Khan Lubna, Malukani Malukani, Saxena Ankur
Nepal J Ophthalmol. 2017 Jul;9(18):160-169. doi: 10.3126/nepjoph.v9i2.19262.
The conjunctiva is a thin and flexible mucus membrane that provides a protective barrier for the eye. Very few histopathologic studies have been conducted on biopsies from conjunctival lesions (CL) in central India.
To study the spectrum of CL and define those lesions that need attention with regard to need of biopsy in order to prevent grave sequelae and ocular morbidity.
Degenerative conditions such as pterygium followed by pinguicula were the commonest lesions seen in conjunctiva. Out of 129 subjects, youngest in the series was 3 years old while oldest patient was 72 years of age. Commonest age interval for involvement was 35 to 50 years. In children below 8 years, cystic lesions (infective or inclusion), limbal dermoid and choristoma were seen. Vascular lesions were noticed by patients for the first time between mid-teens to 25 years age. Premalignant lesions were dysplasia, actinic keratosis and PAM with or without XP. Malignant lesions in this series were squamous cell carcinoma, basal cell carcinoma and sebaceous carcinoma; which were observed in the age interval 25 to 75 years. In none of the malignant conditions there was deeper penetration into the globe or orbit. Though diagnosed within two weeks duration (by incisional biopsy) from appearance of nodule, unfavourable outcome was seen only in one malignant CL; a case having sebaceous carcinoma. In all pediatric cases outcome was good, except in child having choristoma, where amblyopia ensued before a diagnosis was made. Response to sclerotherapy was excellent as all the epibulbar vascular malformations regressed. All degenerative lesions regressed except one recurrence in a recurred pterygium. Case diagnosed as large B cell lymphoma recurred after one year. Dysplastic changes were seen to occur at limbus on followup in one XP, but in all cases of naevi, neither cellular atypia was seen nor melanoma developed.
An overview of various CL disclosed that clinician has to differentiate benign from premalignant and malignant lesions. Early diagnosis, proper histological study and patient education, all are equally important for achieving good outcome.
结膜是一层薄而柔韧的黏膜，为眼睛提供保护屏障。在印度中部，针对结膜病变（CL）活检开展的组织病理学研究极少。
研究结膜病变的范围，并确定那些需要通过活检关注的病变，以预防严重后果和眼部疾病。
诸如翼状胬肉和睑裂斑炎等退行性病变是结膜中最常见的病变。在129名受试者中，该系列中最年轻的为3岁，最年长的患者为72岁。受累最常见的年龄区间为35至50岁。在8岁以下儿童中，可见囊性病变（感染性或包涵性）、角膜缘皮样瘤和迷离瘤。血管病变在青少年中期至25岁之间首次被患者注意到。癌前病变为发育异常、光化性角化病和光化性唇炎伴或不伴着色性干皮病。该系列中的恶性病变为鳞状细胞癌、基底细胞癌和皮脂腺癌；这些病变出现在25至75岁的年龄区间。在所有恶性病变中，均未出现向眼球或眼眶的深部浸润。尽管从结节出现起两周内（通过切开活检）就做出了诊断，但仅在一例恶性结膜病变（皮脂腺癌病例）中出现了不良预后。在所有儿科病例中，预后良好，但在患有迷离瘤的儿童中，在做出诊断之前出现了弱视。硬化治疗的反应极佳，因为所有眼球表面血管畸形均消退。除一例复发性翼状胬肉复发外，所有退行性病变均消退。诊断为大B细胞淋巴瘤的病例在一年后复发。在一名着色性干皮病患者的随访中，角膜缘出现了发育异常改变，但在所有痣病例中，既未见到细胞异型性，也未发生黑色素瘤。
对各种结膜病变的概述表明，临床医生必须区分良性病变与癌前病变和恶性病变。早期诊断、适当的组织学研究和患者教育，对于取得良好预后同样重要。
