Pterygium

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Pterygium
Diagnosis in short

Pterygium. H&E stain.

Synonyms surfer eye

LM hyaline material beneath epithelium, elastic fibres beneath the hyaline material, +/-inflammation, solar elastosis, dilated blood vessels
LM DDx squamous dysplasia, squamous cell carcinoma
Site eye - more specifically conjunctiva

Clinical history sun exposure
Prevalence common
Prognosis benign
Other pinguecula considered early pterygium by some
Treatment excision

Pterygium is a common benign pathology of the eye. It is also known as surfer eye.

It is similar to pinguecula and Raizada et al.[1] suggest pinguecula is an early pterygium; however, this is disputed.

General

  • Pronounced: "tuh-rij-ee-uhm".[2]
  • Conjunctiva lesion that covers part of the sclera.
  • Benign.
  • Due to ultraviolet light exposure, i.e. sunlight.[4]

Gross

  • Medial aspect of eye - covers sclera (white part) and part of the iris (coloured part).

Image

Microscopic

Features:[4]

  • Hyaline material beneath epithelium.
  • Elastic fibres beneath the hyaline material.
  • +/-Inflammation.
  • Solar elastosis.[5]
    • Dense gray/light brown acellular material.
  • Dilated vessels.[5]

Note:

  • Goblet cells within the squamous epithelium are expected; normal conjunctiva has goblet cells.

DDx:

Images

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Right eye

Right Eye, Conjunctiva (Submitted as "Pterygium"), Excision:
- Conjunctival mucosa with solar elastosis and dilated superficial blood vessels, compatible with pterygium.
- NEGATIVE for dysplasia.

Inflammation present

Right Eye, Conjunctiva (Submitted as "Left Pterygium"), Excision:
- Conjunctival mucosa with solar elastosis, mild inflammation and dilated superficial blood 
  vessels, compatible with pterygium.
- NEGATIVE for dysplasia.

No solar elastosis

Right Eye, Conjunctiva (Submitted as "Right Pterygium"), Excision:
- Conjunctival mucosa with dilated superficial blood vessels and 
  benign mild stromal changes.  
- NEGATIVE for dysplasia.

Block letters

CONJUNCTIVA ("PTERYGIUM"), RIGHT, EXCISION:
- CONJUNCTIVAL MUCOSA WITH STROMAL ACTINIC CHANGES -- CONSISTENT WITH PTERYGIUM.
CONJUNCTIVA ("PTERYGIUM"), RIGHT, EXCISION:
- CONJUNCTIVAL MUCOSA WITH STROMAL ACTINIC CHANGES -- CONSISTENT WITH PTERYGIUM.
- NEGATIVE FOR DYSPLASIA.
CONJUNCTIVA ("PTERYGIUM"), RIGHT EYE, EXCISION:
- CONJUNCTIVAL MUCOSA WITH SOLAR ELASTOSIS AND DILATED SUPERFICIAL BLOOD VESSELS -- CONSISTENT WITH PTERYGIUM.
- NEGATIVE FOR DYSPLASIA.

Left eye

CONJUNCTIVA ("PTERYGIUM"), LEFT EYE, EXCISION:
- CONJUNCTIVAL MUCOSA WITH SOLAR ELASTOSIS AND DILATED SUPERFICIAL BLOOD VESSELS -- CONSISTENT WITH PTERYGIUM.
- NEGATIVE FOR DYSPLASIA.

See also

References

  1. Raizada, IN.; Bhatnagar, NK. (Jul 1976). "Pinguecula and pterygium (a histopathological study).". Indian J Ophthalmol 24 (2): 16-8. PMID 1031388.
  2. URL: http://dictionary.reference.com/browse/pterygium. Accessed on: 20 October 2011
  3. URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002006/. Accessed on: 20 October 2011.
  4. 4.0 4.1 Hill, JC.; Maske, R. (1989). "Pathogenesis of pterygium.". Eye (Lond) 3 ( Pt 2): 218-26. doi:10.1038/eye.1989.31. PMID 2695353.
  5. 5.0 5.1 URL: http://www.uic.edu/depts/mcpt/eyepath/specco4.htm. Accessed on: 25 October 2011.
  6. Clear, AS.; Chirambo, MC.; Hutt, MS. (Feb 1979). "Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi.". Br J Ophthalmol 63 (2): 102-9. PMC 1043407. PMID 427069. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1043407/.