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Case 180

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Female patient, dark skin, 24 years of age, lives in Belo Horizonte (MG), with no previous ocular symptoms, complaints that, 30 days ago, red areas appeared on her right eye. At external examination, both eyes aligned perfectly when asked to move simultaneously to different positions. Pupils were isochoric, circular and centered, with unchanged reflections. Eyelids without alterations. In bulbar conjunctiva of the right eye, two pink areas were observed during the slit lamp examination, and presented as soft, lobed masses, each with its pedicle. Visual acuity, eye fundus and intraocular pressure were unchanged.

Based on the patient's medical history and eye examination, which is the most likely diagnosis?

a) Conjunctival squamous cell carcinoma

25%

b) Squamous Cell Carcinoma of the conjunctiva

25%

c) Conjunctival papilloma

25%

d) Kaposi\'s sarcoma

25%
   

Image analysis

 

Image 2: On the bulbar conjunctiva of the right eye there is a bigger lesion (marked in green), measuring 9.6 mm horizontally and 6.2 mm vertically, located at the 6 o'clock position, at a 27 mm distance from the corneal limbus. A smaller lesion is visible (marked in blue) measuring 3.7 mm horizontally and 4.8 mm vertically, located at the 4 o’clock position, at a 2.6 mm distance from the corneal limbus. These reddish lesions, when manipulated, behave like soft, lobed masses, each supported by a narrow stalk. The smallest lesion is translucent with a radial vascular network, and high. The bigger lesion has a smooth, rosy surface, on which there are several small vascular points in red.

Highlights

- The conjunctival papilloma is a benign tumor of the stratified squamous epithelium of the conjunctiva; more common in men (2: 1) and adults.

- It has association with HPV, UV radiation, immunodeficiency and smoking.

- In adults, it is usually unique and extensive, with variable clinical pictures.

- In children, usually multiple, smaller and are more likely to relapse.

- The excisional biopsy is indicated when possible by the extent of the tumor and is necessary for the diagnosis.

- Small lesions admit expectant management, while larger and symptomatic lesions require surgery and cryotherapy.

- It has a good prognosis, with rare progression to carcinoma.

References

- Pereira APF. Lesões não melanocíticas da conjuntiva. 2010.

- Alves LFA et al. Incidence of epithelial lesions of the conjunctiva in a review of 12,102 specimens in Canada (Quebec). Arq. Bras. Oftalmol. [online]. 2011, vol.74, n.1 [cited 2015-02-24], pp. 21-23. Available at: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-7492011000100005&lng=en&nrm=iso>. ISSN 0004-2749.  http://dx.doi.org/10.1590/S0004-27492011000100005.

- Buggage RR, Smith JA, Shen D, Chan C, Bethesda (2002) Conjunctival Papillomas Caused by Human Papillomavirus Type 33. Arch Ophthalmol 120:202-204

- Lima CGMG, Veloso JCB, Tavares AD, Jungman P, Vasconcelos AA. Método citológico e histopatológico no diagnóstico das lesões da conjuntiva: estudo comparativo. Arq Bras Oftalmol. 2005;68(5):623-6.

Authors

Júlio Guerra Domingues, sixth year medical student at UFMG. E-mail: jgdjulio[at]gmail.com

Joel Edmur Boteon, professor of the Department of Ophthalmology and otorhinolaryngology of UFMG’s Medical School. E-mail: botteon.ufmg[at]gmail.com

Supervisors

Joel Edmur Boteon, professor of the Department of Ophthalmology and otorhinolaryngology of UFMG’s Medical School. E-mail: botteon.ufmg[at]gmail.com 

Luiz Carlos Molinari Gomes, collaborating professor of the Department of Ophthalmology and otorhinolaryngology of UFMG’s Medical School. E-mail: luizcarlosmolinari[at]gmail.com 

Reviewers

Letícia Horta, Ana Júlia Bicalho, André Guimarães, Luanna Monteiro, professor Viviane Parisotto.

Translated by

Bárbara de Queiroz e Bragaglia, 5th year medical student at UFMG. E-mail: barbara.bragaglia[at]ufmg.br

 

This clinical case is a result of  the partnership between Imagem da Semana and UNIMED-BH.

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