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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. Diagnosis Dysplasia/CIN, limbal conjunctiva.

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case history
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
slide3

Diagnosis

    • Dysplasia/CIN, limbal conjunctiva
conjunctival intraepithelial neoplasm cin
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
slide5
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.
slide6
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.
slide7
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)

case history1
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”
case history cont
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.
slide12

Diagnosis

    • Malignant melanoma of limbus arising from primary acquired melanosis.
melanocytic tumors of the conjunctiva
Melanocytic tumors of the conjunctiva
  • Ephelis(Freckle)
  • Lentigo
  • Nevus
  • Primary Acquired Melanosis(PAM)
  • Malignant Melanoma
slide14
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
case history2
Case History
  • 60 yo M
  • H/O Pseudophakic bullous keratopathy
  • Waxing and waning corneal edema
  • Decreased vision in his left eye
  • Penetrating keratoplasty