Conjunctival Intraepithelial Neoplasia Mimicking a Pigmentary Lesion in an HIV-Seropositive Indian Male

Abstract

We present the case of a 27-year-old male who presented to our ophthalmology outpatient clinic with a pigmented lesion on the conjunctiva of his right eye. There was no history of ocular trauma or familial ocular complaints, and a thorough evaluation revealed the patient's seropositive status for HIV for the past eight years. The presentation resembled a conjunctival pigmentary lesion, with typical features of ocular surface squamous neoplasia (OSSN) being absent and a demographic incongruent with typical OSSN cases as OSSN typically affects the elderly population. Given the patient's HIV status and the lesion's recent increase in size, a more aggressive treatment approach was warranted. Mass excisional biopsy surgery confirmed conjunctival intraepithelial neoplasia with one positive margin. Adjuvant treatment with mitomycin eye drops (0.04%) resulted in no lesion recurrence at the one-month follow-up. Conjunctival intraepithelial neoplasia can mimic pigmentary lesions in young HIV-positive patients with obvious signs of OSSN being absent. In such cases, the history of seropositivity should be sufficient to suspect it as OSSN and aggressive management measures should be adopted to get best possible outcomes.

Keywords: conjunctival intraepithelial neoplasia; ocular diseases of hiv; ocular oncology; ocular surface squamous neoplasia (ossn); pigmented conjunctival lesion.

Figure 1. Pigmented, elevated, oval conjunctival lesion in the right eye

Figure 2. Histopathology of the lesion with hematoxylin and eosin (H&E) stain showing hyperplastic stratified squamous epithelium with nuclei enlargement, mild to moderate anisonucleosis, with loss of polarity and few prominent nucleoli (arrow)

Figure 3. Histopathology of the lesion with hematoxylin and eosin (H&E) stain showing the atypical cells with enlarged nuclei, loss of polarity and prominent nucleoli (arrow)