Bindehautdegenerationen und -neoplasien

Zusammenfassung

Erhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese, Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.

Abstract

Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.

Kernaussagen

• Eine Degeneration der Bindehaut zeigt sich hauptsächlich in 2 Formen: als Pterygium und Pinguecula.

• Die echten Neoplasien der Bindehaut entstehen in der Regel aus Zellen, die sich in der Bindehaut befinden.

• Die Entstehung vieler Bindehauttumoren scheint UV-getriggert zu sein.

• Die No-Touch-Technik im Rahmen der chirurgischen Tumorentfernung ist bei potenziell metastasierenden Tumoren wie malignem Melanom, Talgdrüsen- und Plattenepithelkarzinom anzustreben.

• Die regelmäßige Nachsorge bei potenziell metastasierenden und rezidivierenden Bindehauttumoren ist essenziell.

• Junktionale Aktivität bei einem Nävuszellnävus des Erwachsenen soll Anlass zu regelmäßigen Kontrollen der Exzisionsstelle geben.

• Die meisten vaskulären Bindehauttumoren sind benigne; eine wichtige Ausnahme ist jedoch das Kaposi-Sarkom.

• Ein Bindehautmelanom kann unpigmentiert sein und sich gelegentlich erst durch eine systemische Metastase bemerkbar machen. Dadurch wird es anfänglich leicht fehldiagnostiziert.

• Eine einseitige therapierefraktäre Konjunktivitis spricht insbesondere bei älteren Patienten bis zum Beweis des Gegenteils für ein Malignom.

• Ein isoliertes Bindehautlymphom soll nach histologischer Diagnosesicherung in erster Linie bestrahlt werden.

Schlüsselwörter

Bindehaut - Neoplasie - Karzinom - Melanom - Pterygium

Key words

conjunctiva - neoplasia - carcinoma - melanoma - pterygium

Publication History

Article published online:
25 May 2022

• Literatur

• 1 Norn MS. Prevalence of pinguecula in Greenland and in Copenhagen, and its relation to pterygium and spheroid degeneration. Acta Ophthalmol (Copenh) 1979; 57: 96-105
• 2 Droutsas K, Sekundo W. Epidemiologie des Pterygiums. Eine Übersicht. Ophthalmologe 2010; 107: 511-512 514-516 DOI: 10.1007/s00347-009-2101-3.
• 3 Chu WK, Choi HL, Bhat AK. et al. Pterygium: new insights. Eye (Lond) 2020; 34: 1047-1050 DOI: 10.1038/s41433-020-0786-3.
• 4 Maxia C, Perra MT, Demurtas P. et al. Relationship between the expression of cyclooxygenase-2 and survivin in primary pterygium. Mol Vis 2009; 15: 458-463
• 5 Chiang C-C, Cheng Y-W, Lin C-L. et al. Cyclooxygenase 2 expression in pterygium. Mol Vis 2007; 13: 635-638
• 6 Di Girolamo N, Chui J, Coroneo MT. et al. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res 2004; 23: 195-228 DOI: 10.1016/j.preteyeres.2004.02.002.
• 7 Ang LPK, Chua JLL, Tan DTH. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol 2007; 18: 308-313 DOI: 10.1097/ICU.0b013e3281a7ecbb.
• 8 Toker E, Eraslan M. Recurrence after primary pterygium excision: amniotic membrane transplantation with fibrin glue versus conjunctival autograft with fibrin glue. Curr Eye Res 2016; 41: 1-8 DOI: 10.3109/02713683.2014.999947.
• 9 Romano V, Cruciani M, Conti L. et al. Fibrin glue versus sutures for conjunctival autografting in primary pterygium surgery. Cochrane Database Syst Rev 2016; (12) CD011308 DOI: 10.1002/14651858.CD011308.pub2.
• 10 Murube J. Pterygium: its treatment with beta therapy. Ocul Surf 2009; 7: 3-9
• 11 Al Fayez MF. Limbal-conjunctival vs. conjunctival autograft transplant for recurrent pterygia: a prospective randomized controlled trial. JAMA Ophthalmol 2013; 131: 11-16 DOI: 10.1001/archophthalmol.2012.2599.
• 12 Zeng W, Liu Z, Dai H. et al. Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis. BMC Ophthalmol 2017; 17: 211 DOI: 10.1186/s12886-017-0601-5.
• 13 Bock F, Regenfuss B, Cursiefen C. Antiangiogene Therapie am vorderen Augenabschnitt. Wann? Was? Wofür?. Ophthalmologe 2011; 108: 230-236 DOI: 10.1007/s00347-010-2262-0.
• 14 Hirst LW. The treatment of pterygium. Surv Ophthalmol 2003; 48: 145-180
• 15 Torres-Gimeno A, Martínez-Costa L, Ayala G. Preoperative factors influencing success in pterygium surgery. BMC Ophthalmol 2012; 12: 38 DOI: 10.1186/1471-2415-12-38.
• 16 Viso E, Gude F, Rodríguez-Ares MT. Prevalence of pinguecula and pterygium in a general population in Spain. Eye (Lond) 2011; 25: 350-357 DOI: 10.1038/eye.2010.204.
• 17 Mimura T, Mori M, Obata H. et al. Conjunctivochalasis: associations with pinguecula in a hospital-based study. Acta Ophthalmol 2012; 90: 773-782 DOI: 10.1111/j.1755-3768.2011.02161.x.
• 18 Triay E, Bergman L, Nilsson B. et al. Time trends in the incidence of conjunctival melanoma in Sweden. Br J Ophthalmol 2009; 93: 1524-1528 DOI: 10.1136/bjo.2009.157933.
• 19 Bredow L, Martin G, Reinhard T. et al. Recurrent conjunctival papilloma progressing into squamous cell carcinoma with change of HPV-finding during the course. Br J Ophthalmol 2009; 93: 1437 1451 DOI: 10.1136/bjo.2007.132852.
• 20 Huang Y-M, Huang Y-Y, Yang H-Y. et al. Conjunctival papilloma: clinical features, outcome, and factors related to recurrence. Taiwan J Ophthalmol 2018; 8: 15-18 DOI: 10.4103/tjo.tjo_2_18.
• 21 Shields CL, Lally MR, Singh AD. et al. Oral cimetidine (Tagamet) for recalcitrant, diffuse conjunctival papillomatosis. Am J Ophthalmol 1999; 128: 362-364 DOI: 10.1016/s0002-9394(99)00265-2.
• 22 Chang S-W, Huang Z-L. Oral cimetidine adjuvant therapy for recalcitrant, diffuse conjunctival papillomatosis. Cornea 2006; 25: 687-690 DOI: 10.1097/01.ico.0000214221.05991.ed.
• 23 Auw-Haedrich C, Martin G, Spelsberg H. et al. Expression of p 16 in conjunctival intraepithelial neoplasia does not correlate with HPV-infection. Open Ophthalmol J 2008; 2: 48-56 DOI: 10.2174/1874364100802010048.
• 24 Hanbazazh M, Gyure KA. Ocular human papillomavirus infections. Arch Pathol Lab Med 2018; 142: 706-710 DOI: 10.5858/arpa.2017-0571-RA.
• 25 Eberwein P, Maier P, Auw-Haedrich C. et al. Isoliertes Carcinoma in situ der Kornea. Ophthalmologe 2009; 106: 918-920 DOI: 10.1007/s00347-008-1892-y.
• 26 Alomar TS, Nubile M, Lowe J. et al. Corneal intraepithelial neoplasia: in vivo confocal microscopic study with histopathologic correlation. Am J Ophthalmol 2011; 151: 238-247 DOI: 10.1016/j.ajo.2010.08.035.
• 27 Cartsburg O, Kersten A, Sundmacher R. et al. Behandlung von 9 plattenepithelialen Carcinomata in situ der Bindehaut (CIN) mit Mitomycin-C-Augentropfen unter zytologischer und DNA-bildzytometrischer Kontrolle. Klin Monbl Augenheilkd 2001; 218: 429-434 DOI: 10.1055/s-2001-16257.
• 28 Kao AA, Galor A, Karp CL. et al. Clinicopathologic correlation of ocular surface squamous neoplasms at Bascom Palmer Eye Institute: 2001 to 2010. Ophthalmology 2012; 119: 1773-1776 DOI: 10.1016/j.ophtha.2012.02.049.
• 29 Al-Barrag A, Al-Shaer M, Al-Matary N. et al. 5-Fluorouracil for the treatment of intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and cornea. Clin Ophthalmol 2010; 4: 801-808
• 30 Chauhan S, Sen S, Sharma A. et al. Human papillomavirus: a predictor of better survival in ocular surface squamous neoplasia patients. Br J Ophthalmol 2012; 96: 1517-1521 DOI: 10.1136/bjophthalmol-2012-301907.
• 31 Feltgen N, Auw-Hädrich C. Ungewöhnlicher Bindehauttumor bei einer jungen Atopikerin. Ophthalmologe 2005; 102: 1204-1206 DOI: 10.1007/s00347-004-1149-3.
• 32 Pradeep TG, Gangasagara SB, Subbaramaiah GB. et al. Prevalence of undiagnosed HIV infection in patients with ocular surface squamous neoplasia in a tertiary center in Karnataka, South India. Cornea 2012; 31: 1282-1284 DOI: 10.1097/ICO.0b013e3182479aed.
• 33 Kallen C, Reinhard T, Schilgen G. et al. Atopische Keratokonjunktivitis. Wahrscheinlich ein Risikofaktor für die Entstehung von Bindehautkarzinomen. Ophthalmologe 2003; 100: 808-814 DOI: 10.1007/s00347-003-0809-z.
• 34 Rundle P, Mudhar HS, Rennie I. Conjunctival intra-epithelial neoplasia occurring in young patients with asthma. Eye (Lond) 2010; 24: 1182-1185 DOI: 10.1038/eye.2009.296.
• 35 Maalouf TJ, Dolivet G, Angioi KS. et al. Sentinel lymph node biopsy in patients with conjunctival and eyelid cancers: experience in 17 patients. Ophthal Plast Reconstr Surg 2012; 28: 30-34 DOI: 10.1097/IOP.0b013e31822fb44b.
• 36 Rao R, Honavar SG, Lahane S. et al. Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy. Br J Ophthalmol 2021; DOI: 10.1136/bjophthalmol-2021-319201.
• 37 Basti S, Macsai MS. Ocular surface squamous neoplasia: a review. Cornea 2003; 22: 687-704
• 38 Lange CA, Tisch-Rottensteiner J, Böhringer D. et al. Enhanced TKTL1 expression in malignant tumors of the ocular adnexa predicts clinical outcome. Ophthalmology 2012; 119: 1924-1929 DOI: 10.1016/j.ophtha.2012.03.037.
• 39 Yousef YA, Finger PT. Predictive value of the seventh edition American Joint Committee on Cancer staging system for conjunctival melanoma. Arch Ophthalmol 2012; 130: 599-606 DOI: 10.1001/archophthalmol.2011.2566.
• 40 Levecq L, De Potter P, Jamart J. Conjunctival nevi clinical features and therapeutic outcomes. Ophthalmology 2010; 117: 35-40 DOI: 10.1016/j.ophtha.2009.06.018.
• 41 Shields CL, Fasiuddin AF, Fasiudden A. et al. Conjunctival nevi: clinical features and natural course in 410 consecutive patients. Arch Ophthalmol 2004; 122: 167-175 DOI: 10.1001/archopht.122.2.167.
• 42 Shields CL, Belinsky I, Romanelli-Gobbi M. et al. Anterior segment optical coherence tomography of conjunctival nevus. Ophthalmology 2011; 118: 915-919 DOI: 10.1016/j.ophtha.2010.09.016.
• 43 Milman T, Eiger-Moscovich M, Henry RK. et al. Validation of the newly proposed World Health Organization classification system for conjunctival melanocytic intraepithelial lesions: a comparison with the C-MIN and PAM classification schemes. Am J Ophthalmol 2021; 223: 60-74 DOI: 10.1016/j.ajo.2020.10.020.
• 44 Bresler SC, Simon C, Shields CL. et al. Conjunctival melanocytic lesions. Arch Pathol Lab Med 2021; DOI: 10.5858/arpa.2021-0006-RA.
• 45 Damato B, Coupland SE. Conjunctival melanoma and melanosis: a reappraisal of terminology, classification and staging. Clin Experiment Ophthalmol 2008; 36: 786-795 DOI: 10.1111/j.1442-9071.2008.01888.x.
• 46 Auw-Haedrich C. Bindehautmelanom. Z Prakt Augenheilkd 2006; 27: 244-250
• 47 Messmer EM, Mackert MJ, Zapp DM. et al. In vivo confocal microscopy of pigmented conjunctival tumors. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1437-1445 DOI: 10.1007/s00417-006-0284-8.
• 48 Peebo BB, Fagerholm P, Lagali N. In vivo confocal microscopy visualization of presumed lymph vessels in a case of corneal transplant rejection. Clin Experiment Ophthalmol 2011; 39: 832-834 DOI: 10.1111/j.1442-9071.2011.02557.x.
• 49 Pfeiffer ML, Savar A, Esmaeli B. Sentinel lymph node biopsy for eyelid and conjunctival tumors: what have we learned in the past decade?. Ophthal Plast Reconstr Surg 2013; 29: 57-62 DOI: 10.1097/IOP.0b013e31827472c5.
• 50 Oellers P, Karp CL. Management of pigmented conjunctival lesions. Ocul Surf 2012; 10: 251-263 DOI: 10.1016/j.jtos.2012.08.002.
• 51 Karim R, Conway RM. Conservative resection and adjuvant plaque brachytherapy for early-stage conjunctival melanoma. Clin Exp Ophthalmol 2011; 39: 293-298 DOI: 10.1111/j.1442-9071.2010.02469.x.
• 52 Damato B, Coupland SE. An audit of conjunctival melanoma treatment in Liverpool. Eye (Lond) 2009; 23: 801-809 DOI: 10.1038/eye.2008.154.
• 53 Jain P, Finger PT, Damato B. et al. Multicenter, international assessment of the eighth edition of the American Joint Committee on Cancer cancer staging manual for conjunctival melanoma. JAMA Ophthalmol 2019; 137: 905-911 DOI: 10.1001/jamaophthalmol.2019.1640.
• 54 Glossmann J-P, Skoetz N, Starbatty B. et al. Konjunktivales Melanom: standardisiertes Vorgehen in Diagnostik, Therapie und Nachsorge. Ophthalmologe 2018; 115: 489-498 DOI: 10.1007/s00347-018-0664-6.
• 55 Coupland SE, Barnhill R, Conway RM. et al. Conjunctival melanoma. In: Amin A, Edge S, Greene F. et al., eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017
• 56 Jain P, Finger PT, Fili M. et al. Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study. Br J Ophthalmol 2021; 105: 1358-1364 DOI: 10.1136/bjophthalmol-2020-316293.
• 57 Heindl LM, Hofmann-Rummelt C, Adler W. et al. Prognostic significance of tumor-associated lymphangiogenesis in malignant melanomas of the conjunctiva. Ophthalmology 2011; 118: 2351-2360 DOI: 10.1016/j.ophtha.2011.05.025.
• 58 Shields JA, Mashayekhi A, Kligman BE. et al. Vascular tumors of the conjunctiva in 140 cases. Ophthalmology 2011; 118: 1747-1753 DOI: 10.1016/j.ophtha.2011.04.034.
• 59 Herwig-Carl MC, Grossniklaus HE, Müller PL. et al. Pyogenic granuloma associated with conjunctival epithelial neoplasia: report of nine cases. Br J Ophthalmol 2019; 103: 1469-1474 DOI: 10.1136/bjophthalmol-2018-312960.
• 60 Kirova YM, Belembaogo E, Frikha H. et al. Radiotherapy in the management of epidemic Kaposiʼs sarcoma: a retrospective study of 643 cases. Radiother Oncol 1998; 46: 19-22
• 61 Kass LG, Hornblass A. Sebaceous carcinoma of the ocular adnexa. Surv Ophthalmol 1989; 33: 477-490
• 62 Honavar SG, Shields CL, Maus M. et al. Primary intraepithelial sebaceous gland carcinoma of the palpebral conjunctiva. Arch Ophthalmol 2001; 119: 764-767
• 63 Ozanics V, Jakobiec F. Prenatal Development of the Eye and its Adnexa. In: Jakobiec F. Ocular Anatomy, Embryology and Teratology. Philadelphia, PA: Harper & Row; 1982: 11-96
• 64 Shields CL, Naseripour M, Shields JA. et al. Topical mitomycin-C for pagetoid invasion of the conjunctiva by eyelid sebaceous gland carcinoma. Ophthalmology 2002; 109: 2129-2133
• 65 Font RL, Rishi K. Sebaceous gland adenoma of the tarsal conjunctiva in a patient with Muir-Torre syndrome. Ophthalmology 2003; 110: 1833-1836 DOI: 10.1016/S0161-6420(03)00578-5.
• 66 Kruse R, Rütten A, Lamberti C. et al. Muir-Torre phenotype has a frequency of DNA mismatch-repair-gene mutations similar to that in hereditary nonpolyposis colorectal cancer families defined by the Amsterdam criteria. Am J Hum Genet 1998; 63: 63-70 DOI: 10.1086/301926.
• 67 Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. J Am Acad Dermatol 1995; 33: 90-104
• 68 Shields JA, Demirci H, Marr BP. et al. Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture. Ophthal Plast Reconstr Surg 2005; 21: 92-96
• 69 Ortiz JM, Yanoff M. Epipalpebral conjunctival osseous choristoma. Br J Ophthalmol 1979; 63: 173-176
• 70 Fry CL, Leone jr. CR. Safe management of dermolipomas. Arch Ophthalmol 1994; 112: 1114-1116
• 71 Sa H-S, Kim HK, Shin JH. et al. Dermolipoma surgery with rotational conjunctival flaps. Acta Ophthalmol 2012; 90: 86-90 DOI: 10.1111/j.1755-3768.2011.02129.x.
• 72 Auw-Haedrich C, Coupland SE, Kapp A. et al. Long term outcome of ocular adnexal lymphoma subtyped according to the REAL classification. Revised European and American Lymphoma. Br J Ophthalmol 2001; 85: 63-69
• 73 Goebel N, Serr A, Mittelviefhaus H. et al. Chlamydia psittaci, helicobacter pylori and ocular adnexal lymphoma-is there an association? The German experience. Leuk Res 2007; 31: 1450-1452 DOI: 10.1016/j.leukres.2006.12.005.
• 74 Shields CL, Demirci H, Karatza E. et al. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology 2004; 111: 1747-1754 DOI: 10.1016/j.ophtha.2004.02.013.
• 75 Lapp T, Mittelviefhaus H, Werner M. et al. Severe bleeding eyelid after trivial trauma: conjunctival metastasis of a renal cell carcinoma. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1705-1706 DOI: 10.1007/s00417-011-1806-6.
• 76 Lapp T, Birnbaum F, Evert M. et al. Kornealer Tumor nach Vorderkammerlinsenimplantation bei Marfan-Syndrom: Kasuistik eines 57-jährigen Patienten. Ophthalmologe 2012; 109: 155-160 DOI: 10.1007/s00347-011-2443-5.
• 77 Herwig MC, Fischer HP, Holz FG. et al. Konjunktivales Myxom – zwei Kasuistiken: histopathologische Aufarbeitung und klinische Korrelation. Ophthalmologe 2010; 107: 843-847 DOI: 10.1007/s00347-009-2120-0.
• 78 Herwig MC, Wells JR, Grossniklaus HE. Conjunctival stromal tumor: report of 4 cases. Ophthalmology 2012; 119: 682-687 DOI: 10.1016/j.ophtha.2011.09.024.
• 79 Auw-Haedrich C, Danielewicz KD, Mendoza PR. et al. Conjunctival stromal tumor: expansion of findings in a newly described entity. Ophthalmology 2016; 123: 1166-1167 DOI: 10.1016/j.ophtha.2015.11.027.
• 80 Müller S, Stahn J, Schmitz K. et al. Rezidivraten nach Pterygiumoperation mit Bindehautschwenklappen vs. freies autologes Transplantat. Ophthalmologe 2007; 104: 480-483 DOI: 10.1007/s00347-007-1539-4.
• 81 Srinivasan S, Dollin M, McAllum P. et al. Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial. Br J Ophthalmol 2009; 93: 215-218 DOI: 10.1136/bjo.2008.145516.
• 82 Sekundo W, Droutsas K, Cursiefen C. Operative Techniken bei chirurgischer Behandlung primärer und rezidivierender Pterygien. Ophthalmologe 2010; 107: 525-528 DOI: 10.1007/s00347-009-2099-6.
• 83 Ali AM, Thariat J, Bensadoun R-J. et al. The role of radiotherapy in the treatment of pterygium: a review of the literature including more than 6000 treated lesions. Cancer Radiother 2011; 15: 140-147 DOI: 10.1016/j.canrad.2010.03.020.
• 84 Küçükerdönmez C, Akova YA, Altinörs DD. Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome. Cornea 2007; 26: 407-413 DOI: 10.1097/ICO.0b013e318033b3d4.
• 85 Shahin MM, Elbendary AM, Elwan MM. Intraoperative subconjunctival bevacizumab as an adjunctive treatment in primary pterygium: a preliminary report. Ophthalmic Surg Lasers Imaging 2012; 43: 459-466 DOI: 10.3928/15428877-20120802-02.