Conjunctival tumor are benign and malignant neoplasms of the thin transparent membrane of the eye covering the anterior part of the sclera and the inner surface of the eyelids. They are manifested by a cosmetic defect. Visual disturbances are possible. Malignant tumors of the conjunctiva are capable of germination of surrounding tissues and metastasis. The diagnosis is made by an ophthalmologist taking into account complaints and the results of an examination of the structures of the eye. Treatment – traditional surgical intervention, laser excision, laser coagulation, electrocoagulation, cryotherapy, local drug therapy.
General information
Conjunctival tumor are a group of epithelial, pigmented, vascular tumors originating from the conjunctival membrane. Benign tumors are more often detected in childhood, and are often congenital in nature. Malignant and precancerous lesions are mainly diagnosed in elderly and senile people. In most cases, conjunctival tumors originate from epithelial or pigment cells, less often from subepithelial layers. The prognosis is usually favorable for life (with the exception of melanoma), however, some neoplasms, including benign ones, can cause visual disturbances and changes in the structures of the eye. The treatment is carried out by specialists in the field of oncology and ophthalmology.
Benign conjunctival tumor
Papilloma is a fairly common conjunctival tumor of epithelial origin. Occurs in the first days of life. It represents single or multiple soft nodules with a large number of small vessels, giving the neoplasms a reddish or pinkish color. Conjunctival tumors are located on a thin, often bleeding leg. They are prone to relapse. Rarely undergo malignant degeneration. Treatment – surgical intervention, cryodestruction, for multiple papillomas – laser vaporization or mitomycin applications.
Stationary nevus is another common conjunctival tumor. It originates from melanin-containing cells. It makes up about 20% of the total number of benign neoplasms of this shell of the eye. Usually occurs in childhood. A pigmented tumor of the conjunctiva looks like a flat smooth spot of yellowish or brownish color with clear contours. A third of nevi have no pigmentation. In the absence of growth and signs of malignancy, treatment is not required.
Dermoid (dermoid cyst of the conjunctiva, lipodermoid) is a congenital cystic tumor of the conjunctiva containing elements of the ectoderm. Like stationary nevi, it accounts for about 20% of the total number of benign conjunctival neoplasms. It can be single- or double-sided. It is usually localized outside of the cornea. It is an oval elastic knot of yellowish color. The cornea may germinate. Large dermoids can restrict the movements of the eyeball. Treatment is surgical excision.
Hemangioma is a conjunctival tumor of vascular origin. It has an innate character. As a rule, it is located in the inner corner of the eye. It looks like a cluster of strongly convoluted cyanotic vessels. Laser removal is shown in the early stages, followed by electrocoagulation.
Lymphangioma is a rare conjunctival tumor originating from the walls of lymphatic vessels. It is usually detected in adults. It is an elastic mobile formation of ordinary or pinkish-yellow color, which does not change the volume when pressed. This conjunctival tumor is prone to slow but steady growth. In the absence of treatment, it can reach large sizes, interfere with the normal movements of the eyeball and cause gross cosmetic defects. After removal, it may recur. The treatment is surgical.
Transitional conjunctival tumor
Bowen’s epithelioma is an obligate precancerous lesion of the conjunctiva of epithelial origin. As a rule, it occurs in adulthood. Localized near the limb. In the initial stages, the conjunctival tumor is a flat or slightly prominent light gray plaque. Subsequently, it becomes more massive, rises more above the surface, acquires a mother-of-pearl hue. The cornea may germinate. Treatment – surgical intervention (possibly in combination with pre- and postoperative treatment with mitomycin), short-range radiotherapy.
Acquired melanosis is a precancerous pigmented tumor of the conjunctiva. Usually occurs at the age of 40-50 years. It looks like a flat dark spot with clear contours. It can affect a significant part of the conjunctiva and move to the cornea. The duration and features of the course of this conjunctival tumor vary significantly. Sometimes spontaneous recovery is noted. In 25-75% of patients, malignancy is observed. Treatment – electrocoagulation, laser coagulation, with the appearance of signs of malignancy – radiation therapy.
Progressive nevus is a precancerous conjunctival tumor originating from pigment cells. The color of the neoplasm can vary from dark brown to light yellow or pinkish. There is an increase in size, the appearance of mottled coloration (alternation of pigmented and non-pigmented areas), blurring of contours and an increase in the number of vessels. The treatment is operative.
Malignant tumor of the conjunctiva
Conjunctival cancer is a primary malignant tumor of the conjunctiva, usually occurring against the background of precancerous diseases. It is rarely diagnosed, mainly affects older people. Men get sick more often than women. A risk factor is constant excessive insolation. In appearance, the conjunctival tumor may resemble Bowen’s disease or keratinizing papilloma. It is a grayish or whitish film, permeated with telangiectasia, or a cluster of pinkish nodules. In the process of growth, the conjunctival tumor spreads to nearby tissues, can germinate the orbit, metastasize to the cervical and parotid lymph nodes.
Cancer can also be localized on the inside of the eyelid. Such neoplasms are more malignant in comparison with conjunctival tumors located in the sclera. In the initial stages, the node grows intra-conjunctivally, causing thickening and compaction of the eyelid. In the future, ulceration is possible. With progression, the conjunctival tumor spreads to the lacrimal muscle, cornea and conjunctiva of the sclera, but does not germinate the tarsal plate.
The diagnosis is established on the basis of examination and biopsy results. Limited nodes of small size are subject to prompt removal. It is possible to use diathermocoagulation. With large conjunctival tumors, X-ray therapy or beta therapy is used. When the orbit is affected, the eye socket is exenterated. The forecast is quite favorable. With tumors that do not spread to the orbit, the absence of relapses within 5 years after the end of treatment is noted in 50-80% of patients.
Melanoma is a malignant tumor of the conjunctiva that occurs against the background of acquired melanosis (75%), progressive nevus (20%) or unchanged tissues. It is a smooth or lumpy tumor-like formation. It can be pigmented (yellowish, brown) or devoid of pigment. It is usually located at the inner corner of the eye or near the limb. When examined on a slit lamp, pigmented “tracks” are found that diverge beyond the conjunctival tumor.
With progression, it can give rise to new nodes in the conjunctiva, germinate the sclera and orbit, as well as metastasize to regional lymph nodes and distant organs. The treatment is operative. In the early stages, the conjunctival tumor is removed from the surrounding tissues, when the sclera germinates, the eyeball is enucleated, and when the orbit germinates, the orbit is exenterated. X-ray therapy and chemotherapy are used. The prognosis is unfavorable in most cases.
