Skip to main content

Conjunctival and Corneal Tumors: Systemic Associations

  • Chapter
  • First Online:
Clinical Ophthalmic Oncology
  • 449 Accesses

Abstract

Conjunctival tumors may be some of the prominent manifestations of systemic inherited diseases. In such instances, ophthalmologists should recognize the systemic association and initiate appropriate systemic and genetic evaluation. Conjunctival tumors and tumor-like conditions associated with systemic disorders can be categorized as pigmented lesions (Peutz–Jeghers syndrome), benign tumors (Goldenhar syndrome), malignant tumors (xeroderma pigmentosum), and amyloidosis. We present a review of this group of conjunctival lesions and their associated systemic disorders. Other entities may also have associated eyelid tumors and are covered in detail elsewhere. Where applicable, the genetic underpinnings of the syndromic association are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AL:

Light chain

CHRPE:

Congenital hypertrophy of the retinal pigment epithelium

GS:

Goldenhar syndrome

MEN:

Multiple endocrine neoplasia

OAV:

Oculoauriculovertebral dysplasia

OAVS:

Oculoauriculovertebral spectrum

PJS:

Peutz–Jeghers syndrome

PS:

Proteus syndrome

TTR:

Transthyretin

XP:

Xeroderma pigmentosum

References

  1. Carney JA, Gordon H, Carpenter PC, et al. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore). 1985;64(4):270–83.

    Article  CAS  Google Scholar 

  2. Kennedy RH, Waller RR, Carney JA. Ocular pigmented spots and eyelid myxomas. Am J Ophthalmol. 1987;104(5):533–8.

    Article  CAS  PubMed  Google Scholar 

  3. Rothenbuhler A, Stratakis CA. Clinical and molecular genetics of Carney complex. Best Pract Res Clin Endocrinol Metab. 2010;24(3):389–99.

    Article  CAS  PubMed  Google Scholar 

  4. Jeghers H, Mc KV, Katz KH. Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance. N Engl J Med. 1949;241(26):1031–6.

    Article  CAS  PubMed  Google Scholar 

  5. Hearle N, Schumacher V, Menko FH, et al. Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin Cancer Res. 2006;12(10):3209–15.

    Article  CAS  PubMed  Google Scholar 

  6. Ma H, Brosens LAA, Offerhaus GJA, et al. Pathology and genetics of hereditary colorectal cancer. Pathology. 2018;50(1):49–59.

    Article  CAS  PubMed  Google Scholar 

  7. Traboulsi EI, Maumenee IH, Krush AJ, et al. Pigmented ocular fundus lesions in the inherited gastrointestinal polyposis syndromes and in hereditary nonpolyposis colorectal cancer. Ophthalmology. 1988;95(7):964–9.

    Article  CAS  PubMed  Google Scholar 

  8. Traboulsi EI, Maumenee IH. Periocular pigmentation in the Peutz-Jeghers syndrome. Am J Ophthalmol. 1986;102(1):126–7.

    Article  CAS  PubMed  Google Scholar 

  9. Giardiello FM, Offerhaus JG. Phenotype and cancer risk of various polyposis syndromes. Eur J Cancer. 1995;31A(7–8):1085–7.

    Article  CAS  PubMed  Google Scholar 

  10. Beggs AD, Latchford AR, Vasen HF, et al. Peutz-Jeghers syndrome: a systematic review and recommendations for management. Gut. 2010;59(7):975–86.

    Article  CAS  PubMed  Google Scholar 

  11. van Lier MG, Wagner A, Mathus-Vliegen EM, et al. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010;105(6):1258–64; author reply 65

    Article  PubMed  Google Scholar 

  12. Happle R. The group of epidermal nevus syndromes Part I. Well defined phenotypes. J Am Acad Dermatol. 2010;63(1):1–22; quiz 3–4

    Article  PubMed  Google Scholar 

  13. Aslam A, Salam A, Griffiths CE, et al. Naevus sebaceus: a mosaic RASopathy. Clin Exp Dermatol. 2014;39(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  14. Traboulsi EI, Zin A, Massicotte SJ, et al. Posterior scleral choristoma in the organoid nevus syndrome (linear nevus sebaceus of Jadassohn). Ophthalmology. 1999;106(11):2126–30.

    Article  CAS  PubMed  Google Scholar 

  15. Shields JA, Shields CL, Eagle RC Jr, et al. Ocular manifestations of the organoid nevus syndrome. Ophthalmology. 1997;104(3):549–57.

    Article  CAS  PubMed  Google Scholar 

  16. Echegaray JJ, Chen R, Bellerive C, et al. Linear nevus sebaceous syndrome presenting as circumscribed choroidal hemangioma. Ophthalmic Genet. 2018;39(2):278–81.

    Article  PubMed  Google Scholar 

  17. Goldenhar M. Associations malformatives de l’oeil et de l’oreille: en particulier, le syndrome: dermoide epibulbaire-appendices auriculaires--fistula auris congenita et ses relations avec la dysostose mandibulo-faciale. J Genet Hum. 1952;1:243–82.

    Google Scholar 

  18. De Golovine S, Wu S, Hunter JV, et al. Goldenhar syndrome: a cause of secondary immunodeficiency? Allergy Asthma Clin Immunol. 2012;8(1):10.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gorlin RJ, Jue KL, Jacobsen U, et al. Oculoauriculovertebral dysplasia. J Pediatr. 1963;63:991–9.

    Article  CAS  PubMed  Google Scholar 

  20. Beleza-Meireles A, Hart R, Clayton-Smith J, et al. Oculo-auriculo-vertebral spectrum: clinical and molecular analysis of 51 patients. Eur J Med Genet. 2015;58(9):455–65.

    Article  PubMed  Google Scholar 

  21. Tasse C, Majewski F, Bohringer S, et al. A family with autosomal dominant oculo-auriculo-vertebral spectrum. Clin Dysmorphol. 2007;16(1):1–7.

    Article  PubMed  Google Scholar 

  22. Rooryck C, Souakri N, Cailley D, et al. Array-CGH analysis of a cohort of 86 patients with oculoauriculovertebral spectrum. Am J Med Genet A. 2010;152A(8):1984–9.

    Article  PubMed  Google Scholar 

  23. Rollnick BR, Kaye CI, Nagatoshi K, et al. Oculoauriculovertebral dysplasia and variants: phenotypic characteristics of 294 patients. Am J Med Genet. 1987;26(2):361–75.

    Article  CAS  PubMed  Google Scholar 

  24. Beleza-Meireles A, Clayton-Smith J, Saraiva JM, et al. Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update. J Med Genet. 2014;51(10):635–45.

    Article  CAS  PubMed  Google Scholar 

  25. Barisic I, Odak L, Loane M, et al. Prevalence, prenatal diagnosis and clinical features of oculo-auriculo-vertebral spectrum: a registry-based study in Europe. Eur J Hum Genet. 2014;22(8):1026–33.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jakobiec FA, Pineda R, Rivera R, et al. Epicorneal polypoidal lipodermoid: lack of association of central corneal lesions with goldenhar syndrome verified with a review of the literature. Surv Ophthalmol. 2010;55(1):78–84.

    Article  PubMed  Google Scholar 

  27. Smith HB, Verity DH, Collin JR. The incidence, embryology, and oculofacial abnormalities associated with eyelid colobomas. Eye (Lond). 2015;29(4):492–8.

    Article  CAS  Google Scholar 

  28. Shrestha UD, Adhikari S. Goldenhar syndrome in association with Duane syndrome. JNMA J Nepal Med Assoc. 2012;52(185):33–5.

    CAS  PubMed  Google Scholar 

  29. Nijhawan N, Morad Y, Seigel-Bartelt J, et al. Caruncle abnormalities in the oculo-auriculo-vertebral spectrum. Am J Med Genet. 2002;113(4):320–5.

    Article  PubMed  Google Scholar 

  30. Margolis S, Aleksic S, Charles N, et al. Retinal and optic nerve findings in Goldenhar-Gorlin syndrome. Ophthalmology. 1984;91(11):1327–33.

    Article  CAS  PubMed  Google Scholar 

  31. Shrestha UD, Adhikari S. Craniofacial Microsomia: Goldenhar syndrome in association with bilateral congenital cataract. Case Rep Ophthalmol Med. 2015;2015:435967.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Brue C, Mariotti C, Celani S, et al. A case of Goldenhar syndrome associated with a new retinal presentation: exudative Vitelliform maculopathy. Case Rep Ophthalmol Med. 2015;2015:626027.

    PubMed  PubMed Central  Google Scholar 

  33. Kallen K, Robert E, Castilla EE, et al. Relation between oculo-auriculo-vertebral (OAV) dysplasia and three other non-random associations of malformations (VATER, CHARGE, and OEIS). Am J Med Genet A. 2004;127(1):26–34.

    Article  Google Scholar 

  34. Lindhurst MJ, Sapp JC, Teer JK, et al. A mosaic activating mutation in AKT1 associated with the Proteus syndrome. N Engl J Med. 2011;365(7):611–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Wiedemann HR, Burgio GR, Aldenhoff P, et al. The proteus syndrome. Partial gigantism of the hands and/or feet, nevi, hemihypertrophy, subcutaneous tumors, macrocephaly or other skull anomalies and possible accelerated growth and visceral affections. Eur J Pediatr. 1983;140(1):5–12.

    Article  CAS  PubMed  Google Scholar 

  36. Happle R. Lethal genes surviving by mosaicism: a possible explanation for sporadic birth defects involving the skin. J Am Acad Dermatol. 1987;16(4):899–906.

    Article  CAS  PubMed  Google Scholar 

  37. Biesecker LG, Happle R, Mulliken JB, et al. Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet. 1999;84(5):389–95.

    Article  CAS  PubMed  Google Scholar 

  38. Nguyen D, Turner JT, Olsen C, et al. Cutaneous manifestations of proteus syndrome: correlations with general clinical severity. Arch Dermatol. 2004;140(8):947–53.

    Article  PubMed  Google Scholar 

  39. De Becker I, Gajda DJ, Gilbert-Barness E, et al. Ocular manifestations in Proteus syndrome. Am J Med Genet. 2000;92(5):350–2.

    Article  PubMed  Google Scholar 

  40. Turner JT, Cohen MM Jr, Biesecker LG. Reassessment of the Proteus syndrome literature: application of diagnostic criteria to published cases. Am J Med Genet A. 2004;130(2):111–22.

    Article  Google Scholar 

  41. Biesecker L. The challenges of Proteus syndrome: diagnosis and management. Eur J Hum Genet. 2006;14(11):1151–7.

    Article  PubMed  Google Scholar 

  42. Morrison PJ, Nevin NC. Multiple endocrine neoplasia type 2B (mucosal neuroma syndrome, Wagenmann-Froboese syndrome). J Med Genet. 1996;33(9):779–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Eng C, Smith DP, Mulligan LM, et al. Point mutation within the tyrosine kinase domain of the RET proto-oncogene in multiple endocrine neoplasia type 2B and related sporadic tumours. Hum Mol Genet. 1994;3(2):237–41.

    Article  CAS  PubMed  Google Scholar 

  44. Jacobs JM, Hawes MJ. From eyelid bumps to thyroid lumps: report of a MEN type IIb family and review of the literature. Ophthal Plast Reconstr Surg. 2001;17(3):195–201.

    Article  CAS  PubMed  Google Scholar 

  45. Eter N, Klingmuller D, Hoppner W, et al. Typical ocular findings in a patient with multiple endocrine neoplasia type 2b syndrome. Graefes Arch Clin Exp Ophthalmol. 2001;239(5):391–4.

    Article  CAS  PubMed  Google Scholar 

  46. Robertson DM, Sizemore GW, Gordon H. Thickened corneal nerves as a manifestation of multiple endocrine neoplasia. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1975;79(6):OP772–87.

    CAS  PubMed  Google Scholar 

  47. Kreps EO, Van Herzeele I, Callewaert BL. Diagnosis of multiple endocrine neoplasia type 2B and management of its ocular features. Ophthalmic Genet. 2018;39(2):268–70.

    Article  CAS  PubMed  Google Scholar 

  48. Riley FC Jr, Robertson DM. Ocular histopathology in multiple endocrine neoplasia type 2b. Am J Ophthalmol. 1981;91(1):57–64.

    Article  PubMed  Google Scholar 

  49. Pacini F, Castagna MG, Cipri C, et al. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol). 2010;22(6):475–85.

    Article  CAS  Google Scholar 

  50. Kraemer KH, Lee MM, Scotto J. Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 830 published cases. Arch Dermatol. 1987;123(2):241–50.

    Article  CAS  PubMed  Google Scholar 

  51. Lim R, Sethi M, Morley AMS. Ophthalmic manifestations of Xeroderma Pigmentosum: a perspective from the United Kingdom. Ophthalmology. 2017;124(11):1652–61.

    Article  PubMed  Google Scholar 

  52. Dollfus H, Porto F, Caussade P, et al. Ocular manifestations in the inherited DNA repair disorders. Surv Ophthalmol. 2003;48(1):107–22.

    Article  PubMed  Google Scholar 

  53. Johnson MW, Skuta GL, Kincaid MC, et al. Malignant melanoma of the iris in xeroderma pigmentosum. Arch Ophthalmol. 1989;107(3):402–7.

    Article  CAS  PubMed  Google Scholar 

  54. Ramkumar HL, Brooks BP, Cao X, et al. Ophthalmic manifestations and histopathology of xeroderma pigmentosum: two clinicopathological cases and a review of the literature. Surv Ophthalmol. 2011;56(4):348–61.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Shields JA, Eagle RC, Shields CL, et al. Systemic amyloidosis presenting as a mass of the conjunctival semilunar fold. Am J Ophthalmol. 2000;130(4):523–5.

    Article  CAS  PubMed  Google Scholar 

  56. Westermark P, Benson MD, Buxbaum JN, et al. Amyloid: toward terminology clarification. Report from the Nomenclature Committee of the International Society of Amyloidosis. Amyloid. 2005;12(1):1–4.

    Article  CAS  PubMed  Google Scholar 

  57. Sandgren O. Ocular amyloidosis, with special reference to the hereditary forms with vitreous involvement. Surv Ophthalmol. 1995;40(3):173–96.

    Article  CAS  PubMed  Google Scholar 

  58. Benson MD, Kincaid JC. The molecular biology and clinical features of amyloid neuropathy. Muscle Nerve. 2007;36(4):411–23.

    Article  CAS  PubMed  Google Scholar 

  59. Reynolds MM, Veverka KK, Gertz MA, et al. Ocular manifestations of familial transthyretin amyloidosis. Am J Ophthalmol. 2017;183:156–62.

    Article  CAS  PubMed  Google Scholar 

  60. Reynolds MM, Veverka KK, Gertz MA, et al. Ocular manifestations of systemic amyloidosis. Retina. 2018;38(7):1371–6.

    Article  PubMed  Google Scholar 

  61. Landa G, Aloni E, Milshtein A, et al. Eyelid bleeding and atypical amyloidosis. Am J Ophthalmol. 2004;138(3):495–6.

    Article  PubMed  Google Scholar 

  62. Al-Nuaimi D, Bhatt PR, Steeples L, et al. Amyloidosis of the orbit and adnexae. Orbit. 2012;31(5):287–98.

    Article  PubMed  Google Scholar 

  63. Dinakaran S, Singh AD, Rennie IG. Orbital amyloidosis presenting as ptosis. Eye. 2005;19(1):110–2.

    Article  CAS  PubMed  Google Scholar 

  64. Shalchi Z, Taylor SR, Lightman S. The eye in haematological disease. Br J Hosp Med (Lond). 2011;72(12):691–7.

    Article  Google Scholar 

  65. Hitchings RA, Tripathi RC. Vitreous opacities in primary amyloid disease. A clinical, histochemical, and ultrastructural report. Br J Ophthalmol. 1976;60(1):41–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Beirao NM, Matos E, Beirao I, et al. Recurrence of vitreous amyloidosis and need of surgical reintervention in Portuguese patients with familial amyloidosis ATTR V30M. Retina. 2011;31(7):1373–7.

    Article  PubMed  Google Scholar 

  67. Savage DJ, Mango CA, Streeten BW. Amyloidosis of the vitreous. Fluorescein angiographic findings and association with neovascularization. Arch Ophthalmol. 1982;100(11):1776–9.

    Article  CAS  PubMed  Google Scholar 

  68. Ando E, Ando Y, Okamura R, et al. Ocular manifestations of familial amyloidotic polyneuropathy type I: long-term follow up. Br J Ophthalmol. 1997;81(4):295–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Lachmann HJ, Goodman HJ, Gilbertson JA, et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007;356(23):2361–71.

    Article  CAS  PubMed  Google Scholar 

  70. Bodez D, Guellich A, Kharoubi M, et al. Prevalence, severity, and prognostic value of sleep apnea syndromes in cardiac amyloidosis. Sleep. 2016;39(7):1333–41.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Blandford AD, Yordi S, Kapoor S, et al. Ocular adnexal amyloidosis: a mass spectrometric analysis. Am J Ophthalmol. 2018;193:28–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elias I. Traboulsi .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scaramuzzi, M., Xu, L.T., Singh, A.D., Traboulsi, E.I. (2019). Conjunctival and Corneal Tumors: Systemic Associations. In: Pe'er, J., Singh, A., Damato, B. (eds) Clinical Ophthalmic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-06046-6_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-06046-6_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06045-9

  • Online ISBN: 978-3-030-06046-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics