Pigmented Viral-Associated Conjunctival Carcinoma

A 54-year-old African-American woman developed a pigmented papillary squamous cell carcinoma in the palpebral and bulbar conjunctiva of the right eye in areas that received no sun exposure. In situ hybridization performed on the tumor showed human papilloma virus 16. The left eye showed a pedunculated nonpigmented conjunctival dysplasia. The tumors were extirpated by cryosurgery and topical interferon alfa 2b in the right eye and simple surgical excision in the left eye. 1. Introduction Conjunctival squamous cell carcinoma is usually unilateral, solar-induced, amelanotic, and located at the limbus in the horizontal meridian. We report a case of bilateral lesions in nonsun-exposed areas, one of which was pigmented and contained human papilloma virus (HPV) 16. 2. Case Report A 54-year-old African-American woman noted an irritation of the right eye of 3-months duration. She was an insulin-dependent diabetic, negative for human immunodeficiency virus (HIV), and a nonsmoker. The right eye showed a gray and brown papillary lesion involving the medial portion of the inferior tarsal conjunctiva (Figure 1). The tumor was 14？mm in horizontal length and spared the lacrimal punctum. A separate ovoid epibulbar plaque of fine, partially pigmented papillae was present on the bulbar conjunctiva inferiorly and measured ？mm. There was no preauricular, submandibular, or cervical lymphadenopathy. She wore gas-permeable hard contact lenses for keratoconus with best corrected visual acuity of 20/25 OD and 20/30 OS. There was no other ocular abnormality. Biopsy of the palpebral conjunctiva was performed. Figure 1: (a)-(b) show partially pigmented papillary tarsal tumor, right lower lid. (c) Region of fine epibulbar papillary tumor (arrows). (d) Tumor has resolved following 2 months of treatment. Pathologic results showed a papillary tumor consisting of mitotically active, pleomorphic epithelial cells with koilocytes within the superficial tumor. Dendritic melanocytes and pigmented macrophages were present in the papillary vascular cores. Immunohistochemical stain for p53 showed positivity in most of the tumor cells (Figure 2). In situ hybridization (ISH) was focally positive for Inform human papillomavirus (HPV) family 16 probe and negative for family 6 probe. Figure 2: (a) Photomicrographs demonstrate cytologic atypia of tarsal tumor, right lower lid. (b) Pigmented melanophages within vascular cores imparting brown color to tumor. (c) Viral-containing koilocytes are present in outer tumor. (d) P53 immunostain is diffusely positive (hematoxylin/eosin (a)–(c) ; (d)