Squamous cell papilloma of the conjunctiva due to human papillomavirus (HPV): Presentation of two cases and review of literature

Department of Ophthalmology, Medical School, University of Ioannina, Greece.
Clinical Ophthalmology (Impact Factor: 0.76). 09/2012; 6(1):1553-61. DOI: 10.2147/OPTH.S34999
Source: PubMed


We describe two patients with squamous cell papilloma of the conjunctiva due to human papilloma virus (HPV) and review the literature.
Two patients with conjunctival tumors were examined and treated in the University Eye Clinic and diagnosed in the University Pathology Department, University Hospital of Ioannina, Greece. The first patient was a 48-year-old man presenting with an extended papillomatous lesion in bulbar conjunctiva covering part of the cornea of his right eye. The second patient was a 24-year-old man presenting with a polypoidal papillomatous lesion on the caruncle of his right eye. The two lesions were removed surgically, cryotherapy was applied to the adjacent conjunctiva, and topical mitomycin-C was used. The amniotic membrane was used to restore the conjunctival defect in the first patient. The two removed lesions were sent to the Pathology Department for histopathological examination. Immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction (PCR) analysis were performed.
In the first patient, histopathology showed the presence of a benign squamous papilloma with koilocytosis. DNA in situ hybridization with broad-spectrum probes showed that this patient was positive for HPV DNA. In the second patient, histopathology showed the presence of a squamous papilloma with mild dysplasia and koilocytosis. Immunohistochemical analysis was positive for HPV protein and p16 protein. DNA in situ hybridization with broad-spectrum probes showed that the patient was positive for HPV DNA. PCR analysis showed the presence of HPV 6. According to morphological and molecular findings, both patients were diagnosed with squamous cell papilloma due to HPV.
HPV can infect the ocular surface. According to clinical results, the ophthalmologist in cooperation with the pathologist can recommend appropriate laboratory examinations to confirm the diagnosis and successfully treat conjunctival papillomas.

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    • "Overall, it is thus unlikely that RtPV2-like viruses are involved in causing the observed disease signs. They might be involved in causing conjunctival papillomas [19,20], but in spite of the fact that skin papillomas are reported in reindeer from time to time, not much knowledge exists on papillomatosis in reindeer as a disease, or the virus(es) causing them. The impact of papillomavirus infections on reindeer in general and the specific role of RtPV2 thus has to be further addressed. "
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    ABSTRACT: IMPORTANCE Conjunctival papilloma is a benign epithelial tumor occurring in both children and adults with varying clinical features and outcomes. In this article, we describe our experience regarding the difference in the clinical features and outcomes of conjunctival papilloma based on age at initial examination. OBJECTIVE To evaluate the clinical features, treatment, and outcomes in patients with conjunctival papilloma based on age at initial examination. DESIGN Retrospective study. SETTING Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania. PARTICIPANTS Ten children and adolescents (aged ≤20 years) and 63 adults (aged >20 years) with conjunctival papilloma. INTERVENTIONS Excisional biopsy, cryotherapy, oral cimetidine, topical or injection interferon alfa-2b, and photodynamic therapy. MAIN OUTCOME MEASURE Tumor response. RESULTS A comparison of conjunctival papillomas between age groups revealed significant differences in the mean number of tumors per eye (children and adolescents vs adults, 2 vs 1; P = .05), tumor basal dimension (8 vs 6 mm; P = .05), and associated feeder vessels (20% vs 47%; P = .05). Primary treatment included sole treatment with oral cimetidine (15% vs 5%), topical interferon alfa-2b (0% vs 1%), cryotherapy (0% vs 3%), photodynamic therapy (0% vs 1%), excisional biopsy and cryotherapy (38% vs 65%), excisional biopsy and cryotherapy with adjuvant oral cimetidine (8% vs 9%), and excisional biopsy and cryotherapy with adjuvant topical or injection interferon alfa-2b (38% vs 15%). Significant differences in age groups in treatment outcome during the follow-up period (mean, 24 vs 38 months) included complete regression with single treatment (38% vs 95%; P < .01) and tumor recurrence (15% vs 1%; P = .05). CONCLUSIONS AND RELEVANCE Conjunctival papillomas are larger and more likely to be multiple in children and adolescents than in adults. Excisional biopsy and cryotherapy with or without adjuvant oral cimetidine and/or topical interferon alfa-2b provide satisfactory tumor control. Papilloma recurrence is more common in children and adolescents than in adults.
    No preview · Article · Mar 2013 · Jama Ophthalmology
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