Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaConjunctival Melanoacanthoma: A New Pigmented ConjunctivalEntitySaeed F. Al Wadani 1, 3 , Michael J. Mines 1, 2 , L. David Monroe 4 ,Charles Eberhart 1 . 1 Wilmer Eye Institute, Johns Hopkins University,Baltimore, MD; 2 Dept of Surgery, Ophthalmology Div, UniformedServices University, Bethesda, MD; 3 Ophthalmology, King SaudUniversity, Riyadh, Saudi Arabia; 4 Eye and Laser Institute, BocaRaton, FL.Purpose: A range of pigmented conjunctival lesions have beendescribed, but the nomenclature used to classify these tumors varies,and understanding of their underlying pathobiology is limited. Wereport the clinical and pathological features of a conjunctival lesionwith both melanocytic and epithelial components that does notclearly fit into the current classification scheme of pigmentedconjunctival entities. Rather, it has features similar to those of oralmelanoacanthoma, benign lesions which to our knowledge have notbeen previously reported on the ocular surface.Methods: Histopathological and immunohistochemical evaluation ofthe lesion was performed in the Johns Hopkins surgical pathologylaboratory using standard techniques.Results: The lesion arose on the perilimbal conjunctiva of a 48 yearold African American man as a solitary, well defined, reddishmovable plaque concerning for malignancy. On microscopicexamination, the lesion was characterized by thickened epitheliumwith downward growth of epithelial nests and strands highlighted bycytokeratin immunostains. Dense chronic inflammation was presentbelow the lesion. Diffusely admixed with the epithelial elements werean increased number of melanocytes immunoreactive for MITF,MART-1, S100 and HMB-45. Many of these appeared bland,dendritic and localized to the epithelial base, but pagetoid spread andmore compact cells were also noted. Ki67 revealed proliferation inboth the epithelial and melanocytic components.Conclusions: The microscopic features of this case do not clearlyconform to the existing classification of pigmented conjunctivallesions. It thus challenges current understanding of thepathophysiology of this class of entities, and raises questionsregarding appropriate clinical care. Interestingly, the lesion appearshighly similar to oral melanoacanthoma, a rare benign pigmentedlesion of the oral mucosa generally seen in black patients, andcharacterized by proliferation of both keratinocytes and HMB-45immunoreactive dendritic melanocytes. To our knowledge,conjunctival melanoacanthoma have not been previously reported.Melanoacanthoma are benign, but our conjunctival lesion hasfeatures which overlap with primary acquired melanosis with atypiaor melanoma in situ. Recognizing the potential of melanoacanthomato arise on the bulbar conjunctiva therefore may alter the diagnosisand treatments of patients with these lesions.Conjunctival MelanoacanthomaCommercial Relationships: Saeed F. Al Wadani, None; MichaelJ. Mines, None; L. David Monroe, None; Charles Eberhart, NoneSupport: Research to Prevent BlindnessMonday, May 06, 2013 2:45 PM-4:30 PMTCC 303 Paper SessionProgram #/Board # Range: 2189-2195Organizing Section: CorneaProgram Number: 2189Presentation Time: 2:45 PM - 3:00 PMFully Functional Bioengineered Lacrimal Gland Regeneration asan Organ Replacement Regenerative TherapyMasatoshi Hirayama 1 , Miho Ogawa 2 , Masamitsu Oshima 3 , TetsuyaKawakita 1 , Shigeto Shimmura 1 , Takashi Tsuji 2, 3 , Kazuo Tsubota 1 .1 Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan;2 Organ Technologies Inc., Tokyo, Japan; 3 Research Institute forScience and Technology, Tokyo University of Science, Chiba, Japan.Purpose: Tear secreted from lacrimal gland plays a multifaceted roleto maintain a homeostatic microenvironment for ocular surface. Dryeye is an important public health problem, and it is expected todevelop a novel therapeutic treatment for the restoration of thelacrimal gland functions. Here, we report a successful fullyfunctioning lacrimal gland replacement achieved though thetransplantation of bioengineered lacrimal gland germ in adult mouse.Methods: The care and handling of animals were performed inaccordance with NIH guidelines. Protocols were approved by theAnimal Care and Use Committee. We had successfully demonstratedthe bioengineered lacrimal gland germ regeneration by organ germmethod (ARVO2012). We regenerated the bioengineered lacrimalgland germ and harderian gland germ, and transplanted them to adultlacrimal gland defect model mouse. The development ofbioengineered glands, histological structure including expression ofaquapolin-5 (AQP5), lactoferrin and lipids, tear secretion ability andocular surface protection effect were analyzed.Results: The bioengineered lacrimal gland germ and harderian glandgerm successfully achieved correct gland structure including acini,myoepithelial cells and nerve, followed by successful ductintegration. AQP5 and lactoferrin in the bioengineered lacrimalgland, and lipids in the bioengineered harderian gland werehistologically detected. The bioengineered lacrimal gland receivedappropriate neural control and had a secretion ability equivalent tothat of natural lacrimal gland. Tear from the bioengineered glandshad appropriate tear components such as lactoferrin. The ocularsurface status including fluorescein staining and corneal epithelialthickness was significantly improved in the bioengineered lacrimalgland transplantation mouse compared with that in the lacrimal glanddefect model mouse.Conclusions: We demonstrated that bioengineered lacrimal glandand harderian gland, which had the correct gland structure, couldproduce the tear followed by successful duct integration and restorethe lacrimal gland physiological functions in response to nervousstimulations, and could protect the ocular surface. This study thusrepresents a substantial advance and demonstrates the possibility ofnovel therapeutic approach for dry eye as a future organ replacementregenerative therapy.Commercial Relationships: Masatoshi Hirayama, None; MihoOgawa, None; Masamitsu Oshima, None; Tetsuya Kawakita,None; Shigeto Shimmura, None; Takashi Tsuji, None; KazuoTsubota, AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical(C), Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa(F), Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki(P), Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company(P)Support: None in the Support282 Dry Eye and Lacrimal Gland IIProgram Number: 2190©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.