Oral cimetidine adjuvant therapy for recalcitrant, diffuse conjunctival papillomatosis.
OBJECTIVE
To describe a case of recurrent, advanced conjunctival papillomatosis, treated by oral cimetidine (CIM) combined with secondary surgical intervention and an application of intraoperative mitomycin C.


METHODS
Case report and literature review.


RESULTS
A 9-year-old boy suffered from recurrent, progressive, diffuse multifocal conjunctival papillomatosis over the left upper and lower palpebral and the fornical conjunctiva. He underwent 3 separate surgeries; however, they did not prevent tumor recurrence. The recurrent lesions were more severe and extensive than before the surgeries. To avoid postoperative symblepharon, ankyloblepharon, dry eye, and possible corneal neovascularization after extensive lesion excision, oral CIM at a dosage of 200 mg 4 times daily was administered for 4 months before surgery. A debulking excision of the residual tumor with an intraoperative application of mitomycin C was performed as a secondary therapy after the main mass decreased in size. Postoperative oral CIM was continued for 6 months. The papillomatosis cleared without recurrence or symblepharon, ankyloblepharon, conjunctival scarring, or corneal neovascularization after 4 years of follow-up examinations.


CONCLUSIONS
Oral CIM can be used as an initial, nonsurgical strategy for treating cases of massive, recalcitrant conjunctival papillomatosis. If there is tumor shrinkage, surgical debulking with applications of mitomycin C may be sufficient to eliminate any residual tumor tissue without inducing conjunctival scarring or corneal neovascularization.
Chang
Shu-Wen
SW
Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, Taipei, Taiwan. swchang@mail.femh.org.tw
Huang
Zei-Lun
ZL
D000284:Administration, Oral; D000477:Alkylating Agents / Q000008:administration & dosage; D002648:Child; D002927:Cimetidine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003230:Conjunctival Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D052163:Human papillomavirus 6 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery / Q000628:therapy / Q000821:virology; D013508:Ophthalmologic Surgical Procedures; D010212:Papilloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy* / Q000821:virology; D030361:Papillomavirus Infections / Q000188:drug therapy / Q000601:surgery / Q000628:therapy* / Q000821:virology; D016133:Polymerase Chain Reaction
D000477:Alkylating Agents; D004279:DNA, Viral; D006635:Histamine H2 Antagonists; D016685:Mitomycin; D002927:Cimetidine