[Inverted transitional cell papilloma of the conjunctiva with peripheral carcinomatous transformation]

Inverted papilloma is a benign epithelial neoplasm of mucous membrane, usually arising in the nose and paranasal sinuses, much rarer of the conjunctiva. Histologically ribbons or bulbous expansions of the epithelium invaginate into the underlying connective tissue. In opposite to their sinonasal counterparts the few described papillomas of the conjunctiva til now have not shown any signs of malignant transformation or recurrence after local excision.

A 96-year old woman presented with a solid tumour on the nasal bulbar conjunctiva of her right eye, which had persisted at least over 6 months. Ocular examination showed a 25 x 15 x 15 mm reddish tumour with papillary surface. Histologic features of the excised specimen were consistent with inverted papilloma, but here were significant carcinomatous foci in peripheral areas. Four months later there was a tumour recurrence on the bulbar and tarsal conjunctiva.

Inverted papilloma of the conjunctiva is an unusual diagnosis and to date there is no previous report of malignant transformation. With only seven cases described so far the biologic behavior remains uncertain, but it seems to be more aggressive than assumed so far. Complete excision is the treatment of choice, but patients should be carefully observed and adjuvant therapy could be necessary to ensure tumour control.