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Pyogenic granuloma associated with conjunctival epithelial neoplasia: report of nine cases
  1. Martina C Herwig-Carl1,
  2. Hans E Grossniklaus2,
  3. Philipp L Müller1,
  4. Lisa Atzrodt3,
  5. Karin U Loeffler1,
  6. Claudia Auw-Haedrich3
  1. 1 Division of Ophthalmic Pathology, Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
  2. 2 L.F. Montgomery Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
  3. 3 Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  1. Correspondence to Dr Martina C Herwig-Carl, Division of Ophthalmic Pathology, Department of Ophthalmology, University Hospital Bonn, Bonn 53127, Germany; martina.herwig{at}


Aims To systematically describe the clinical and histopathological features of a case series of conjunctival carcinomatous lesions underlying as—and also masquerading—pyogenic granuloma.

Methods Nine cases of conjunctival carcinomatous lesions underlying a pyogenic granuloma (which were clinically predominant) were retrospectively identified. Patients’ records were analysed for demographic data, clinical appearance and the postoperative course. Formalin-fixed paraffin-embedded specimens were routinely processed and stained with H&E and periodic acid-Schiff. Immunohistochemical stains for cytokeratin were performed in selected cases.

Results All nine tumours were located in the conjunctiva (bulbar, tarsal, limbal conjunctiva) of patients between 44 and 80 years. The lesions exhibited clinical features of pyogenic granuloma which dominated the clinical appearance. Additional features comprised a papillomatous appearance of the adjacent conjunctiva, a more whitish aspect of the lesion and a history of squamous cell carcinoma (SCC) respectively surgery for other entities. Histopathological analysis revealed a carcinomatous lesion (conjunctival intraepithelial neoplasia or SCC) at the base of a classic pyogenic granuloma in all nine cases. Surgical removal (R0 resection) was performed. Three cases received adjuvant mitomycin C or interferon α2b treatment. Two lesions locally recurred within 2 years after initial presentation.

Conclusion Carcinomatous lesions may be accompanied by a pyogenic granuloma which may dominate the clinical pictures. As the tumour is usually located at the base of the lesion, a complete surgical excision followed by histopathological analysis is mandatory for each lesion appearing as conjunctival pyogenic granuloma.

  • pyogenic granuloma
  • squamous cell carcinoma
  • conjunctival intraepithelial neoplasia
  • histology
  • tumour

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  • KUL and CA-H contributed equally.

  • Presented at 45th Annual Meeting of the German Speaking Ophthalmic Pathologists (DOP; October 2017, Greifswald, Germany) by PLM (case 4). 56th Annual Meeting of the European Ophthalmic Pathology Society (EOPS; June 2015, Freiburg, Germany) by KUL (case 5). 55th Annual Meeting of the European Ophthalmic Pathology Society (EOPS; June 2014, Coimbra, Portugal) by CAH (case 6).

  • Contributors All authors and coauthors fulfil the criteria of authorship. MCHC, KUL and CAH mainly planned, conducted and reported the work. HEG, PLM and LA were engaged in acquiring patient’s history and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval An ethical approval was granted by the Ethics Committee of Bonn, Atlanta and Freiburg.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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