Sectorial Conjunctival Papillar Reaction, a Sign for Conjunctivo-Corneal Neoplasia

Abstract

Abstract: : Purpose: Lid tumors mimicking an inflammatory conjunctival inflammatory reaction is a well known fact, usually reported as masquerade syndrome. It is less well known that tumors of the bulbar conjunctiva or cornea can be associated with a papillary reaction. The aim of this study was to report a series of cases later diagnosed as spinocellular carcinomas or corneo-conjunctival intraepithelial neoplasias (CIN) of the ocular surface, that produced a localised tarsal papillary reaction and to analyse the histology of this reaction. Patients and Methods: We report a series of 4 cases presenting a sectorial tarsal papillary reaction that was associated with neoplastic changes of the bulbar conjunctiva or cornea. The clinical course, diagnostic delay, histology of the neoplastic lesions and histology of the tarsal conjunctival reaction in one case were examined. Results: Localised papillary reaction ultimately related to CIN or spinocellular carcinoma was noted in 4 patients. In 2 cases the association was obvious and there was no diagnostic delay. The lesions were excised and histology showed spinocellular carcinoma. The patients were maintained on retinoic acid ointment preventively and remained free of recurrence at the end of the follow-up period (3 and 5 years respectively) In the 3^rd case, treated for 18 months with anti-allergic and/or corticosteroid drops, the barely visible bulbar neoplastic lesion was interpreted as a pinguecula during the diagnostic delay. In the 4^th case the patient was treated for a corneo-conjunctival herpetic disease for 6 months. In both cases the histological diagnosis was CIN. The papillary reaction resolved in all 4 cases after the excision of the lesion. Histology of the tarsal conjunctiva of case 3 showed lympho-plasmocytoid reaction in the stroma, several classical papillae with a lymphoid infiltration as well as tarsal adipose degeneration. Conclusions: Unilateral or sectorial papillary reaction can be a masquerade not only caused by lid tumors but also by tumors of the ocular surface. An exquisitely localised papillary reaction, as seen in this series, should suggest a masquerade syndrome and possible neoplasias on the lid border but also on the ocular surface should be looked for in order to avoid deleterious delays in the management of these cases.

Keywords: conjunctiva • tumors • clinical (human) or epidemiologic studies: out