Eye
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Staging-conjunctiva carcinoma
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Last staff update: 9 July 2024
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PubMed Search: Conjunctival carcinoma staging
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Cite this page: Nix JS. Staging-conjunctiva carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeconjTNM.html. Accessed July 15th, 2024.
Definition / general
- All carcinomas of the conjunctiva are covered by this staging system
- These topics are not covered: conjunctival lymphoma, conjunctival melanoma
Essential features
- AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
ICD coding
- ICD-O
- 8076/2 - squamous cell carcinoma in situ with questionable stromal invasion
- 8076/3 - squamous cell carcinoma, microinvasive
- 8090/3 - basal cell carcinoma, NOS
- 8410/3 - sebaceous adenocarcinoma
- 8430/3 - mucoepidermoid carcinoma
- 8560/3 - adenosquamous carcinoma
- ICD-10
- C69.00 - malignant neoplasm of unspecified conjunctiva
- C69.01 - malignant neoplasm of right conjunctiva
- C69.02 - malignant neoplasm of left conjunctiva
Primary tumor (T)
- TX: cannot be assessed
- T0: no evidence of primary tumor
- Tis: carcinoma in situ
- T1: tumor 5 mm or less in greatest dimension, invading through conjunctival basement membrane without involvement of additional structures
- T2: tumor larger than 5 mm in greatest dimension, invading through conjunctival basement membrane without involvement of additional structures
- T3: tumor invades adjacent structures, excluding the orbit
- T4: tumor invades the orbit with or without further extension
- T4a: tumor invades orbital soft tissues, without bone invasion
- T4b: tumor invades bone
- T4c: tumor invades adjacent paranasal sinuses
- T4d: tumor invades brain
Notes:
- Adjacent structures include cornea, intraocular contents, forniceal conjunctiva, palpebral conjunctiva, lacrimal punctum, canaliculi, plica, caruncle, posterior eyelid lamella, anterior eyelid lamella, eyelid margin (Amin: AJCC Cancer Staging Manual, 8th Edition, 2017)
Regional lymph nodes (N)
- NX: cannot be assessed
- N0: no regional lymph node metastasis
- N1: regional lymph node metastasis
Notes:
Prefixes
- y: preoperative radiotherapy or chemotherapy
- r: recurrent tumor stage
Registry data collection variables
- Ki67 growth fraction (percentage of positive tumor cells by immunohistochemistry)
Histologic grade (G)
- GX: cannot be assessed
- G1: well differentiated
- G2: moderately differentiated
- G3: poorly differentiated
- G4: undifferentiated
Histopathologic type
- Carcinomas of the conjunctiva
- Conjunctival intraepithelial neoplasia, including squamous cell carcinoma in situ
- Squamous cell carcinoma
- Mucoepidermoid carcinoma
- Spindle cell carcinoma
- Sebaceous gland carcinoma, including those with pagetoid spread
- Basal cell carcinoma
Microscopic (histologic) images
Contributed by J. Stephen Nix, M.D.
Carcinoma in situ
Nonkeratinizing carcinoma in situ
Sebaceous carcinoma
Board review style question #1
A squamous cell carcinoma of the conjunctiva is excised with negative margins and the carcinoma is negative for invasion beyond the conjunctival basement membrane. What is the appropriate primary tumor (T) stage?
- Tis
- T1
- T2
- T3
- T4a
Board review style answer #1
A. Tis.
Squamous cell carcinoma in situ of the conjunctiva does not invade through the conjunctival basement membrane and is designated as Tis by the AJCC (8th edition). Answer B is incorrect because T1 tumors are ≤ 5 mm in greatest dimension and invade beyond the basement membrane without involvement of adjacent structures. Answer C is incorrect because T2 tumors are > 5 mm in greatest dimension and invade beyond the basement membrane without involvement of adjacent structures. Answer D is incorrect because T3 tumors involve adjacent structures (excluding the orbit). Answer E is incorrect because T4 tumors invade the orbital soft tissue without bone invasion.
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Reference:
Staging-conjunctiva carcinoma Board review style question #2
Which entity would be assessed using the conjunctival carcinoma staging criteria as defined by the AJCC (8th edition)?
- Diffuse large B cell lymphoma
- Melanoma
- Mild conjunctival squamous intraepithelial neoplasia
- Plasmacytoma
- Sebaceous carcinoma
Board review style answer #2
E. Sebaceous carcinoma.
Carcinomas of the conjunctiva, including sebaceous carcinoma, are staged using the conjunctival carcinoma staging system (AJCC 8th edition). Answer C is incorrect because staging is not needed for mild conjunctival squamous intraepithelial neoplasia / dysplasia, which is confined to the lower third of the epithelium, as it does not reach the threshold for squamous cell carcinoma in situ, defined as full thickness epithelial dysplasia. Answers A, B and D are incorrect because diffuse large B cell lymphoma, melanoma and plasmacytoma are not carcinomas and are not staged using this system.
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Reference:
Staging-conjunctiva carcinoma
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