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B. Patel, N. Ghazi; Large-Cell Acanthoma of the Conjunctiva: A New Entity With Possible Malignant Potential. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2624.
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To describe a conjunctival lesion suggestive of large cell acanthoma (LCA) which has not been previously described in the conjunctiva.
A 49-year old male presented with a right temporal bulbar conjunctival lesion with clinical features of a pingueculum. It recurred twice following initial excision. The recurrences were subsequently excised. All three specimens were examined by routine light microscopy.
Microscopic examination of the first two excisions disclosed a well-demarcated intraepithelial lesion with acanthosis, hyperorthokeratosis, hypergranulosis and focal parakeratosis. It was composed of large cells, approximately twice the size of normal epithelial cells, with an abrupt transition to normal conjunctival epithelium (Figure 1). Solar elastosis of the stroma was also present. The third excision had different histological features from those of the previous two excisions The features were rather consistent with CIS in that the lesion was composed of large dysplastic and dyskeratotic cells that involved the full thickness of the epithelium with loss of normal epithelial maturation and no stromal invasion (Figure 2). No hypergranulosis or orthokeratosis was present. Contiguous areas reminiscent of LCA with an abrupt transition between normal and abnormal epithelium were present.
The findings noted in the first two excisions are more consistent with those seen in LCA of the skin than with those of actinic keratosis. This may be the first case of LCA in the conjunctiva and suggests that LCA may have a malignant behavior and transformation potential.
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