Malignant melanoma of conjunctiva

GB Mathur; RS Kothari; HN Mangal; Hari Charan

ARTICLES

Year : 1971 | Volume : 19 | Issue : 1 | Page : 34-37

Malignant melanoma of conjunctiva

GB Mathur, RS Kothari, HN Mangal, Hari Charan
Department of Ophthalmology and Pathology, Dr. Sampoorna Nand Medical College, & Associated Group of Hospitals, Jodhpur, India

Correspondence Address:
G B Mathur
Department of Ophthalmology and Pathology, Dr. Sampoorna Nand Medical College, & Associated Group of Hospitals, Jodhpur
India

Source of Support: None, Conflict of Interest: None

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PMID: 15744963

How to cite this article:
Mathur G B, Kothari R S, Mangal H N, Charan H. Malignant melanoma of conjunctiva. Indian J Ophthalmol 1971;19:34-7

How to cite this URL:
Mathur G B, Kothari R S, Mangal H N, Charan H. Malignant melanoma of conjunctiva. Indian J Ophthalmol [serial online] 1971 [cited 2023 Nov 29];19:34-7. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1971/19/1/34/34998

Malignant melanoma of conjunctiva is relatively rare, and pedunculated melanoma of conjunctiva are rarer still. In a recent series, Greer^[2] found 21 cases of malignant melanoma among 153 pigmented tumors in the conjuctival region and Reese^[5],[6]in 134 cases found 33 belonging to this category. The largest series in the literature is of Jays,^[3],[4]who described 104 cases from the Institute of Ophthalmology in London.

Here is the report of an interesting case of a fast growing pedunculated malignant melanoma of conjunctiva encountered in Mahatma Gandhi Hospital, Jodhpur.

Case Report

Wirdhu, 40 years, Hindu male was admitted to the male eye ward, complaining of gradually increasing swelling in the conjunctival region of the right eye for the last four months.

It started gradually about 4 months back. The patient had not noticed any appreciable discolouration of conjunctiva prior to this. He had a little pain and redness of the eye when the swelling started. Past history did not reveal anything of significance.

On examination, there was a dark pigmented and pedunculated swelling protruding from the centre of the lower lid. It was freely mobile and was soft in consistency. Dark pigmentation was also present on the plica, the caruncle and the nasal and lower quadrants of the palpebral and bulbar conjunctiva. The lower fornix also revealed similar pigmentation. The upper palpebral conjunctiva and the fornix were normal [Figure - 1]. The rest of the anterior segment of the eye was also normal, and so was the pupiilary reaction. Fundus was normal. The visual acuity was also 6/6 in the left eye. The right eye was normal in all respects.

General examination showed fair health with a B. P. of 130/80 mm. of Hg. Other systems were normal.

Investigations

Total leucocytic count was 6,400 per cmm., with a differential count of polymorphs, 68%; lymphocytes 30%; eosinophils 2%, red blood cells 4.0 million/cmm., haemoglobin 11.2 gm%. E. S. R. 25 mm., 1st hour, bleeding time 1 minute 20 seconds; clotting time 3 minutes. Nothing abnormal was detected on screening of the chest and examination of the urine. The pedunculated, pigmented swelling was excised under local anaesthesia. It was very friable and bled easily but its removal presented no difficulty.

Histologically the tumor mass comprised of cells showing great variation in size and shape and an abundance of cytoplasm. The nuclei presented an equally bizzarre appearance in their shape and size, some being oval and others spindle shaped. Mitosis and hyperchromatism were in abundance. The cells were oval, polyhedral or slightly elongated in shape. The cytoplasm of 60-80 per cent cells contained variable amount of melanin; some of the cells being distended by the pigment and appeared as solid globular mass of melanin. Unicellular as well as multicellular giant cells were also seen here and there. The tumour cell masses were separated by thin strands of moderately vascular stroma. The stroma showed infiltration with lymphocytes and other mononuclear cells. The lumina of the lymphatics and venules were dilated and at places filled with the tumour cells.

A section of the adjoining conjunctiva showed hyperplasia of the epithelium. The cells in the lower part were distended with melanin. The subepithelial region showed a marked infiltration with lymphocytes, plasma cells, monocytes and a few neutrophils. There was no evidence of malignancy in this part. These histopathological features are well illustrated in [Figure - 2],[Figure - 3],[Figure - 4],[Figure - 5].

Discussion

Conjunctival malignant melanoma may arise in any one of the two ways, i.e., either apparently spontaneously or developing from a benign naevus, which may have been stationary for many years. (Jay^[3],[4] ). In any case it appears that the pre-existing naevus changes its character, usually after the age of 45 years.

Once the growth starts, it usually takes about a year to attain the size of a pea, but occasionally it is much more rapid as in the present case. The tumor may become raised, lobulated or nodular. Sometimes it has a relatively narrow base, which for considerable time is freely mobile with the conjunctiva on the sclera, before it becomes fixed. Occasionally, it is pedunculated as was in this case (Duke Elder^[1] ). Exceptionally, growth may be so rapid and extensive that the entire conjunctival sac including both fornices may be filled, the cornea covered and globe hidden in the neoplastic tissue (Valier-Viale et al^[7] ) Histologically several cellular types can be recognised in such tumours:

1. Epithelioid Cells: The most common type, are large polyhedral cells with round or oval nuclei, prominent nucleoli, and an abundant cytoplasm usually containing fine melanin granules. Occasionally they become multinuclear to form giant cells.

2. Spindle Cells: Large or small fusiform cells with oval nuclei and prolonged at the ends to form fibers.

3. Naevoid Cells: Intermediate in size between benign naevus cells, with round, hyperchromatic nuclei.

The present case of pedunculated malignant melanoma of conjunctiva was fast growing like that of Vailere - Vialex et al and most probably was spontaneous in origin.

Summary

A case of pedunculated and fast growing malignant melanoma of conjunctiva is presented which was spontaneous in origin.

References

1.	DUKE-ELDER, S. W. (1965) 'System of Ophthalmology Vol. VIII Part 2 Henry Kimpton, London p. 1220.
2.	GREER, (C H. 'Precancerous melanosis; Proc. Roy. Soc. Med. 47, 730 (1954).
3.	JAY, BARRIE 'A follow up study of limbal melanomata' Proc. Roy. Soc Med. 57, 497. (1964).
4.	JAY, BARRIE 'Naevi & melanomata of the Conjunctiva Brit J. Ophthal. 49, 169, (1963).
5.	REESE, A. B. 'Precancerous & Cancerous melanosie: of conjunctiva' Amer. J. Ophthal. 40, 96. (1955).
6.	REESE A. B. (1963) Tumours of the eye', Publisher N. Y. 2nd ed. p. 330.
7.	VALIERE -- VIALEISE, ROBIN, A., LOUBET AND CHAPUT 'Voluminous naevo carcinoma starting from the conjunctiva and covering and hiding the cornea and eyeball' (In French) Bull. Soc. Ophthal. Fr. 4, 216 (1965).