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Year : 2019  |  Volume : 62  |  Issue : 3  |  Page : 481-482
Inverted mucoepidermoid papilloma of conjunctiva: A rare histological entity


1 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication26-Jul-2019
 

How to cite this article:
Singh V, Parwaiz A, Radotra BD, Singh M. Inverted mucoepidermoid papilloma of conjunctiva: A rare histological entity. Indian J Pathol Microbiol 2019;62:481-2

How to cite this URL:
Singh V, Parwaiz A, Radotra BD, Singh M. Inverted mucoepidermoid papilloma of conjunctiva: A rare histological entity. Indian J Pathol Microbiol [serial online] 2019 [cited 2019 Oct 17];62:481-2. Available from: http://www.ijpmonline.org/text.asp?2019/62/3/481/263472




Conjunctival squamous papillomas are usually exophytic in nature but rarely they can present as inverted papillomas. The inverted papilloma of the conjunctiva was first described by Streeten et al. (year) are characterized by folds and ribbons of lining epithelium with endophytic downward growth into the underlying stroma.[1]

Inverted papillomas typically involve the nose, paranasal sinuses, lacrimal sac and rarely, the conjunctiva. They exhibit a strong tendency for local recurrence and can undergo malignant transformation.[2]

Inverted mucoepidermoid papilloma is rare variant of inverted papilloma. It was first described by Jakobiec et al.[3] and recommended the term owing to the significant cystic component within the acanthotic lobules to distinguish these conjunctival lesions from inverted papilloma of other sites. They proposed that these lesions can/should be considered as benign in nature.

This entity can be confused with low grade mucoepidermoid carcinoma, hence knowledge about existence of this entity and rendering correct diagnosis is important to ensure appropriate treatment.

An 81-year-old man presented to ophthalmology outpatient department with complaints of a reddish mass over inner part of his right lower eyelid and increased epiphora since 1 year. The mass was slowly progressive and painless in nature. On examination, the visual acuity was 6/9 in both eyes. A single. well-defined, reddish fleshy mass (1 × 0.8 cm) was seen over the right inferior palpebral conjunctiva [Figure 1]a. His past medical history was unremarkable. An excisional biopsy of mass was performed and the greyish-white sample measured 1.0 cm × 0.5 cm × 0.3 cm. Histopathologic examination demonstrated a single polypoidal fragment lined by stratified squamous cells with dispersed goblet cells. The sub epithelium showed downward extension of conjunctival epithelium with formation of small islands and cystic spaces lined by stratified squamous epithelium with goblet cells. Goblet cells with acidic mucin were highlighted by PAS – Alcian blue stain [Figure 1]b, [Figure 1]c, [Figure 1]d. No increased atypia, mitosis, necrosis or intermediate cell population was noted to suggest mucoepidermoid carcinoma or any other malignancy. Based on these histological features diagnosis of Inverted mucoepidermoid papilloma was made. The post-operative period was uneventful with a recurrence free follow up of 8 months.
Figure 1: (a) The right lower palpaebral conjunctiva showing the mass (arrow) (b) Haematoxylin and Eosin stain - Shows a polypoidal fragment lined by lined by stratified squamous cells with dispersed goblet cells (c) Haematoxylin and Eosin stain - Shows downward extension of conjunctival epithelium into the sub epithelium in form of small islands and cystic spaces lined by stratified squamous epithelium with goblet cells. (d) PAS -Alcian blue stain – Highlights the dispersed goblet cells

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Inverted mucoepidermoid papilloma of conjunctiva is a rare entity and on literature search, we could only find one case report from India.[4]

The most effective treatment is simple surgical excision. However, the rarity of this condition does not clearly establish the biological behaviour of the tumour. Although, these tumours are usually benign, Heuring and colleagues found peripheral carcinomatous foci within the lesion in their case.[5] However, in this case we did not find any evidence of malignancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Streeten BW, Carrillo R, Jamison R, Brownstein S, Font RL, Zimmerman LE. Inverted papilloma of the conjunctiva. Am J Ophthalmol 1979;88:1062-6.  Back to cited text no. 1
    
2.
Halimi M, Aghbali A, Emamverdizadeh P, Talesh KT. Inverted papilloma of the palate with malignant transformation. J Oral Maxillofac Pathol 2012;16:291-3.  Back to cited text no. 2
  [Full text]  
3.
Jakobiec FA, Harrison W, Aronian D. Inverted mucoepidermoid papillomas of the epibulbar conjunctiva. Ophthalmology 1987;94:283-7.  Back to cited text no. 3
    
4.
Bhushan G, Raina UK, Gupta A, Bhambhwani V, Khurana N, Ghosh B, et al. Inverted mucoepidermoid papilloma of conjunctiva in a child. J AAPOS 2015;19:266-7.  Back to cited text no. 4
    
5.
Heuring AH, Hütz WW, Eckhardt HB, Bohle RM. Inverted transitional cell papilloma of the conjunctiva with peripheral carcinomatous transformation. Klin Monbl Augenheilkd 1998;212:61-3.  Back to cited text no. 5
    

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Correspondence Address:
Bishan Das Radotra
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_276_18

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