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02-04-2013 | Internal medicine | Article

Features, outcomes of conjunctival papilloma differ by age at onset


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medwireNews: Conjunctival papillomas that arise in childhood or adolescence tend to be larger, more numerous, and more likely to recur than when they occur in adults, US scientists report.

Carol Shields (Ocular Oncology Service, Philadelphia, Pennsylvania) and team described features of these benign epithelial tumors, which may be associated with human papillomavirus infection and are characterized by prominent intrinsic vascularity.

From a hospital database the team identified 73 consecutive patients (63% men) with 108 conjunctival papillomas who were treated between 1970 and 2012. Ten of the patients were children or adolescents (≤20 years) at initial examination and 63 were adults; the mean age of participants at initial examination was 43 years (range 4-85 years).

A comparison of tumor features by age revealed a number of differences. For instance, compared with adults, children and adolescents had more tumors per eye on average (2 vs 1), larger tumors (8 vs 6 mm), and fewer associated feeder vessels (20 vs 47%). Also, the most common location of the tumor epicenter was the fornix in children and adolescents (27%) but the caruncle in adults (24%).

Histopathologic features did not differ between children and adults, Shields et al note.

Conjunctival papillomas were managed with a variety of approaches, including cryotherapy, excisional biopsy, topical interferon alfa-2b, photodynamic therapy, oral cimetidine, and various combinations of the above. The primary treatment approach did not differ between age groups.

However, treatment outcomes over an average follow-up period of 12 months differed significantly by age. Children and adolescents were significantly less likely than adults to experience complete regression with a single delivery of any form of treatment (38 vs 95%) and significantly more likely to have tumor recurrence (15 vs 1%).

Overall, 88% of the patients achieved complete regression with primary treatment while 12% had residual and/or recurrent tumors, requiring additional treatment.

Writing in JAMA Ophthalmology, the researchers conclude that conjunctival papillomas are more common in adults than in children or adolescents, but that childhood papillomas are often larger and multicentric compared with those in adults.

"No-touch surgical excision and adjunctive double freeze-thaw cryotherapy are the preferred methods of treatment," they conclude. "Recurrence can be minimized by complete tumor excision, cryotherapy, and adjunctive oral cimetidine and/or interferon alfa-2b."

By Joanna Lyford, Senior medwireNews Reporter