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• W2072159865 abstract "Dear Editor, Pinguecula is a common degenerative condition of conjunctiva. In atypical cases an erroneous diagnosis of carcinoma may be made. We report an atypical presentation of histopathologically proven pinguecula. A 50-year-old carpenter presented with a dark lesion associated with watering, redness, irritation and itching in right eye since three weeks. He reported no vision loss, pain, trauma or topical use of medication or cosmetics. There was no contributory medical history. On examination, his best corrected visual acuity was 20/40 in both eyes. Ocular movements were normal. The right eye had a vascularized pigmented lesion with surface ulceration, surrounding conjunctival chemosis and vascularization of the surrounding conjunctiva in the temporal bulbar conjunctiva, 3 mm from limbus [Fig. 1]. It measured 8 mm horizontally by 5 mm vertically, with maximal elevation of 2 mm and irregular borders. It was freely mobile over the underlying sclera. There was dellen in the peripheral cornea. Two prominent forniceal vessels extended to the mass. Both eyes had nuclear sclerosis, normal intraocular pressure and normal fundus. Regional lymph nodes were not palpable.Figure 1: Slit lamp photograph of right eye showing vascular pigmented conjunctival lesionIn view of the suspicious nature of the lesion, we performed an excision biopsy with 4mm tumor-free margins using a ‘no touch’ method,1 avoiding direct manipulation of the tumor to preclude tumor cell seeding. The conjunctiva was then re-apposed. Histopathology showed surface epithelium with areas of atrophy and hyperplasia. Sub-epithelial tissue demonstrated hyalinization and calcareous degeneration [Fig. 2]. Areas of granulation tissue with perivascular mononuclear inflammatory cell reaction were seen. Histopathological picture was suggestive of pinguecula.Figure 2: Histopathology of the same lesion showing hyalinization and calcareous degenerationPrimary malignant melanoma may arise from nevi, primary acquired melanosis or de novo. These present as a pigmented vascularized lesions with rapid growth. Histologically, the overlying epithelium is invaded with atypical cells and inflammatory infiltrate.2 Conjunctival nevus and congenital ocular melanocytosis have congenital onset, though conjunctival nevus may present in young adult. Histologically, nevus cells are seen in the sub-epithelial tissue in interlacing fasciculi.23 Primary acquired melanosis has an onset in middle age and has brown diffuse structure.2 Other simulating lesions include nevus of sclera, pseudo pigmentation in blue sclera, ectatic sclera and scleromalacia perforans, endogenous pigmentation (blood, bile), metabolic disorders (Ochronosis, Gaucher's disease), exogenous pigmentations (epinephrine, argyrosis, mascara, dyes, iron and foreign bodies), pigment spots of the sclera2 and aspergilloma.4 Pinguecula is a degenerative process of sub-epithelial connective tissues of bulbar conjunctiva in the inter-palpebral region, over which the epithelium may be ulcerated, atrophic or thickened.5 Histologically, the most characteristic feature is sub-epithelial senile elastosis.5 The control of elastogenesis is seriously defective so that the elastic fibers are abnormal in biochemical composition. P53 mutations in limbal epithelial cells probably caused by ultraviolet radiation, may contribute.6 Secondary hyalinization and calcareous degeneration may be observed.3 Epithelium becomes atrophic or acanthotic and dyskeratotic which can lead to erroneous diagnosis of carcinoma.57 The conjunctival lesion so closely resembled a conjunctival melanoma that an excision biopsy was performed with the ‘no touch’ technique.1 A diagnosis of secondary change in a pinguecula may be made with caution, but must be confirmed by histopathology to facilitate definitive diagnosis and subsequent management." @default.
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• W2072159865 modified "2023-09-26" @default.
• W2072159865 title "Pinguecula masquerading as conjunctival melanoma" @default.
• W2072159865 doi "https://doi.org/10.4103/0301-4738.29517" @default.
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