Abstract
BackgroundConjunctival lesions are common with a wide spectrum of benign, premalignant, and malignant lesions. Few histopathological studies have been conducted on conjunctival lesions with variable designs and results. Our aim in this study is to provide information on common conjunctival lesions seen in an ophthalmology tertiary care center in Saudi Arabia.MethodsA retrospective, observational study of all consecutive conjunctival tissue specimens sent for histopathological assessment to the pathology department from 2015 to 2019 were analyzed. Clinical data were collected from medical records, and the histopathological slides were reviewed by a single pathologist.ResultsA total of 110 conjunctival specimens from 108 patients were included (mean age: 53 years, 67 males and 43 females). Bilateral involvement was mostly found in inflammatory lesions (40%). Most lesions were benign (91%), with a significantly longer duration of symptoms in malignant lesions (p = 0.036*). The clinical diagnosis matched the final histopathological diagnosis in 75.5% of the total specimens. The most frequent category of benign lesions was fibrodegenerative and proliferative lesions (53.6%), with a significantly higher prevalence among adult males (p < 0.001). Melanocytic lesions were more common in children (33.3%) than adults (9.8%), and the mean age of children was significantly lower (p = 0.013). The most frequent malignant lesion was ocular surface squamous neoplasia (50%), with equal prevalence among males and females. The overall outcome was favorable in 89.4% and unfavorable in 10.6%, mostly due to surgical complications, further progression of the lesion, or recurrence.ConclusionThis study shows variability in the frequency of conjunctival lesions based on gender, age, geographical, racial, and environmental factors. There has been a shift in the gender-based prevalence of ocular squamous neoplasia over the last three decades, probably due to a change in lifestyle.
Highlights
The conjunctiva is a thin, transparent membrane that covers the inner surface of the eyelids and anterior sclera and provides a protective barrier for the eyes
A broad spectrum of lesions may arise from the conjunctiva, including the caruncle, ranging from benign lesions, such as pterygium, solid dermoid, nevus, and pyogenic granuloma, to premalignant ocular surface squamous neoplasia (OSSN) and aggressive malignancies, such as malignant melanoma and squamous cell carcinoma (SCC) [1,2,3,4,5]
We had cases ranging from mild squamous dysplasia to severe dysplasia, often with papillomatous configuration, as we have demonstrated in Fig. 5, to invasive SCC [18]
Summary
The conjunctiva is a thin, transparent membrane that covers the inner surface of the eyelids and anterior sclera and provides a protective barrier for the eyes. A broad spectrum of lesions may arise from the conjunctiva, including the caruncle, ranging from benign lesions, such as pterygium, solid dermoid, nevus, and pyogenic granuloma, to premalignant ocular surface squamous neoplasia (OSSN) and aggressive malignancies, such as malignant melanoma and squamous cell carcinoma (SCC) [1,2,3,4,5]. Benign lesions, such as nevi, were the most common (9.5%), whereas the most common malignant neoplastic lesion was SCC (3.5%) [2] Another similar study in the Egyptian population reported that pyogenic granulomas (30.7%) and nevi (22.9%) (mostly compound nevi) were the most frequent histologically diagnosed conjunctival lesions with correct clinical diagnosis in most cases [1]. The most frequent malignant lesion was ocular surface squamous neoplasia (50%), with equal prevalence among males and females. There has been a shift in the gender-based prevalence of ocular squamous neoplasia over the last three decades, probably due to a change in lifestyle
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