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C.M. Anjema, N. Willis, J. Heathcote; Conjunctival Intraepithelial Neoplasia: A Re-evaluation of the Pathologic Diagnosis and Natural History . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2433.
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Purpose: To re-evaluate the pathologic diagnosis in cases of conjunctival intraepithelial neoplasia (CIN), establish the prevalence of actinic keratosis in Ontario and compare the recurrence rates of actinic keratosis and dysplasia. Methods: Retrospective pathologic review of cases with a clinical or pathologic diagnosis of CIN/dysplasia/keratosis from archives of UWO teaching hospitals between 1990 and 2002. Immunohistochemical evaluation of expression of p53 and bcl-2 in selected examples of pterygium, actinic keratosis and dysplasia. Results: 43 cases were evaluated, 11 (26%) female, 32 (74%) male, with an average age of 64.2 years (Range: 36-92 years, SD: 11.4 years). Dysplasia was more prevalent in males than females (40.6% vs 9.1%); in this group pterygium was more prevalent in females than males (54.6% vs 18.8% (p < 0.061)). There was no difference in prevalence of actinic keratosis between men and women (40.6% vs 36.4%). Using published criteria the pathological diagnosis was revised in 12/24 (50%) cases of dysplasia, 5/14 (35%) cases of actinic keratosis and 2/5 (40%) of cases of pterygium (p < 0.012). Follow-up was available on 32/42 (74.4%) patients for 3-108 months (ave 25 months). The recurrence rate was 6/32 (18.8%); all were cases of dysplasia with follow-up of 12-108 months (ave 59 months). Pathological features indicative of actinic keratosis rather than dysplasia were squamoid cell type (vs basaloid, p<0.001), variable architectural disarray (vs graded, p<0.001), and variable cytological atypia (vs uniform, p<0.001). Elastosis (p<0.486), parakeratosis (p<0.057), and distinct margins (p<0.081) did not aid in diagnosis. Strong expression of p53 in greater than 70% of cells was seen in actinic keratosis and dysplasia, but not pterygium (p < 0.023). Weak expression of bcl-2 was seen in all types of lesion. Conclusions: The pathologic diagnosis of conjunctival epithelial lesions is subjective and strict criteria need to be applied. In Ontario, actinic keratosis comprises approximately 50% of such lesions. Actinic keratosis shows little or no tendency to recur. Differences in natural history between actinic keratosis and dysplasia are not explained by differential expression of p53 and bcl-2.
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