Quhill Hibba, Rundle Paul A, Mudhar Hardeep Singh
Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.
Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK.
Ocul Oncol Pathol. 2017 Sep;3(3):220-223. doi: 10.1159/000460820. Epub 2017 Mar 9.
To describe an unusual brown pigmented lesion of the conjunctiva in an anophthalmic socket in a 16-year-old male.
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.
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.
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.
描述一名16岁男性无眼球眼眶结膜处一种罕见的褐色色素沉着病变。
一名16岁男性患者因睑板腺功能障碍佩戴义眼时出现眼眶刺激症状。在无眼球眼眶的球结膜上可见一处扁平、上皮下、深褐色色素沉着区域，边界不规则且不清晰。患者认为该病变至少已存在2年。他既往眼部病史为9岁时右眼遭受儿童期创伤，当时接受了一期眼球摘除术并植入了羟基磷灰石眼眶植入物。不幸的是，植入物一年后脱出并被取出。
对色素沉着病变进行切开活检显示为结膜上皮下温和的梭形细胞黑素细胞病变，黑素小体大小和形状均匀。免疫组织化学显示细胞表达Melan A和HMB45，而CD68和全细胞角蛋白呈阴性。这些特征符合常见的蓝痣。
这是首次记录无眼球眼眶眼球摘除术后结膜痣。我们提出了发病机制，并建议进行监测，因为存在恶变黑素瘤的风险。
