RESUMEN
OBJECTIVE: To implement a double-staining technique to identify the most sensitive and specific combinations of melanoma antigen recognized by T cells (Melan-A), microphthalmia-associated transcription factor (MITF), human melanoma black 45 (HMB45), and Ki67 aiming to assist in the diagnosis of atypical melanocytic conjunctival lesions that are more prone to malignant progression. METHODS: Eight specimens of conjunctival melanoma and of primary acquired melanosis with moderate to severe atypia were double-immunostained with a combination of a cytoplasmic marker (anti-Melan-A or anti-HMB45), and a nuclear marker (anti-MITF or anti-Ki67). Eight specimens of normal conjunctiva and of conjunctival nevi served as controls. The specimens were processed using 3,3-diaminobenzidine substrate for nuclear stains and the fast-red substrate for cytoplasmic stains. Each slide was analyzed by light microscopy and provided a percent scale and a 0 to 4+ score for each nuclear and cytoplasmic component. RESULTS: Melan-A and MITF were strongly positive markers for all melanocytic cells, whereas Ki67 and HMB45 provided a variable response for identifying potentially proliferative or aggressive cells. HMB45 and MITF proved to be the best combination for differentiating between atypical and benign lesions on a percent scale and a 0 to 4+ scale (pâ¯=â¯0.0004), with the 3 other combinations providing mainly confirmatory diagnostic information (p < 0.05). CONCLUSIONS: Our study used an immunohistochemical double-staining approach to differentiate between atypical and benign melanocytic lesions of the conjunctiva. Our findings should aid in a more complete immunohistopathological diagnosis of conjunctival melanocytic lesions, particularly in diagnostically difficult cases.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias de la Conjuntiva/diagnóstico , Melanoma/diagnóstico , Melanosis/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias de la Conjuntiva/metabolismo , Femenino , Humanos , Inmunohistoquímica , Antígeno Ki-67/metabolismo , Antígeno MART-1/metabolismo , Masculino , Melanoma/metabolismo , Antígenos Específicos del Melanoma/metabolismo , Melanosis/metabolismo , Factor de Transcripción Asociado a Microftalmía/metabolismo , Persona de Mediana Edad , Nevo Pigmentado/metabolismo , Estudios Retrospectivos , Coloración y Etiquetado , Antígeno gp100 del MelanomaAsunto(s)
Endotaponamiento/efectos adversos , Enfermedades de los Párpados/diagnóstico , Párpados/patología , Granuloma de Cuerpo Extraño/diagnóstico , Aceites de Silicona/efectos adversos , Biopsia , Diagnóstico Diferencial , Enfermedades de los Párpados/etiología , Humanos , Coagulación con Láser/métodos , Masculino , Persona de Mediana Edad , Oftalmoscopía , Desprendimiento de Retina/cirugíaRESUMEN
A 30-year-old woman presented with left eye pain and photophobia for over eight weeks. A hair was found to be embedded obliquely within the corneal stroma with overlying reepithelialization. The foreign body had been quiescent for over four years prior to any ocular symptoms. Successful removal of the hair was performed using local anesthetic, jeweler's forceps, a microblade, and a thirty-gauge needle with good visual outcome. We report an interesting case of an acute exacerbation of a previously quiescent, chronic corneal foreign body secondary to what we presume to be human hair following trauma, with only three other cases in the English literature.