11/24. cryotherapy for conjunctival primary acquired melanosis and malignant melanoma. Experience with 62 cases.Sixty-two patients were treated by some combination of cryotherapy and surgery with an average follow-up of 3.3 years for one of the following diseases: focal or diffuse flat conjunctival primary acquired melanosis (PAM) with atypia but without a nodule of melanoma (10 cases); unifocal malignant melanoma with or without focal or diffuse PAM (30 cases); and multinodular/multicentric melanoma with and without PAM (22 cases). Of the ten patients who had PAM with atypia, invasive nodules of malignant melanoma did not develop. A second treatment was required to control the disease in four of the ten patients with extensive or diffuse lesions, and one has mild persistent disease. Of the 30 patients with unifocal nodules of malignant melanoma, 27 remained free of recurrence after one treatment, and 2 are asymptomatic after two treatments. One patient with a thick nodule at presentation required a parotidectomy and radical neck dissection for cervical metastases after recurrence in the conjunctival sac. In the group of 22 patients with multinodular malignant melanoma, only two did not have recurrent disease after one treatment. Of those who received multiple therapies, seven remained free of recurrence for at least 2 years after the last treatment; regional or distant metastases developed in nine; four required exenteration; and eight died. Conjunctival adjunctive cryotherapy avoids exenteration in extensive lesions of pure PAM and in unifocal melanoma, but even after multiple therapies, multinodular malignant melanoma had a 45% rate of metastasis. Metastasis was related to the presence of PAM sine pigmento in four patients (microscopically but not clinically detectable PAM); to the location of the nodules (9 of 10 patients who experienced metastases had forniceal, palpebral, and/or caruncular nodules); to the thickness or depth of invasion of the nodules (greater than 2 mm); and to the development of intralymphatic spread ("in-transit" local metastasis) within the conjunctival sac in six patients. No metastases were encountered among patients with strictly limbal nodules and among five patients with invasive nodules composed of spindle cells in part or in toto. Therapeutic success in this spectrum of melanocytic proliferations is closely correlated with the clinical extent of the disease when initiating definitive therapy.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
12/24. Recurrent conjunctival melanoma with neuroidal spindle cell features.A 66-year-old white woman had had a 20-year history of flat primary acquired melanosis involving the left inferior forniceal and palpebral conjunctiva. Over the ensuring 12 years, the patient experienced multiple recurrences of invasive malignant melanoma that emerged from the progressive primary acquired melanosis. Two of these recurrences were composed of nonpigmented spindle cells, and in the most florid invasive malignant melanoma that developed, the spindle cells formed a nodule 7.5 mm thick. The spindle cells were organized into fascicles and small bundles, the latter separated by a loose stroma that was devoid of mucopolysaccharides. The fascicular and neuroidal features in this case were sufficiently well developed to suggest the incorrect diagnosis of a neural tumor or a neurofibroma. However, the presence of intraepithelial atypical melanocytes at the edge of the spindle cell lesion, the absence of mucopolysaccharides in the stroma, the mitotic activity, and the absence of intercellular reticulin fibers favored the diagnosis of a spindle cell invasive malignant melanoma. This morphologic variant of conjunctival melanoma is compared with related cutaneous lesions of melanoma featuring a spindle cell population.- - - - - - - - - - ranking = 10keywords = spindle cell, spindle (Clic here for more details about this article) |
13/24. Unusual melanocytic nevi of the conjunctiva.In one patient, an epithelioid cell nevus of the conjunctiva contained numerous large, unpigmented, mononucleated, binucleated, and multinucleated benign-appearing nevus cells with abundant cytoplasm and frequent intranuclear vacuoles. Despite their overall size, the cells manifested a low nuclear-cytoplasmic ratio. After a partial excision of the lesion, the remainder spontaneously regressed during a two-year period. Another patient's lesion was dominated by a proliferation of spindle nevus cells developing in a long-standing epibulbar nevus. The spindle cells were moderately pigmented, frequently located within walls of epithelial inclusion cysts, and had benign cytologic features. Finally, in a third patient with the cutaneous B-K mole syndrome, a dysplastic conjunctival nevus developed that featured intraepithelial, atypical melanocytic proliferation with superficial colonization of the substantia propria. This portion coexisted with a deeper, preexistent lesion in the substantia propria that was comprised of orderly nests of unpigmented cuboidal nevus cells surrounded by pigmented, spindle-shaped blue nevus cells--a so-called "mixed nevus."- - - - - - - - - - ranking = 1.4959368720603keywords = spindle cell, spindle (Clic here for more details about this article) |
14/24. Conjunctival myxoma: a case report.A rare case of conjunctival myxoma in an 18-year-old female is reported. Clinically it presented as a painless mass located in the nasal bulbar conjunctiva. It was composed of spindle and stellate shaped cells in a loose mucoid stroma. Some of the cells had intracytoplasmic vacuoles consistent with dilated rough endoplasmic reticulum and/or intranuclear vacuoles of nuclear membrane invaginations. mast cells were also seen in the stroma. No recurrence has been reported eight months postoperatively.- - - - - - - - - - ranking = 0.24796843603016keywords = spindle (Clic here for more details about this article) |
15/24. Multicentric Kaposi's sarcoma of the conjunctiva in a male homosexual with the acquired immunodeficiency syndrome.A 38-year-old male homosexual with the new acquired immunodeficiency syndrome (AIDS) had biopsy proven Kaposi's sarcoma of the right palpebral conjunctiva, extraocular mucocutaneous areas, and lymph nodes. Histologically, the palpebral tumor was characterized by atypical spindle cell proliferation and multiple slit-like vessels. Staining for factor viii-related antigen was positive in the cytoplasm of some tumor cells. Electron microscopy disclosed weibel-palade bodies in cells lining scattered slit-like vascular channels. The palpebral tumor mass was relatively nonadherent to its surrounding tissues and thus its simple excision was noteworthy; despite the prominent vascularity of the tumor, minimal bleeding was associated with its surgical resection. Any patient with AIDS should have all mucosal surfaces routinely examined for the presence of Kaposi's sarcoma lesions.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
16/24. Conjunctival myxoma. A clinicopathologic study.A 54-year-old white man had a slowly growing painless epibulbar mass that clinically mimicked a lymphangioma. Morphologically, the paucicellular tumor contained stellate and spindly cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The clinical differential diagnosis included lymphangioma, amelanotic nevus, lymphoma, reactive lymphoid hyperplasia, dermoid, lipoma, and botryoid rhabdomyosarcoma. Pathologically, lymphangioma, myxoid neurofibroma, and spindle cell lipoma were all considered. The authors discuss the clinical and histopathologic features of the various tumors, and confirmation of the diagnosis of conjunctival myxoma by differential alcian blue staining properties dependent on critical electrolyte concentration.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
17/24. Blue nevi of the conjunctiva.Two examples of conjunctival blue nevi are presented. The clinical and histologic features of these lesions are not in accord with descriptions of blue nevi in the ophthalmic literature. In both cases, the nevi's clinical appearance was brown instead of blue; the nevi could be moved with the conjunctiva over the sclera; and they were not present at birth. Histologically, they demonstrated subepithelial, spindle-shaped melanocytes. The location of the cells was no deeper than that of common acquired compound or subepithelial conjunctival nevi.- - - - - - - - - - ranking = 0.24796843603016keywords = spindle (Clic here for more details about this article) |
18/24. Spindle cell carcinoma of the conjunctiva.Spindle cell carcinoma, a variant of squamous cell carcinoma, has long been recognized in numerous tissues (including the skin, the upper respiratory tract, the oral cavity, and the esophagus). Two cases of spindle cell carcinoma of the conjunctiva are reported here. Histopathologic examination of these cases shows the characteristic spindle-shaped cells in continuity with the overlying epithelium. Electron microscopy of one case showed desmosomes and cytoplasmic tonofibril-like material. Our direct experience with one of these two cases has shown the malignant neoplasm to be aggressive.- - - - - - - - - - ranking = 1.2479684360302keywords = spindle cell, spindle (Clic here for more details about this article) |
19/24. myxoma of the conjunctiva: a case report and a review of the literature.A rare case of conjunctival myxoma is reported. A painless tumor was noted in the left bulbar conjunctiva of an 80-year-old woman. The extirpated tumor, 12 x 10 mm, was hypocellular and composed of spindle-shaped or stellate tumor cells. The tumor stroma showed extensive myxomatous changes. alcian blue stain with hyaluronidase digestion revealed that the matrix contained rich amounts of hyaluronidase-sensitive acid mucopolysaccharides. Immunohistochemically, the tumor cells were positive for vimentin and alpha-smooth muscle actin, suggesting a fibroblastic or myofibroblastic cell phenotype. A review of the literature revealed the rare incidence and invariable benign behavior of conjunctival myxoma.- - - - - - - - - - ranking = 0.24796843603016keywords = spindle (Clic here for more details about this article) |
20/24. Squamous cell carcinoma of the conjunctiva in a patient with the acquired immunodeficiency syndrome.PURPOSE: To alert ophthalmologists to the possibility of human immunodeficiency virus (hiv) infection in individuals with conjunctival squamous cell carcinoma. methods: We treated a 24-year-old patient with the acquired immunodeficiency syndrome who developed a limbal mass. The mass was excised and examined by routine histologic and immunohistochemical methods. RESULTS: The histopathologic examination disclosed infiltrating squamous cell carcinoma with features of spindle cell carcinoma. Frequent abnormal mitotic figures were present in this neoplasia. CONCLUSIONS: Squamous cell carcinoma with histologic features of aggressive behavior in a young individual should alert physicians to the possibility of hiv infection. Such patients may require frequent follow-up examination, even after complete excision of the tumor.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
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