Spontaneous Regression Of Conjunctival Keratoacanthoma
AlBayyat, G. J., Venkateswaran, N., Arreaza, D., Dubovy, S. R., Galor, A., & Karp, C. L. (2019). Spontaneous regression of conjunctival keratoacanthoma. BMJ case reports, 12(7), e228833. https://doi.org/10.1136/bcr-2018-228833
View Original Source →Abstract
An 83-year-old white man presented with a rapidly growing conjunctival mass in his left eye over the course of 1 month. While awaiting surgical intervention, the tumour underwent partial, spontaneous regression to half its original size. The lesion was ultimately excised with wide margins using a no-touch technique and application of cryotherapy to the corneal and conjunctival margins and scleral bed. Histopathological analysis revealed a conjunctival keratoacanthoma. To our knowledge, this is the first case documenting the partial, spontaneous regression of a conjunctival keratoacanthoma over a 5 week time course from the time of diagnosis to surgical excision.
Case Details
Disease Location
Conjunctiva
Personal Characteristics
83-year-old man. History of cataract extraction with insertion of intraocular lenses in both eyes. Renal cell carcinoma
Clinical Characteristics
Presented with a rapidly growing conjunctival mass in his left eye over the course of 1month. On examination, his corrected visual acuity was 20/20 in the right eye and 20/30 in the left eye. An 8×11mm, elevated, leukoplakic conjunctival mass was noted abutting the limbus in the left eye. The mass was fixed to the globe. After bleeding and partial regression, the remaining lesion was surgically excised. The patient was treated with topical antibiotics and steroid drops postoperatively. Pathology showed a 14.0×6.0×2.5 mm lesion with acanthotic epithelium with a marked amount of hyper and parakeratosis, atypical epithelium with extension to the corneal border, mixed acute and chronic inflammatory infiltrate in the substantia propria, and squamous metaplasia at the corneal border. This was consistent with squamous cell carcinoma (SCC), ka type
Remission Characteristics
Five weeks after the onset of the lesion while waiting for surgery and without any intervention, the patient noted a sudden spontaneous bleeding from the mass and associated decrease in the size of the lesion
Treatment & Mechanisms
Proposed Remission Mechanisms
The regression process is thought to be driven by wnt and retinoic acid signalling pathways.
Clinical Treatment
Surgical excision (after partial remission). Topical antibiotics and steroid drops postoperatively.