually present at birth, but may appear up to 10
years; may enlarge with age; a cosmetic concern
Orbital hemangiomas are usually in the superonasal orbit
Maybe observed through the lid as bluish mass or be
accompanied by red hemangioma of the skinstrawberry nevus
Conjunctival Signs
Appears as a mass of fine tortuous blood vessels,
newly formed vessels, more often inner canthus or
deep fornice, reddish to dark purplish tortuous vessel
masses
Cavernous with a broad base
Capillary—Mass of fine tortuous blood vessels
Treatment
Surgical removal if cosmetic concern
3
Telangiectasia
General characteristics
Due to local irritation, systemic disease,
inflammations, I.e. Acne Rosacae, vascular
disease, collagen disease, idopathetic
Signs
Dilation of pre-existing vessels of conjunctiva;
superficial, localized, dilated, or convoluted
blood vessel (arteriole), saccular-like
aneuryms or berry shaped
4