Díaz Díaz A L, Tello A, Chaparro Tapias T A, Secondi R, Sánchez España J C
Fundación Oftalmológica de Santander (FOSCAL) , Cirugía plástica ocular, oncológica y órbita. Bucaramanga, Colombia.
Ophthalmology Department. Sapienza University. Viale del Policlinico, 00185, Rome, Italy.
Clin Ter. 2019 Mar-Apr;170(2):e81-e83. doi: 10.7417/CT.2019.2113.
We report a rare case of rapid transformation of a conjunctival keratoacanthoma (KA) into a highly aggressive squamous cell carcinoma requiring enucleation. To our knowledge, this is the second such case reported in the literature.
Case report.
A 73-year-old man presented with a recurrent conjunctival lesion in the right eye. A slit lamp examination revealed a hyperkeratotic lesion in the limbar conjunctiva adhered to deep planes but with no ocular involvement. An incisional biopsy was performed because an area of scleromalacia was observed underlying the lesion. Histological findings were consistent with conjunctival KA. One week later, a raised lesion was observed invading the anterior chamber. Histological examination of another excisional biopsy specimen indicated conjunctival squamous cell carcinoma. The right eye was enucleated. Histological analysis confirmed intraocular tumor invasion. Complete clinical remission was observed over one year of follow up.
Although conjunctival keratoacanthoma is normally benign, it is important to correctly differentiate between KA and squamous cell carcinoma, and closely monitor the eye after surgery because of the rare possibility of recurrence or conversion to squamous cell carcinoma. Immunohistochemistry could help in the diagnosis and management of dubious cases.
我们报告一例罕见的结膜角化棘皮瘤（KA）迅速转变为侵袭性高的鳞状细胞癌并需行眼球摘除术的病例。据我们所知，这是文献中报道的第二例此类病例。
病例报告。
一名73岁男性因右眼结膜病变复发就诊。裂隙灯检查发现角膜缘结膜有一个角化过度的病变，与深层组织粘连，但未累及眼球。由于在病变下方观察到巩膜软化区域，故进行了切开活检。组织学检查结果与结膜KA一致。一周后，发现一个隆起的病变侵犯前房。对另一个切除活检标本的组织学检查显示为结膜鳞状细胞癌。右眼被摘除。组织学分析证实有眼内肿瘤侵犯。随访一年观察到完全临床缓解。
尽管结膜角化棘皮瘤通常为良性，但正确区分KA和鳞状细胞癌很重要，且由于存在罕见的复发或转变为鳞状细胞癌的可能性，术后需密切监测眼部情况。免疫组织化学有助于可疑病例的诊断和处理。
