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Differentiating Benign vs Malignant Conjunctival Tumors in Children
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In this retrospective analysis of 806 patients (aged <21 years) with conjunctival tumors, 61% were diagnosed with nevus, 5% with benign reactive lymphoid hyperplasia, 4% with nodular conjunctivitis, 4% with dermoid, and 3% with primary acquired melanosis. In 97% of cases, tumors were benign; the mean age at detection was 11 years. The remaining 3% of tumors were malignant, including melanoma (2.2%) and lymphoma (1.1%), and were detected at a mean age of 14 years. Compared with nevus, melanoma was more prevalent at 10 to 15 years, associated with thicker tumors, a larger base, tumor hemorrhages, and no intrinsic cysts. Compared with benign reactive lymphoid hyperplasia, lymphoma was associated with more diffuse tumor locations and a larger base.
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In children, the majority of conjunctival tumors were benign. The 3% of malignant cases included melanoma and lymphoma.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
Conjunctival tumors in children are usually benign and rarely malignant.
Objective
To evaluate clinical features of conjunctival tumors in children by comparing benign tumors with their malignant counterparts.
Design, Setting, and Participants
This retrospective case series reviewed 806 cases of conjunctival tumor in children (aged <21 years) who were evaluated at a tertiary referral center between November 1, 1975, and July 1, 2015. This study included 262 children who were part of a published review.
Main Outcomes and Measures
Features of benign and malignant tumors were compared. Data were collected on patient demographics, tumor features, and specific diagnoses to determine findings related to each tumor.
Results
Among the 806 patients with conjunctival tumor, the top 5 diagnoses included nevus (492 [61%]), benign reactive lymphoid hyperplasia (BRLH) (38 [5%]), nodular conjunctivitis (31 [4%]), dermoid (30 [4%]), and primary acquired melanosis (27 [3%]). Overall, conjunctival tumors were benign (779 [97%]) or malignant (27 [3%]), including melanoma (18 [2.2%]) and lymphoma (9 [1.1%]). The mean age at detection was 11 years for benign tumors and 14 years for malignant tumors (P = .005), with mean difference of 3 years (95% CI, 1.2-4.6). The relative frequency of any malignancy (per all conjunctival tumors) by age bracket (0-5 years, >5-10 years, >10-15 years, and >15-<21 years) was 1%, 2%, 3%, and 7%, respectively. A comparison between nevus and melanoma found differences with melanoma in the 10 to 15 years age bracket (29% vs 61%; difference of 32% [95% CI, 10%-55%]; P = .006), mean tumor thickness (1.1 mm vs 1.5 mm; difference of 0.4 mm [95% CI, -0.29 mm to 1.12 mm]; P = .04), tumor base of 10 mm or greater (relative risk [RR] = 4.92; 95% CI, 1.73-13.97; P = .003), tumor hemorrhage (RR = 25.30; 95% CI, 11.91-53.78; P < .001), and lack of intrinsic cysts (RR = 5.06; 95% CI, 1.84-13.98; P = .002). A comparison between BRLH and lymphoma revealed lymphoma with a larger base (RR = 5.16; 95% CI, 1.19- 22.19; P = .002) and diffuse location (RR = 16.50; 95% CI, 4.31-63.22; P < .001) and inferior (RR = 12.38; 95% CI, 2.88-53.16; P < .001) or superior vs nasal (RR = 8.25; 95% CI, 1.56-43.51; P = .01). The small cohort of malignant lesions precluded determining if these features were independent of one another.
Conclusions and Relevance
These data, from an ocular tertiary referral center, suggest that conjunctival tumors in children are nearly always benign. The few malignant tumors included melanoma and lymphoma. Melanoma, compared with nevus, was associated with older children (aged >10-15 years) with larger tumor, hemorrhage, and lack of cyst. Lymphoma, compared with BRLH, was associated with larger size and diffuse involvement.
Additional Info
Clinical Features Differentiating Benign From Malignant Conjunctival Tumors in Children
JAMA Ophthalmol 2017 Jan 26;[EPub Ahead of Print], CL Shields, K Sioufi, AE Alset, NS Boal, MG Casey, AN Knapp, JA Sugarman, MA Schoen, PS Gordon, EA Say, JA ShieldsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
There have been only a few series on conjunctival tumors in children, most of which have been histopathologic series and only one substantial previous clinical series on 262 cases from our department.1 In this current analysis, we assessed a large cohort of 806 consecutive conjunctiva tumors in children, and assessed, for the first time in the literature, clinical features to help differentiate benign from malignant tumors.
To start, there were a few notable differences in white versus black children in that white children demonstrated more commonly nevus, papilloma, and lymphoid tumor whereas black children showed greater frequency of racial melanosis. Overall, of the 806 cases, only 3% were malignant, and these included melanoma (2%) and lymphoma (1%). Those children with malignant tumors (vs nonmalignant tumors) tended to be significantly older in age (mean age, 14 years vs 11 years), and usually were >15 years old. When judging malignancy overall (per all conjunctival tumors), malignant tumors were found in 1% of younger children, 3% of younger teenagers, and 7% of older teenagers.
Another way of looking at it is based on likelihood per age bracket. Specifically, for melanocytic conjunctival tumors (nevus vs melanoma), nevus was far more common in those <10 years (99% vs 1%), 10 to 15 years (97% vs 3%), and even 15 to 21 years (93% vs 7%). A comparison of conjunctival nevus vs melanoma found differences with melanoma in older children, greater tumor thickness and base, tumor hemorrhage, and lack of intrinsic tumor cysts.
The other important conjunctiva malignancy in children was lymphoma. Comparing benign reactive lymphoid hyperplasia vs malignant lymphoma revealed lymphoma with greater base and more likely located as a diffuse mass or in a non-nasal bulbar site. Thus, a lymphoid tumor in the nasal bulbar region was more likely benign reactive lymphoid hyperplasia, whereas a tumor located in the superior, inferior, or both locations was likely lymphoma.
Overall, the great majority of conjunctival tumors in children are benign, but keep in mind the two important malignant tumors, melanoma and lymphoma. Clinical features can go a long way in differentiating these conditions.
Reference
http://journals.lww.com/co-ophthalmology/pages/articleviewer.aspx?year=2007&issue=09000&article=00002&type=abstract