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

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

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.

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.

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 2

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.)

• The left eye and a broad zone of bulbar conjunctiva were excised because of the clinical diagnosis of malignant melanoma of the conjunctiva.

• Diagnosis– Malignant melanoma of limbus arising from

primary acquired melanosis.

Melanocytic tumors of the conjunctiva

• Ephelis(Freckle)• Lentigo• Nevus• Primary Acquired Melanosis(PAM) • Malignant Melanoma

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

Corneal Cases

Case 3

Case History

• 60 yo M• H/O Pseudophakic bullous keratopathy• Waxing and waning corneal edema• Decreased vision in his left eye• Penetrating keratoplasty