|Year : 1983 | Volume
| Issue : 5 | Page : 658-660
Tumour and cysts of conjunctiva -A study of 175 cases
SC Reddy, C Sundararama Sarma, VV Ramana Rao, S Banerjea
Department of Ophthalmology and Pathology, Rangaraya Medical College, Kakinada, India
S C Reddy
Asst. Prof. of Ophthalmology, Rangaraya Medical College & Government General Hospital, Kakinada (A.P).
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Reddy S C, Sarma C S, Ramana Rao V V, Banerjea S. Tumour and cysts of conjunctiva -A study of 175 cases. Indian J Ophthalmol 1983;31:658-60
|How to cite this URL:|
Reddy S C, Sarma C S, Ramana Rao V V, Banerjea S. Tumour and cysts of conjunctiva -A study of 175 cases. Indian J Ophthalmol [serial online] 1983 [cited 2019 Aug 21];31:658-60. Available from: http://www.ijo.in/text.asp?1983/31/5/658/36623
In majority of the tumours of conjunctiva, the diagnosis is not difficult in view of their clinical features but some times the difficulty may arise in differentiating a granuloma from a benign or malignant neoplasm, especially when the tumour is small in size.
Depending on the histiogenesis the tumours of conjunctiva have been classified as (i) epithetial tumours, (ii) mesoblastic tumours, (iii) reticulosis, (iv) vascular tumours, (v) pigmented tumours and (vi) peripheral nerve tumours. Any one of them can be either benign or malignant. Aetiologically the cysts of conjunctiva have been classified as (i) congenital epibulbar growths, (ii) traumatic cysts, (iii) parasitic cysts, (iv) epithelial cysts of nontraumatic origin and (v) lymphatic cysts. Though epibulbar dermoids are usually solid growths, they may assume cystic from occasionally. 
Among the many reports available on this subject in Indian Literature, only few are on the study of large series of tumours , and cysts  of conjunctiva, and the rest are on isolated cases. Hence it was thought worthwhile to document the authors' experience in the literature.
| Material and Methods|| |
This study comprises of an analysis of 175 cases of conjunctival growths, diagnosed histologically during the past two decades (1961-80) in the teaching Government General Hospital attached to Rangaraya Medical College, Kakinada. The growths were excised for cosmetic reasons in majority of the cases and for symptomatic relief in few cases. They were subiected to histological examination with routine fixation and staining procedures. Special stains were done wherever required.
| Observations and Discussions|| |
Out of 175 cases of conjunctival growths, 18 were malignant tumours (10.3%), 115 benign tumours (65.7%), and 42 cysts (24.0%). The sex and age incidence in various types of tumours and cysts of conjunctiva is shown in [Table - 1]. Eighty were males and 95 were females; the age of patients ranged between 1 and 65 years. Majority of patients (70.8%) were below 30 years age. There were 38 children (21.7%) in this study. Both eyes were involved in only one case (amyloidosis) and the rest were unilateral.
Malignant tumours were seen twice in males than in females; the age of these patients ranged between 25 and 65 years. A similar sex and age distribution was reported by Ziadi et al. But Das' has reported their occurance in the age group of 10-59 years. Squamous cell carcinoma was the commonest (14 cases) malignant tumour observed in this study and the others were seen in isolated cases. In one case of squamous cell carcinoma, the tumour was found to be extensive and fixed to the deeper structures, so enucleation of the eye was done. In the rest of the cases, only excission of the tumour was done.
Histiocytoma is the term used to indicate certain benign fibrous tumours believed to be of histiocytic origin. Whether such lesions are true tumours or non-neoplastic granulomas, however, remains undescided. They are usually solitary, well demarcated, and non encapsulated.
The common histological pattern of histiocytoma consists of spindle cells and fibres disposed in bundles and whorls and in storiform, stellate and radiating arrangements but it may show variation'. In view of the presence of more mitotic figures with the above histological picture, the diagnosis of malignant histiocytoma was made.
In the present study, out of 12 cases of papillomas changes of malignancy were observed in one case and hence it was labelled as malignant papilloma. The favourite site of squamous cell carcinoma is limbal epithelium in the inter-palpebral zone. The incidence of limbal carcinoma in our study (11 out of 14 cases, 78.6%) is slightly higher than Ziadi et al  series (7 out of 10 cases, 70.0%).
The incidence of common tumours of conjunctiva in comparison to the previous reports is shown in [Table - 2]. The low incidence of tumours in this series is due to the presence of large number of granulomas and cysts than in their series. The high incidence in Das  series could be explained on the fact that all were limbal tumours only.
In the present series, granulomas were the commonest (69 out of 115 cases, 39.4%) among the benign tumours. Sixty four of them were non specific granulomas, 4 were foreign body granulomas and 1 was tuberculous granuloma. A much lower incidence of the same (13.73%) has been reported by Ziadi et al.  Neurofibroma of bulbar conjunctiva is rare. It was observed in 1.7% of the cases in this series (2 neurofibroma and 1 neurofibrolipoma), while the same was reported in 3.92% of the cases by Ziadi et al. 
There were 25 limbal tumours in this study; 12 of them were malignant (11 squamous cell carcinoma and 1 malignant histiocytoma) and 13 were benign (4 dermoid, 4 papilloma, 3 granuloma, 1 fibroma and 1 neurofibroma).
The incidence of cysts in this series was 24.0%, while a much lower incidence of the same (11.77%) was reported by Ziadi et al.  The inclusion/implantation cysts were grouped into the category of epithelial cysts in the present study. Of all the conjunctival cysts in this study, epithelial cysts (38 cases) were seen more frequently. Four of these cysts were seen in the substance of the pterygium, giving the appearance of cystic pterygium. Ratnakar et al  have reported 18.75% (6 out of 32 cases) of retention cysts and 50% of inclusion/implantation cysts (16 out of 32 cases) in their series.
| Summary|| |
In an analysis of 175 cases of conjunctival growths, 18 were found to be malignant tumours, 115 benign tumours and 42 cysts. The age of patients ranged between 1 and 65 years, and 70.8% of them were below 30 years. Among the malignant tumours squamous cell carcinoma (14 cases) was the commonest observed in this study. Granulomas (65 cases) were the commonest of all benign tumours, followed by papillomas (11 cases). Of all the conjunctival cysts, epithelial cysts (38 cases) were seen more frequently. Isolated cases of rare tumours like malignant histiocytoma, pleomorphic adenoma, dyskeratosis, rhinosporidiosis, and cysts like cysticercus cellulosa were also noted in the present study.
| References|| |
Duke Elder, S., and Leigh, A.G., System of Ophthalmology, Vol. 8, Diseases of Outer eye,
Part-2, Henry Kimpton, London, p. 1137-1242, 1965.
Das, S.P., J. All India Ophth. Soc.
14, 83, 1966.
Ziadi, N., Nath, K., and Gogi, R., Indian J. Ophthal., 28,
Ratnakar, K.S., and Goswamy, V., East. Arch. Ophthal., 6, 57,
Ashley, D.J.B., Evans' histological appearance of tumours, 3rd ed., Churchill Livingstone, Edinburgh, p. 20, 1978.
[Table - 1], [Table - 2]
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