Images in Clinical Medicine

Conjunctival Viral Papilloma

Wasee Tulvatana, M.D., and Kittisak Kulvichit, M.D.

N Engl J Med 2007; 356:1352March 29, 2007

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A healthy 9-year-old boy had a 1-year history of an itchy right eye with frequent tearing. Small masses that gradually developed in the right caruncula lacrimalis area were associated with intermittent, spontaneous minor bleeding. The ophthalmic examination showed diffuse, multifocal small nodules with papillomatous growth and vascular fronds. The upper and lower tarsal conjunctiva was also involved (Panel A). No warts were noted on the remainder of the physical examination. A histopathological examination of the ocular lesion revealed acanthotic conjunctival epithelial growth in a fingerlike pattern with central fibrovascular cores (Panel B). Koilocytosis, a nuclear pyknosis with cytoplasmic clearing, was occasionally seen (Panel B, arrowhead). The findings were consistent with the presence of viral papilloma. The various serotypes of human papillomavirus infection are considered to be causes of this condition. This type of lesion may resolve spontaneously. Although several excisions were performed in this case, the papilloma recurred.

Wasee Tulvatana, M.D.
Kittisak Kulvichit, M.D.
Chulalongkorn University, Bangkok 10330, Thailand
wasee.t@chula.ac.th

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