Clinical Features and Surgical Treatment Outcomes of Conjunctival Squamous Papilloma

Chan Joo Ahn; Nam Ju Kim; Ho Kyung Choung; Joon Young Hyon; Sang In Khwarg

doi:10.3341/jkos.2016.57.2.167

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Ahn, Kim, Choung, Hyon, and Khwarg: Clinical Features and Surgical Treatment Outcomes of Conjunctival Squamous Papilloma

Original Article

J Korean Ophthalmol Soc 2016;57(2):167-173.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.167

Clinical Features and Surgical Treatment Outcomes of Conjunctival Squamous Papilloma

Chan Joo Ahn, MD¹, Nam Ju Kim, MD^2,³, Ho Kyung Choung, MD^2,⁴, Joon Young Hyon, MD^2,³, Sang In Khwarg, MD^1,^2,⁵

¹Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea

²Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

⁴Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea

⁵Seoul Artificial Eye Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea

Address reprint requests to Sang In Khwarg, MD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-2879, Fax: 82-2-741-3187 E-mail: khwarg@snu.ac.kr

Received 1 October 2015 Revised 11 October 2015 Accepted 9 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical features, surgical treatments, and their outcomes in conjunctival squamous papilloma.

Methods

A retrospective chart review was conducted on 31 patients with 32 eyes that were treated for conjunctival papilloma from October 2000 to February 2015 in Seoul National University Hospital and Seoul National University Bundang Hospital.

Results

Among the 31 patients, 9 patients had papilloma which recurred after previous surgical excision at another hospital. Twenty-five eyes had one papilloma lesion, 2 eyes had 2 lesions, and 5 eyes had more than 3 lesions. The most affected location of papilloma was the tarsal conjunctiva. The recurrent group displayed a tendency to have multiple lesions. Surgical excision without any adjuvant therapy was performed in 13 eyes; surgical excision and cryotherapy in 15 eyes; surgical excision, cryotherapy, and topical interferon alfa-2b in 3 eyes; and surgical excision and amniotic membrane transplantation in 1 eye. The mean postoperative follow up period was 11.1 months. There were 5 cases of recurrence and the mean time of recurrence after surgical excision was 4.22 months (range, 3 days to 9 months). Among 5 cases of recurrence, 3 cases were after surgical excision only, 1 case was after surgical excision and cryotherapy, and 1 case was after surgical excision, cryotherapy, and topical interferon alfa-2b. These 5 recurred cases were retreated with surgical excision and cryotherapy, surgical excision and topical interferon alfa-2b, or surgical excision, cryotherapy, and topical interferon alfa-2b.

Conclusions

Conjunctival squamous papilloma is likely to recur even though the tumor is completely removed. Therefore, long-term postoperative follow up may be necessary for recurrence.

Keywords: Conjunctival papilloma, Conjunctival squamous papilloma, Cryotherapy, Interferon alfa-2b, Surgical excision

REFERENCES

1). Yuen HK, Yeung EF, Chan NR, et al. The use of postoperative topical mitomycin C in the treatment of recurrent conjunctival papilloma. Cornea. 2002; 21:838–9.

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Figure 1.

Conjunctival squamous papilloma before and after treatment. 27-year-old man (recurred case 5 on Table 5) visited our clinic because of 2 times' recurrence of conjunctival squamous papilloma after surgical excision over 2 years. (A) Multiple confluent papilloma are observed in the caruncle, inferior fornix, inferior bulbar and tarsal conjunctiva of left lower lid on the first examination. (B) The photography taken at 2 month after surgery. Conjunctival squamous papilloma resolved completely after treatment with excision and cryotherapy and interferon alfa-2b for 2 months. (C, D) The photography taken at 9 months after surgery. There was recurrence of conjunctival squamous papilloma at medial tarsal conjunctiva of left upper lid (arrow in C), and lateral tarsal conjunctiva of left lower lid (arrow in D).

Table 1.

Anatomic distribution of conjunctival squamous papilloma

Tumor location	No. of cases^*
Bulbar conjunctiva	4
Tarsal conjunctiva	9
Forniceal conjunctiva	6
Eyelid margin	6
Punctum or peripunctum	6
Caruncle	8
Medial canthal angle	3

^* Permission for counting of repetition.

Table 2.

Quadrantic distribution of conjunctival squamous papilloma

Tumor location	No. of cases^*
Superior temporal	1
Superior nasal	7
Inferior temporal	11
Inferior nasal	25

^* Permission for counting of repetition.

Table 3.

Comparison of clinical features of conjunctival squamous papilloma based on primary and recurred tumor at initial examination

Case	Sex		Age (years)	Laterality		No. of papilloma^*			Quadrantic distribution^†				No. of quadrant which papilloma in^*				Papilloma features^‡		Size of papilloma (mm)^§
Case	Male	Female	Age (years)	Right	Left	n = 1	n = 2	n ≥ 3	Superotemporal	Superonasal	Inferotemporal	Inferonasal	1	2	3	4	Sessile	Pedunclated	≤5	5< and ≤10	10<
Recurred cases (N =9 patients 9 eyes)	5	4	38.44 + 14.10	3	6	3	i	5	1	4	3	5	7	1	0	1	3	6	3	4	2
Primary cases (N = 22 patients 23 eyes)	12	11	40.82 + 19.61	13	10	22	1	0	0	3	8	20	15	8	0	0	6	13	17	2	0

Values are presented as mean ± SD unless otherwise indicated.

^* p = 0.001, Fisher's exact test;

^† Permission for counting of repetition;

^‡ Excluded 4 eyes which have no medical records about papilloma features;

^§ Excluded 4 eyes which have no medical records about size of papilloma.

Table 4.

Surgical treatment and result of conjunctival squamous papilloma

Surgery and adjuvant therapy	No. of cases	Total period of F/U (months)	No. of recurred cases during F/U period after treatment (n, %)
Excision only	13	3.6 ± 5.8	3 (23.07)
Excision and cryotherapy	15	18.5 ± 36.5	1 (6.67)
Excision, cryotherapy, and IFN-α	3	10 ± 7.9	1 (33.33)
Excision and amniotic membrane transplantation	1	0.5	0
Total	32	11.1 ± 25.9	5

Values are presented as mean ± SD unless otherwise indicated. IFN-α = interferon alfa-2b; F/U = follow up.

Table 5.

Recurred cases after surgical resection with or without adjuvant therapy: further treatments and results

	Recurred cases
	1	2	3	4	5
Sex/age	F/39	M/39	M/44	M/71	M/27
Laterality of eye	Left	Left	Left	Right	Left
Primary or recurred case on initial visit	Recurred case	Recurred case	Primary case	Primary case	Secondly recurred case
Main location of tumor	Medial canthal angle	Inferior fornix, punctum	Caruncle	Nasal bulbar conjunctiva	Upper and lower tarsal conjunctiva, caruncle
Initial treatment	Excision only	Excision only	Excision only	Excision and cryotherapy	Excision and cryotherapy + IFN-α
First recurrence time after treatment (months)	2	0.1 (3 days)	6	4	9
Treatment after first recurrence	Excision only	Excision + IFN-α	Excision + IFN-α	Excision and cryotherapy	Excision and cryotherapy + IFN-α
Second recurrence time after second treatment (months)	36	3	-	-	-
Treatment after second recurrence	Excision and cryotherapy + IFN-α	Excision + IFN-α	-	-	-
Total period of F/U (months)	180	8	15	128	16
Result on last F/U	No recurrence	No recurrence	No recurrence	No recurrence	No recurrence

IFN-α = interferon alfa-2b; F/U = follow up.

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