Conjunctival Tumors Research Articles

Two Decades of Insights: Comprehensive Histopathological and Epidemiological Analysis of Conjunctival Tumors

This study analyzed 2102 conjunctival lesions excised between 1981 and 2003 at a single tertiary center in Serbia, with the aim of evaluating their histopathological characteristics, anatomical localization, and demographic distribution. Of the total cases recorded, 55.1% were male, indicating a slight male predominance. The bulbar conjunctiva was the most commonly affected site (34.5%), with 39.3% of tumors extended to multiple regions of the conjunctiva, including areas such as the plica and caruncula. The most common benign lesion was compound conjunctival nevus (16.7%), while squamous cell carcinoma (SCC) (11.4%) and melanoma (11.3%) were the most prevalent malignant tumors. Tumor incidence peaked in the 61–70 and 51–60 year age groups, with malignant tumors such as SCC being more frequent in males. Comparisons with similar global studies reveal that our findings align with worldwide trends, such as the predominance of SCC, which has been linked to UV exposure, and the frequency of melanoma in fair-skinned populations. However, the lower prevalence of fibrodegenerative lesions like pterygia and pinguecula in our cohort likely reflects Serbia’s cooler climate compared to regions with higher UV exposure. These findings underscore the diverse nature of conjunctival tumors, the critical role of histopathological examination for diagnosis, and the influence of environmental factors. This study provides valuable insights into the epidemiology of conjunctival tumors, contributing to global understanding and guiding future diagnostic and therapeutic approaches.

Therapeutic Potential of Crocin and Nobiletin in a Mouse Model of Dry Eye Disease: Modulation of the Inflammatory Response and Protection of the Ocular Surface

Background: Dry eye disease (DED) is a multifactorial condition characterized by ocular surface inflammation, tear film instability, and corneal epithelial damage. Current treatments often provide temporary relief without addressing the underlying inflammatory mechanisms. Objectives: This study examined the therapeutic potential of crocin and nobiletin, two naturally derived compounds with well-known antioxidant and anti-inflammatory properties, in a mouse model of DED induced by lacrimal gland excision (ELG). Methods: Thirty female Balb/c mice were divided into five groups (n = 6 each): Control (sham surgery), untreated DED, nobiletin-treated DED (32.75 µM), crocin-treated DED (34 µM), and 1% betamethasone-treated DED. Treatments were administered three times daily for 28 days. Ocular tissues were evaluated using Hematoxylin and Eosin (H&E) staining and fluorescein staining. Conjunctival inflammatory cytokines, including interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α), were measured by enzyme-linked immunosorbent assay (ELISA). Results: Histological analysis showed that the crocin and nobiletin treatment groups exhibited reduced epithelial disruption, keratinization, and inflammatory cell infiltration compared to the untreated DED group. The ELISA assay revealed that both compounds efficiently inhibited the production of the pro-inflammatory cytokines IL-6, TNF-α, and IL-1β, which are key mediators of DED pathogenesis. Fluorescein staining further confirmed the protective impact of crocin and nobiletin on corneal epithelial integrity. Moreover, the anti-inflammatory and epithelial-preserving effects of these compounds were comparable to those of the corticosteroid betamethasone. Conclusions: Overall, these findings suggest that crocin and nobiletin have therapeutic potential for DED management by modulating inflammatory responses and enhancing ocular surface healing. These naturally derived compounds offer promising avenues for the development of safer and more effective treatments for this challenging condition. However, further investigations, including clinical trials, are essential to elucidate the underlying mechanisms of action and optimize therapeutic approaches.

A novel 3D-printed brachytherapy applicator and Monte Carlo model for the treatment of conjunctival tumors

PurposeTo develop a custom low dose rate brachytherapy applicator for the treatment of conjunctival malignancies which leverages 3D-printing technology to provide enhanced design flexibility and availability. MethodsAn elliptical shell applicator inspired by the ocular surgery post-operation conformer shells was developed for the placement of the applicator around the cornea of the eye, with a central hole provide patient comfort. The applicator featured two concentric circles of slots for iodine-125 seeds, providing customization of the dose distribution depending on the location of the target. The applicator was modeled using computer-aided design software. The resultant model STL file was used for 3D printing of the applicator and the development of a Monte Carlo model of the applicator and its dose distribution. ResultsThe applicator was successfully 3D printed using biocompatible resin, which could be sterilized for treatment after manual source loading. A Geant4 model of the applicator was created directly from the STL model and was applied to a phantom to estimate the dose distribution delivered by the applicator. The toroidal dose distribution allowed for treatment of the conjunctiva while reducing dose to the cornea compared to traditional eye plaque designs. ConclusionsA custom 3D-printed applicator was successfully developed and modeled for the treatment of conjunctival malignancies. This novel applicator design potentially provides higher quality, more customizable dose distributions for patients and the simplicity of the design makes it accessible for any clinic with 3D-printing technology.

Isolated conjunctival cavernous hemangioma: a rare case report

Vascular conjunctival tumors are uncommon, usually benign lesions. Here, we report a 65-year-old male who presented with a nasal interpalpebral bulbar firm, oval, and dark-brown and non-mobile conjunctival mass. The systemic and ocular examinations including fundoscopy and gonioscopy were within normal limits. With a diagnosis of conjunctival malignant melanoma (CMM), the patient underwent excisional biopsy, partial sclerectomy, and cryotherapy. Microscopic examination revealed dilated vascular channels filled by red blood cells, separated by fibrous interstitium and no sign of malignancy. Therefore, a diagnosis of conjunctival cavernous hemangioma was made. Our case demonstrates that the conjunctival cavernous hemangioma can mimic malignant conjunctival lesions as well as extrascleral extension of uveal melanoma or uveal prolapse due to scleral necrosis.

Immunotherapy for local/regional control of locally advanced orbital and periocular squamous cell carcinoma.

e18034 Background: Periocular squamous cell carcinoma can be of eyelid skin, ocular surface (bulbar) or palpebral conjunctival, or of lacrimal sac/nasolacrimal duct mucosal origin, is relatively rare, and presents unique anatomic considerations due to proximity to the eye and inherent risk to ocular structures associated with high dose radiation therapy. We herein report on 17 patients with orbital or periocular SCC who were treated with immunotherapy (IO) to decrease surgical morbidity or to avoid high dose radiation therapy. Methods: Retrospective review of all previously unreported patients with orbital, conjunctival, or periocular SCC who were treated with IO either in the neoadjuvant setting prior to surgery or for treatment of periocular SCC with perineural spread into the orbit and skull base. Results: 17 patients, 12 men and 5 women (Age range: 44-92; median=70 years old) with orbital (n=6), conjunctival (n=5), or lacrimal sac/duct (n=2) squamous cell carcinoma (SCC), or periocular SCC with perineural spread into the orbit and skull base (n=4) who were treated with IO either as single drug (n= 11) or in combination with chemotherapy (n= 6 ). In all patients either cemiplimab or pembolizumab was used. In 13 patients IO was used in the neoadjuvant setting prior to planned surgery. In 4 patients with perineural spread as they had non surgically resectable disease, IO was used to avoid high dose radiation therapy with its inherent significant risk of ocular toxicity. Overall, 3 patients achieved complete response, 10 patients achieved partial response, and 4 patients had stable disease, using RECIST criteria. One of 5 patients with conjunctival SCC also had nodal metastasis at presentation and achieved a dramatic complete response of both the conjunctival tumor and the nodal metastasis and managed to avoid surgery altogether. This patient had a very high tumor mutation burden (TMB). One patient developed diabetic ketoacidosis as a side effect of IO; otherwise the adverse effects were low grade. Conclusions: IO either as single drug or in combination with chemotherapy has a fairly high response rate in patients with ocular adnexal, conjunctival or orbital SCC and in patients with periocular SCC with perineural spread in the orbit and skull base. Future prospective trails using IO for orbital and ocular adnexal SCC should be planned and should aim to correlate molecular data such as TMB with response.

Impact of Equine Ocular Surface Squamous Neoplasia on Interactions between Ocular Transcriptome and Microbiome.

Ocular surface squamous neoplasia (OSSN) represents the most common conjunctival tumor in horses and frequently results in vision loss and surgical removal of the affected globe. Multiple etiologic factors have been identified as contributing to OSSN progression, including solar radiation exposure, genetic mutations, and a lack of periocular pigmentation. Response to conventional treatments has been highly variable, though our recent work indicates that these tumors are highly responsive to local immunotherapy. In the present study, we extended our investigation of OSSN in horses to better understand how the ocular transcriptome responds to the presence of the tumor and how the ocular surface microbiome may also be altered by the presence of cancer. Therefore, we collected swabs from the ventral conjunctival fornix from 22 eyes in this study (11 with cytologically or histologically confirmed OSSN and 11 healthy eyes from the same horses) and performed RNA sequencing and 16S microbial sequencing using the same samples. Microbial 16s DNA sequencing and bulk RNA sequencing were both conducted using an Illumina-based platform. In eyes with OSSN, we observed significantly upregulated expression of genes and pathways associated with inflammation, particularly interferon. Microbial diversity was significantly reduced in conjunctival swabs from horses with OSSN. We also performed interactome analysis and found that three bacterial taxa (Actinobacillus, Helcococcus and Parvimona) had significant correlations with more than 100 upregulated genes in samples from animals with OSSN. These findings highlight the inflammatory nature of OSSN in horses and provide important new insights into how the host ocular surface interacts with certain microbial populations. These findings suggest new strategies for the management of OSSN in horses, which may entail immunotherapy in combination with ocular surface probiotics or prebiotics to help normalize ocular cell and microbe interactions.

A rare case of eyelid choriostoma in an adult male: A case report

Choristomas are rare tumors, commonly occurring in the head and neck region. These are defined as the presence of normal tissues, such as muscle, bone, cartilage, dermal appendages, and epidermal components, in abnormal locations. They are mostly seen in the pediatric population. Occurrence in the adult population is fairly rare. Ocular choristomas comprise a substantial portion of all conjunctival and corneal tumors. These are the most common types of epibulbar and orbital tumors in children. Rarely, they may present as a growth in the eyelid region. The authors present one such rare case of eyelid choristoma masquerading as a chalazion, in an elderly patient. The patient presented with an eyelid mass, initially diagnosed as a Chalazion. The mass was excised and sent for histopathological evaluation, which revealed fibrocartilagenous tissue, suggesting a choristoma. The patient was followed up for a period of six months, without any recurrence.

Intra-Operative Infrared Thermography of Ocular Surface During Cryodestruction of Epibulbar Tumours

The paper presents the possibilities of intraoperative use of infrared (IR) thermography to image the temperature distribution of the outer ocular surface during cryodestruction of conjunctival tumours with localization in the ciliary body projection to determine an individual freezing regimen. IR thermography was carried out using a portable device for infrared real-time thermography. Thermal fields were visualized, and the duration of cooling and warming of the structures of the outer ocular surface around the area of freezing, including the cornea, were recorded. It was found that intraoperative IR thermography during cryodestruction of epibulbar tumours in the projection of the ciliary body allows real-time noninvasive imaging of the temperature fi eld dynamics around the freezing zone, which can be used to select individual cooling exposure to reduce the risk of complications by avoiding excessive cooling of intraocular structures. It was also determined that IR thermography makes it possible to assess the individual dynamics of rewarming of the ocular tissues to the initial level if a repeated cycle of tumour cryodestruction is necessary.

Evaluation of the accuracy of clinical diagnosis of conjunctival neoplasms : Comparison with histological findings after excision

Neoplasms of the conjunctiva include many different entities with abroad variety of clinical presentations. This can make aprecise clinical diagnosis difficult. R0 resection is the gold standard treatment for most malignant conjunctival neoplasms, but not every benign lesions must treated by excision. In clinical practice it is important to make an accurate clinical diagnosis to enable the best possible management of conjunctival neoplasms. The aim of this study was to determine the accuracy of clinical diagnosis of neoplasms of the conjunctiva. Within aretrospective design, the data from all patients with excision of aconjunctival lesion between 2011 and 2020 in the Department of Ophthalmology of the UKSH Campus Kiel were extracted and analyzed. The specificity, sensitivity, and positive and negative predictive value for the preoperative clinical rating of dignity and diagnosis were evaluated based on the histological diagnostic findings. Of 220 included cases, 75% were benign and 25% malignant. The most frequent neoplasm of the conjunctiva was benign conjunctival nevus. The sensitivity for clinical prediction of abenign lesion was 0.86 (95% confidence interval [CI] 0.59-0.92), the specificity 0.95 (CI 0.85-0.99), and the positive predictive value 0.98 (CI 0.94-1.0). The sensitivity for clinical prediction of malign dignity was 0.95 (CI 0.85-0.99), the specificity 0.88 (CI 0.83-0.93), and the positive predictive value 0.73 (CI 0.61-0.83). The derived values for clinical diagnosis of conjunctival neoplasms can be rated as good. However, in clinical practice, untypical lesions can be hard to diagnose correctly, and the clinical diagnosis should be carefully reviewed; if in doubt, excision should be preferred.

OSSN: An underrated neoplasia of the eye

: Ocular surface squamous cell carcinoma (OSSN) is a general term for various conjunctival tumors, including conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC).: To evaluate the clinico-demographic characteristics and histopathological findings of ocular surface squamous cell carcinoma. : eyes of 47 patients aged 21 to 80 years with conjunctival tumors were included in the study and underwent excisional biopsy and subsequent histopathological examination. : Statistically significant associations were found with age, symptom duration, and lesion size (p<0.05). Benign and preinvasive lesions are more common than invasive lesions.

Разработка нового нанобиотехнологического метода и его применение для дифференциальной диагностики опухолей придаточного аппарата глаза

Aim: to develop a new nanobiotechnology method for the differential diagnosis of ocular adnexal tumors. Patients and Methods: 192 eyelid or conjunctival tumor samples from 192 patients were examined. Controls were healthy tissue samples from the same eye. To register and obtain significant differences in the generation of biogenic silver nanoparticles in situ, the key parameters of the reaction of the reduction of silver cations were selected and optimized. To generate de novo biogenic silver nanoparticles, tissue samples were placed in a sterile solution of a cation source in aseptic conditions. Nanoparticles were generated in situ using a sterile solution of Tollens' reagent (Ag(HN3)2NO3). Results: the optimal parameters of a new nanobiotechnology method were established to conduct the reduction reaction to generate biogenic silver nanoparticles. The required concentration of Tollens' reagent (source of cations) was 63 μg/ml. The wavelength used to observe the de novo generation of biogenic silver nanoparticles (λ) was 410 nm. Obtaining the most significant changes in the optical density of the reaction mixture with biogenic nanoparticles required 10 to 20 min, although the first changes were documented starting from the 5th minute of the reduction reaction. Benign and malignant tumors are characterized by different metabolic activities, i.e., benign eyelid and conjunctival tumors reduce cations more slowly than malignant tumors. The parameters of reducibility of benign ocular adnexal tumors did not significantly differ depending on tumor location and type. Among the malignant conjunctival tumors, melanoma is characterized by the highest reducibility p<0.05). Among the malignant eyelid tumors, no significant differences were found for different tumor types. Conclusions: this novel nanobiotechnology method provides a differential diagnosis of benign and malignant ocular adnexal tumors. The practical relevance of this method lies in differentiating benign and malignant tumors to schedule management strategies and surgical interventions. KEYWORDS: tumor, eyelids, conjunctiva, silver nanoparticles, biogenic synthesis, express diagnostics, ocular oncology. FOR CITATION: Saakyan S.V., Skladnev D.A., Alekseeva A.P., Beznos O.V., Sorokin V.V. Development of a new nanobiotechnology method for the differential diagnosis of ocular adnexal tumors. Russian Journal of Clinical Ophthalmology. 2024;24(1):25–29 (in Russ.). DOI: 10.32364/2311-7729-2024-24-1-5.

Targeted Therapy and Immunotherapy for Advanced Malignant Conjunctival Tumors: Systematic Review.

To review the outcomes of targeted therapy and immunotherapy in advanced conjunctival tumors, including conjunctival squamous cell carcinoma, conjunctival melanoma, and conjunctival lymphoma. A Pubmed database systematic search was performed between January 1999 and December 2022. The literature search was limited to studies published in English. This review included 142 patients with advanced malignant conjunctival tumors from 42 articles. In the conjunctival squamous cell carcinoma group, 2 cases of advanced conjunctival squamous cell carcinoma treated with epidermal growth factor receptor inhibitors showed significant tumor size improvement after 7.5 months of follow-up. Among 7 cases treated with systemic immunotherapy, 5 cases (72%) had complete response (CR), 1 case (14%) showed partial response (PR), and 1 case (14%) had stable disease (SD) after 16 months. In the conjunctival melanoma group, among 18 cases treated with combined v-raf murine sarcoma viral oncogene homolog B1/mitogen-activated extracellular signal-regulated kinase inhibitors, 6 (33%) had CR, 5 (28%) had PR, 2 (11%) had SD, and 5 (28%) had progressive disease after 24.8 months of follow-up. Of 44 conjunctival melanoma cases treated with immunotherapy, 12 (28%) had CR, 9 (20%) had PR, 7(16%) had SD, and 16 (36%) had progressive disease after 14.2 months. Systemic Rituximab treatment for conjunctival lymphoma cases resulted in CR in 21 patients (63%), PR in 11 patients (33%), and SD in 1 patient (3%) after 20.5 months of follow-up. Intralesional Rituximab injections in 38 conjunctival lymphoma cases showed CR in 28 patients (75%), PR in 7 patients (19%), SD in 1 patient (2%), and progressive disease in 2 patients (4%) after 20.4 months of follow-up. Despite limited clinical case reports and short-term follow-ups, targeted therapy and immunotherapy have shown promising results for advanced malignant conjunctival tumors.

Eyelid and conjunctival mast cell tumors: A retrospective study of 26 dogs and 8 cats.

The objective of the study was to describe clinical and histologic characteristics of eyelid (LMCT) and conjunctival (CMCT) mast cell tumors in dogs and cats presented to a referral clinic in Germany. Medical records were reviewed to identify dogs and cats diagnosed with LMCTs or CMCTs between 2006 and 2020. LMCT were diagnosed in 31 patients and were cutaneous (n = 28; 20 dogs and 8 cats) or subcutaneous (three dogs). Five cases involved the mucocutaneous junction (four dogs, one cat). CMCTs occurred only in dogs (n = 3). At the time of presentation two of the four canine LMCT cases involving the mucocutaneous junction had metastasized to a mandibular lymph node. When applying the Kiupel system, both these cases were categorized as high grade. 85.7% (18/21) of the canine (19 cutaneous and 2 subcutaneous) LMCT and all CMCT cases were categorized as Kiupel low grade. No local recurrences occurred in all LMCT cases in which clean surgical margins were obtained (n = 18, mean surgical margin width: dogs 9.4 mm, cats 3.8 mm). Two cats (2/4) and four dogs (4/7) with questionable or incomplete surgical margins experienced local recurrences (mean time to recurrence of 180 and 637 days in dogs and cats, respectively). Recurrence of low-grade LMCTs and CMCTs following excision with clean margins is rare. Tumors involving the mucocutaneous junction may be of higher grade and prone to lymphatic metastasis.

Self-Retained, Sutureless Amniotic Membrane Transplantation for the Management of Ocular Surface Diseases.

Amniotic membrane (AM) has anti-inflammation, anti-fibrotic, and regenerative effects. Sutureless cryopreserved AM transplantation, ProKera® (Bio-Tissue, Inc., Miami, FL, USA), is easily applied by ophthalmologists in the treatment of ocular surface diseases. This retrospective study included patients with ocular surface diseases who received ProKera® between January 2022 and May 2023. Six patients (9 eyes) with a mean age of 56.8 ± 20.8 years old (range 25-74) and a mean follow-up period of 7.8 ± 4.1 months (range 1-12) were included, including 2 of recurrent conjunctival tumors with limbal and corneal involvement (cases 1-2), 1 of pterygium with marked astigmatism (case 3) and 3 of Stevens-Johnson syndrome (SJS, cases 4-6). ProKera® was inserted after the lesion excision and deep keratectomy in cases 1-3, and no recurrence or corneal complication was noted. Cases 4-5 were discharged from the intensive care unit and presented with severe chronic SJS. Most ocular manifestations improved significantly after symblepharon release and ProKera® insertion, except for corneal conjunctivalization in 1 eye (case 5). Case 6 involved early ProKera® use at the bedside during acute SJS, resulting in complete resolution. We concluded that the adjunctive application of ProKera® can be effective for ocular surface reconstruction and provides options to intervene earlier for outpatients or patients unstable for invasive surgical intervention.

Conjunctival tumors in children : Histopathological diagnoses in 262cases

The spectrum of conjunctival tumors in children and adolescents significantly differs from that of adults. The aim of this study was to show the distribution of histopathological diagnoses of pediatric conjunctival tumors. Retrospective case series including all conjunctival tumors of children and adolescents under 18years of age examined histologically over aperiod of 25years (1990-2015) at the Eye Center in Freiburg, Germany. Among the 262 conjunctival specimens, the most common diagnoses were conjunctival nevi (148, [56%]), most often with junctional activity (106/148, [72%]), pyogenic granulomas (26, [10%]), and dermolipomas (18, [7%]). In one case amalignant tumor (conjunctival melanoma) was detected (1, < 1%). The results suggest that pediatric conjunctival tumors are benign in most cases. Most of them were of melanocytic origin, with a junctional conjunctival nevus being the most common diagnosis.

Conjunctival Nevus.

To provide an up-to-date review of the epidemiology, presentation, diagnosis, and treatment options for conjunctival nevi (CN). Around 17.2%-42% of all conjunctival tumors have been found to be CN, which most frequently present in White individuals between the first to early third decade of life, with equal distribution between males and females. CN commonly occur in the interpalpebral bulbar conjunctiva with pigmentation ranging from amelanotic to dark. Diagnosis is typically made through slit lamp examination, visualized by a well circumscribed, variably elevated, variably pigmented, solitary lesion with clear cysts distributed throughout the pigment. In ambiguous cases, anterior segment optical coherence tomography (AS-OCT) can highlight the presence of sub-clinical cysts, whose presence points to a diagnosis of nevus. However, excisional biopsy with histopathology examination is the gold standard for identifying CN. CN are benign, variably pigmented lesions. They are the most common of the conjunctival melanocytic tumors. Due to the extremely low risk of transformation to malignant melanoma (MM), CN are usually managed with routine observation and photo documentation.

Concordancia clínica y patológica en tumores conjuntivales: Análisis de 195 casos

PurposeThe present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. MethodsA retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid, and others) and degree of malignancy (benign, premalignant, and malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen's kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. ResultsOf 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen's kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1, respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. ConclusionsMost of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

State of the Art of Pharmacological Activators of p53 in Ocular Malignancies.

The pivotal role of p53 in the regulation of a vast array of cellular functions has been the subject of extensive research. The biological activity of p53 is not strictly limited to cell cycle arrest but also includes the regulation of homeostasis, DNA repair, apoptosis, and senescence. Thus, mutations in the p53 gene with loss of function represent one of the major mechanisms for cancer development. As expected, due to its key role, p53 is expressed throughout the human body including the eye. Specifically, altered p53 signaling pathways have been implicated in the development of conjunctival and corneal tumors, retinoblastoma, uveal melanoma, and intraocular melanoma. As non-selective cancer chemotherapies as well as ionizing radiation can be associated with either poor efficacy or dose-limiting toxicities in the eye, reconstitution of the p53 signaling pathway currently represents an attractive target for cancer therapy. The present review discusses the role of p53 in the pathogenesis of these ocular tumors and outlines the various pharmacological activators of p53 that are currently under investigation for the treatment of ocular malignancies.

A rare case of orbital and diffuse conjunctival venous malformation

Cavernous hemangiomas (CH) are slow-flow venous malformations (VMs), not true vascular tumors. Although these are the most common benign orbital tumors in adults, conjunctival VMs are a rarity and account for less than 1% of all conjunctival tumors. We herein report a case of a 25-year-old male patient who presented with a large violaceous mass involving the inferior bulbar conjunctiva that had been present for 10 years. It was painless, progressive, and gradually increased in size over 10 years, and was associated with occasional bleeding. Any syndromic association was ruled out. Contrast-enhanced magnetic resonance imaging (CEMRI) revealed the presence of slow-flow vascular malformations involving the right superior and inferior eyelids with intraconal and extraconal involvement. An incision biopsy and histopathology (H/P) confirmed the diagnosis of formerly-called cavernous hemangioma (slow-flow VMs). The conjunctival mass was further managed by surgical debulking with ocular surface reconstruction, whereas the intraorbital part was kept under observation owing to its small size. The postoperative period was uneventful.

Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases

PurposeThe present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. Methodsretrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. ResultsOf 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. ConclusionMost of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.