A 65 year old woman presents with a fleshy pink nodule on the bulbar conjunctiva.
The nodule is biopsied and the H and E is shown (figure 1).
The tumour showed nuclear pleomorphism and mitotic activity at higher power (not shown) and exhibited an infiltrative morphology.
Figure 2 is a cytokeratin immunostain.
Figure 3 is a GCDFP-15 immunostain.
1. What is the likeliest diagnosis and what further enquiries can be made?
This patient had a mastectomy for breast carcinoma some years previous. This conjunctival biopsy shows metastatic breast carcinoma to the bulbar conjunctiva. The tumour was positive for ER receptor as well.
Metastatic deposits to conjunctiva are rare. In a previous study involving the review of 2455 conjunctival lesions only one was a conjunctival metastasis 1 In a second study examining 10 patients with conjunctival metastases, the primary tumours were from the breast, lung, larynx and skin (melanoma) with one of indeterminate origin 2. In all 10 cases, the primary tumour had been diagnosed before the conjunctival presentation 2. Only in one case has the conjunctival metastasis been the initial manifestation of the systemic malignancy 3. Conjunctival metastases often present with a rapidly growing, fixed, fleshy nodule, with episcleral and conjunctival feeder vessels 2.
1. Grossniklaus HE, Green WR, Luckenbach M, Chan CC. Conjunctival lesions in adults: a clinical and histopathological review. Cornea 1987; 6; 78-106
2. Kiratli H, Shields CL, Shields JA, DePotter P. Metastatic tumours to the conjunctiva: a report of 10 cases. Br J Ophthalmol 1996; 80; 5-8.
3. Shields JA, Gunduz K, Shields CL, et al. Conjunctival metastasis as the initial manifestation of lung cancer. Am J Ophthalmol. 1997;124; 399-400.