Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Konjunktivni melanom je relativno rijetka maligna bolest. Obično se javlja kao jednostrana, pigmentirana lezija koja zahvaća intrepalpebralnu bulbarnu spojnicu perilimbalno, a najčešće se razvija iz primarne stečene melanoze. Muškarac star 81 godinu, inače zdrav, došao je na pregled zbog protrudirajućeg tumora desnoga oka koji je polagano rastao unazad dvije godine. Biomikroskopski pregled otkrio je masivan, smeđe pigmentirani tumor koji se izdizao iznad temporalne 4/5 rožnice i susjednih 3 mm bjeloočnice temporalno od limbusa uzrokujući mehanički ektropij s keratiniziranom sponicom donje vjeđe. Samo limbus od 2 do 4 sata nije bio prekriven tumorom. Površina tumora širine 10 mm u bazi i visine 7 mm bila je nepravilna, nekrotična, s bogatom mrežom krvnih žila i točkastim krvarenjima. Citološkim brisom površine tumora nađene su samo upalne stanice. Bojanja na melanomske antigene HMB 45 i BerEp4(EA) bila su negativna. Zahvaljujući nekrotičnoj površini tumora bilo je moguće uzeti komadić tumora i poslati ga na histopatološku analizu kojom je postavljena dijagnoza melanoma. Kao najmanje invazivna palijativna operacija učinjena je enukleacija bez primarnog orbitalnog implanta. Također je cirkularno izrezano 4 mm susjedne vizualno nepromijenjene spojnice. Histopatološkom analizom tumora postavljena je konačna dijagnoza konjunktivnog melanoma.Conjunctival melanoma is a relatively rare malignancy. It is usually a pigmented, unilateral lesion, often in the perilimbal interpalpebral bulbar conjunctiva, mostly arising from primary acquired melanosis. An 81-year-old male, otherwise healthy, presented with a 2-year history of a slowly growing protruding massive pigmented tumor of the right eye. Biomicroscopy showed a massive pigmented brown tumor protruding from 3 mm of the temporal sclera and 4/5 of the temporal cornea causing mechanical ectropion with keratinized conjunctiva of the lower eyelid. The extent of the tumor was 10 o\u27clock with only the limbus from 2 to 4 o\u27clock being tumor-free. The surface of the tumor of 10 mm in size at the base and 7 mm in height was rough, necrotic, with rich feeder vessels and spotting bleedings. Cytology of the tumor surface revealed only inflammatory cells. Melanoma cell staining was negative for both HMB 45 and BerEp4(EA). Since the tumor surface was highly necrotic, a fragment was obtained and referred for histopathology. The diagnosis was: melanoma. Enucleation with no primary orbital implant was performed as a less invasive palliative surgery. An additional 4-mm fragment of the healthy-looking marginal conjunctiva was also excised. Histopathology of the tumor indicated conjunctival melanoma
