Abstract

DO.24.06

HPV-negative conjunctival papilloma progressing into HPV-positive squamous cell carcinoma

Bredow L., Martin G., Reinhard T., Mittelviefhaus H., Auw-Haedrich C.
Universitäts-Augenklinik Freiburg

Case report: An 83-year-old Caucasian woman presented at our clinic with a reddish, papillomatous lesion covering the medial and inferior quadrants of the bulbar conjunctiva of the left eye. As a squamous cell carcinoma was suspected the tumour was surgically removed, and the resection margins were treated with cryotherapy. Histopathological examination showed no signs of malignancy but revealed a limbal papilloma. Two following resections due to recurrences again each revealed a papilloma. Two years later the patient presented with an advanced tumour recurrence, which could not be excised in toto. This time, histological examination revealed not a papilloma but a well differentiated squamous cell carcinoma. The patient refused radiation therapy. Six months later exenteration of the left orbit was inevitable because the squamous cell carcinoma had led to gross deformation of the medial and inferior part of the eyelid. When examining the paraffin-embedded tissue with PCR for human papilloma virus (HPV) no HPV could be detected in the first three specimens containing the papilloma, but the carcinoma specimen was HPV-16 positive.
Only rarely conjunctival papilloma progresses into squamous cell carcinoma. An infection with HPV-16, which is known to play a role in the tumourigenesis of other epithelial tumors like cervical cancer, could be an explanation for malignant transformation in this patient.

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