Conjunctival intraepithelial neoplasia

Author: Deepali Jain, M.D. (see Authors page)

Revised: 17 April 2018, last major update September 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Conjunctival intraepithelial neoplasia [title]

Cite this page: Jain, D. Conjunctiva: conjunctival intraepithelial neoplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyecinconj.html. Accessed July 19th, 2018.
Definition / general
  • Precursor to squamous cell carcinoma
  • Dysplastic changes of conjunctiva ranging from dysplasia to carcinoma in situ
  • Clinically present as gelatinous, leukoplakic or papilliform lesions (Optometry 2011;82:15)
  • Associated with ocular pigmentation, tobacco use, sun exposure (Br J Ophthalmol 2003;87:396), exposure to petroleum products, chronic cyclosporine for transplants
  • Incidence of 1.9 cases per 100K per year, usually in elderly but younger age in xeroderma pigmentosum with more aggressive course (Graefes Arch Clin Exp Ophthalmol 2011;249:1217)
  • High grade ocular surface squamous neoplasia (OSSN): associated with male gender, temporal and superior locations, lack of corneal involvement, papillomatous and nodular appearance, microscopic multifocality, and positive margins on biopsy (Ophthalmology 2012;119:1773); giant OSSN (a single tumor > 15 mm basal diameter or > 6 limbal clock hours) can be treated with interferon alpha-2b (Ophthalmology 2012;119:938)
  • HIV: associated with aggressive tumors presenting at younger ages
  • HPV 6/11 in 38%, HPV 16 in 30 - 58%, HPV 18 in 50 - 57% (Ophthalmology 2002;109:542)
Gross description
  • Sharply circumscribed limbus lesion; annular and gelatinous; may see delicate epithelial proliferation of cornea with indirect illumination
Microscopic (histologic) description
  • Sharply circumscribed atypia
  • Dysplasia begins in basal layers and extends towards surface
  • Large or small squamous cells, may be spindled
  • Often atypical mitotic figures at all levels of epithelium
  • Fronds of proliferating blood vessels and connective tissue resemble papilloma
  • Rarely HPV related changes (koilocytes)
  • Intratumoral pigmented dendritic melanocytes give rise to pigmented in situ lesion (Ophthalmology 2008;115:1673)
  • Usually NO keratinization or dyskeratosis
  • No invasion of epithelial basal membrane
Microscopic (histologic) images

Images hosted on other servers:
Missing Image Missing Image

Various images

Positive stains
Differential diagnosis