title: Actinic granuloma of the conjunctiva in young women.
abstract: OBJECTIVE
  To report the occurrence of actinic granuloma of the conjunctiva in young women.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Three eyes of 3 young women with a unilateral conjunctival mass of recent onset.
  
  
  METHODS
  Three young women (21, 23, and 23 years of age) sought treatment for painless red masses of the conjunctiva that were thought clinically to be pingueculitis, actinic keratosis, or ocular surface squamous neoplasia (OSSN), but were diagnosed histopathologically as actinic granuloma. Special stains were performed to exclude infectious and autoimmune causes of granulomatous inflammation, followed by dermatologic work-up and systemic investigations. Diagnosis of actinic granuloma of the conjunctiva was confirmed.
  
  
  METHODS
  Patients' characteristics (age, sex, early onset), clinical presentation, same geographical location, typical histopathologic features, and lack of systemic association.
  
  
  RESULTS
  All 3 cases were in young women with a rapid-onset conjunctival growth with conjunctival feeder vessels and intrinsic vessels; however, there was no surface keratin, and rose bengal stain results were negative. Histopathologic analysis of all 3 cases revealed elastolysis and granulomatous inflammation characterized by multinucleated giant cells, some of which displayed elastophagocytosis that was highlighted by Verhoeff-van Giesen elastic stain. There was absence of cytologic atypia of surface epithelium. Mucin stains and special stains for an infectious cause demonstrated negative results. Serologic investigations and systemic work-up results were negative, which excluded any systemic associations with this condition. This led to the final diagnoses of actinic granuloma of the conjunctiva.
  
  
  CONCLUSIONS
  Conjunctival actinic granuloma is an underrecognized entity. We present 3 cases of this condition to highlight its occurrence in young women and the role of histopathologic examination to avoid misinterpretation of this condition. Both clinician and pathologist should consider this entity as a differential diagnosis of benign conjunctival lesions and OSSN.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Dalmia Ophthalmic Pathology Services, L. V. Prasad Eye Institute, Bhubaneswar, Orissa, India. dr.rmittal@gmail.com
authors.forename: Ruchi
authors.initials: R
authors.lastname: Mittal
authors.forename: Manju
authors.initials: M
authors.lastname: Meena
authors.forename: Debarati
authors.initials: D
authors.lastname: Saha
mesh_terms: D003228:Conjunctiva / Q000098:blood supply / Q000528:radiation effects*; D003229:Conjunctival Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005843:Geography; D006101:Granuloma, Giant Cell / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D013472:Sunlight; D014466:Ultraviolet Rays / Q000009:adverse effects*; D055815:Young Adult