Grossniklaus H E, Green W R, Luckenbach M, Chan C C
Cornea. 1987;6(2):78-116. doi: 10.1097/00003226-198706020-00002.
A total of 2,455 conjunctival lesions in adults (over 15 years old) obtained during a 61-year period were reviewed and histopathologically classified as congenital, acquired epithelial, acquired subepithelial, pigmented, inflammatory/degenerative, and miscellaneous. The most common lesions in decreasing order of frequency were: pterygium, nevus, dysplasia, nonspecific nongranulomatous inflammation, and epithelial inclusion cyst. The most common conjunctival malignancy in adults was squamous cell carcinoma, followed by melanoma, and pagetoid change associated with sebaceous gland carcinoma. Squamous cell carcinomas arise from progressive stages of mild, moderate, and severe dysplasia. These tumors have a low malignant potential but may behave more aggressively in the spindle cell and mucoepidermoid variants. Melanomas arise de novo, from nevi or, most commonly, from acquired melanosis and have an associated 14-32% mortality rate by metastatic spread. Sebaceous carcinomas are often initially clinically misdiagnosed, involve the conjunctiva by pagetoid spread, and can have a low rate of metastasis and death if diagnosed early and excised with frozen-section monitoring of the surgical margins.
回顾了61年间收集到的2455例成人（15岁以上）结膜病变，并根据组织病理学将其分为先天性、获得性上皮性、获得性上皮下、色素性、炎症/退行性及其他类型。按发生频率由高到低排列，最常见的病变依次为：翼状胬肉、痣、发育异常、非特异性非肉芽肿性炎症及上皮植入性囊肿。成人最常见的结膜恶性肿瘤为鳞状细胞癌，其次为黑色素瘤，以及与皮脂腺癌相关的佩吉特样改变。鳞状细胞癌起源于轻度、中度和重度发育异常的进展阶段。这些肿瘤的恶性潜能较低，但梭形细胞和黏液表皮样变体可能表现得更具侵袭性。黑色素瘤可原发产生、由痣发展而来，或最常见地，由获得性黑素沉着发展而来，通过转移扩散，其死亡率为14% - 32%。皮脂腺癌通常最初在临床上被误诊，通过佩吉特样扩散累及结膜，如果早期诊断并在手术切缘进行冰冻切片监测下切除，其转移率和死亡率可能较低。
