Case History 67 yo F Progressive visual loss in the SO associated with corneal degeneration and a limbal tumor Gross description – Opaque white tissue measures 13x12mm – Extends from the limbus to the edge of cornea

Diagnosis Dysplasia/CIN, limbal conjunctiva

Conjunctival intraepithelial neoplasm (CIN) Definition: CIN includes a wide range of neoplastic intraepithelial changes ranging from dysplasia to full-thickness epithelial neoplasia or carcinoma in situ Synonyms include mild, moderate, and severe dysplasia, carcinoma in situ, ocular surface squamous neoplasia, intraepithelioma and bowenoid dyskeratosis

CIN Clinically, lesions are sharply demarcated and arise at the limbus, where corneal stem cells are located, with either or both conjunctival and corneal involvement. Most lesions are pink, nonkeratinized, well- vascularized and have a raspberry-like configuration. Rarely, these changes spontaneously regress.

CIN Microscopic findings – Keratinization and dyskeratosis are not a common feature of CIN. – Atypical mitosis are frequent and may be located at all levels of the epithelium. – The intraepithelium dysplastic changes are graded as mild, moderate, or severe based on the thickness of intraepithelial involvement.

CIN Differential diagnosis. – UV-related epithelial hyperplasia – Intraepithelial sebaceous gland carcinoma – Inraepithelial invasion by adenocarcinoma originating from aprocrine glands of moll – Primary acquired melanosis (HMB45, S-100, Melan A)

Case 2

Case History 50 yo F 2Y/H progressively enlarging pigmented area involving the conjunctiva and cornea of the left eye. 3X3.5 mm. pigmented limbal nodule appeared in this area of heavily pigmented conjunctiva, which had been previously biopsied and diagnosed as “primary acquired melanosis”

Case History (Cont.) The left eye and a broad zone of bulbar conjunctiva were excised because of the clinical diagnosis of malignant melanoma of the conjunctiva.

Diagnosis – Malignant melanoma of limbus arising from primary acquired melanosis.

Melanocytic tumors of the conjunctiva Ephelis(Freckle) Lentigo Nevus Primary Acquired Melanosis(PAM) Malignant Melanoma

PAM Clinical Characteristics – The melanosis of unilateral, diffuse, brown pigmentation that moves with the conjunctiva over the sclera (analogous to lentigo maligna of the skin). – Age of onset is 40 to 50 years of age. – No clinical differentiation in PAM with or without atypia

Corneal Cases

Case 3

Case History 60 yo M H/O Pseudophakic bullous keratopathy Waxing and waning corneal edema Decreased vision in his left eye Penetrating keratoplasty