Conjunctival 'mucoepidermoid carcinoma' revisited: a revision of terminology, based on morphologic, immunohistochemical and molecular findings of 14 cases, and the 2018 WHO Classification of Tumours of the Eye.

In 2018, the consensus meeting for the WHO Classification of Tumours of the Eye decided that conjunctival mucoepidermoid carcinoma should be reclassified as adenosquamous carcinoma, as this represented a better morphological fit. To examine the applicability of this terminology, we studied the clinical, histopathological, immunohistochemical and molecular pathology of 14 cases that were originally diagnosed as conjunctival mucoepidermoid carcinoma. There were 7 (50%) females and 7 (50%) males. The median age was 64 years. The left eye was affected in 8 and the right eye in 6 patients. In-situ carcinoma was present in 11/14 (79%) cases and comprised in-situ squamous cell carcinoma (SCC) and conjunctival intraepithelial neoplasia with mucinous differentiation (CIN-Muc). Invasive carcinoma was present in 11/14 (79%) cases. Group 1 (1/11 cases, 9%) comprised invasive SCC only. Group 2 (6/11 cases, 55%) comprised SCC with mucinous differentiation, manifesting as scattered intracellular mucin, occasionally together with intercellular mucin, with no evidence of true glandular differentiation. Group 3 (3/11 cases. 27%) comprised true adenosquamous carcinoma. Group 4 (1/11 cases, 9%) comprised pure adenocarcinoma. Thirteen of 14 cases (93%) underwent FISH for MAML2 translocation and none were rearranged. Two cases harboured high-risk HPV (type 16 and 18). The combined findings confirm that all lesions in our study were not mucoepidermoid carcinoma, but represented predominantly SCC with mucinous differentiation and adenosquamous carcinoma. We, therefore, recommend future revision of the WHO classification to include SCC with mucinous differentiation alongside adenosquamous carcinoma.

Conjunctival Blue Naevus in an Anophthalmic Socket.

PURPOSE OF THE STUDY: To describe an unusual brown pigmented lesion of the conjunctiva in an anophthalmic socket in a 16-year-old male. PROCEDURES: A 16-year-old male patient presented with socket irritation whilst wearing an artificial eye due to meibomian gland dysfunction. An area of flat, subepithelial, dark brown pigmentation with irregular and indistinct borders on the bulbar conjunctiva of the anophthalmic socket was seen. The patient believed it had been present for at least 2 years. His past ocular history was of childhood trauma to the right eye at the age of 9 years, and he underwent primary enucleation and hydroxyapatite orbital implant insertion at that time. Unfortunately, the implant extruded and was removed a year later. RESULTS: An incisional biopsy of the pigmented lesion showed a conjunctival, subepithelial bland spindle cell melanocytic lesion, with uniform-sized and -shaped melanosomes. Immunohistochemistry showed the cells to express Melan A and HMB45 and they were negative for CD68 and pan-cytokeratins. The features were of a common blue naevus. CONCLUSION: This is the first documentation of a post-enucleation conjunctival naevus in an anophthalmic socket. We propose a pathogenesis and suggest surveillance as there is a risk of transformation to melanoma.

Small choroidal melanocytic lesions: features predictive of growth.

PURPOSE: To evaluate clinical features at presentation of small choroidal melanocytic lesions that were predictive of growth. DESIGN: Retrospective observational case series. PARTICIPANTS: A cohort of 240 patients with a presumptive diagnosis of small choroidal melanocytic lesions who were observed to document growth before treatment. METHODS: Data regarding size, location, diagnostic features, and growth were collected. To evaluate the diagnostic features at presentation, Barnard and Fisher exact tests were performed for categorical variables, and the Wilcoxon rank sum test was used for continuous factors. MAIN OUTCOME MEASURE: Documented growth. RESULTS: Eleven patients with small choroidal melanocytic lesions (4.6%) demonstrated growth within 50 months of follow-up. Lesions that demonstrated growth were significantly thicker (> or =2.0 mm; P<0.001) and closer to the foveola (<3.0 mm; P = 0.002). Significant increases in the risk of growth also were observed for gender (male), presence of symptoms, and orange pigment. CONCLUSIONS: Significant clinical features of small choroidal melanocytic lesions predictive of growth are greater thickness (> or =2.0 mm), location closer to the foveola (<3.0 mm), and presence of symptoms and orange pigment.

Retinal vascular tumors.

Retinal vascular tumors can be classified into four distinct clinical entities, which include retinal capillary hemangioma, retinal cavernous hemangioma, retinal arteriovenous communications (Wyburn-Mason syndrome), and retinal vasoproliferative tumor.