Clinicopathologic and immunohistochemical studies of conjunctival large cell acanthoma, epidermoid dysplasia, and squamous papilloma.

Abstract

PURPOSE:

To evaluate clinicopathologically and immunohistochemically a spectrum of conjunctival squamous proliferations.

DESIGN:

Retrospective clinicopathologic study.

METHODS:

One large cell acanthoma, 7 epidermoid dysplasias, and 4 squamous papillomas were evaluated with microscopy and biomarkers Ki-67, p53, epithelial membrane antigen (EMA), Ber-EP4, AE1, AE3, and 8 individual cytokeratins. Normal associated conjunctiva served as a baseline for interpretation.

RESULTS:

The large cell acanthoma recurred 4 times but retained its benign histopathologic features. The cells were 2-3 times larger than the keratinocytes of the normal conjunctiva and did not display atypia. Immunohistochemistry revealed a low Ki-67 proliferation index (PI) in the large cell acanthoma compared with high indices in dysplasias and papillomas. p53 was negative in the nuclei of normal epithelium while positive in all neoplasms, most intensely in the dysplasias. Immunostaining showed similar staining patterns for cytokeratins in large cell acanthoma and normal conjunctiva, except for full-thickness CK14 positivity and CK7 negativity in the lesion. Dysplasias generally lost normal CK7 expression and frequently abnormally expressed CK17. The papillomas displayed a normal cytokeratin pattern but exhibited a higher than normal PI and weak p53 positivity.

CONCLUSIONS:

Conjunctival large cell acanthoma is a morphologically distinctive clonal entity with clinical and immunohistochemical phenotypic characteristics denoting a dysplasia of minimal severity. Because of recurrences without invasion, it requires treatment. Dysplasias exhibited more deviant biomarker abnormalities including frequent aberrant full-thickness CK17 positivity and CK7 negativity. The absence of major cytokeratin derangements in the squamous papillomas may be of ancillary diagnostic value for lesions displaying borderline cytologic features.

• Authors: Frederick A Jakobiec, Pia R Mendoza, Kathryn A Colby
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 156 Issue 4 Pg. 830-46 (Oct 2013) ISSN: 1879-1891 [Electronic] United States
• PMID: 23786782 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Antigens, Neoplasm
• Biomarkers, Tumor
• Neoplasm Proteins

Topics

• Acanthoma (chemistry, pathology, surgery)
• Adult
• Aged
• Aged, 80 and over
• Antigens, Neoplasm (analysis)
• Biomarkers, Tumor (analysis)
• Carcinoma in Situ (chemistry, pathology, surgery)
• Conjunctival Neoplasms (chemistry, pathology, surgery)
• Female
• Humans
• Immunoenzyme Techniques
• Male
• Middle Aged
• Neoplasm Proteins (analysis)
• Neoplasm Recurrence, Local (diagnosis)
• Papilloma (chemistry, pathology, surgery)
• Paraffin Embedding
• Retrospective Studies