PURPOSE: To describe the history and clinical presentation of a case of conjunctival lichen planus simulating ocular surface squamous neoplasia (OSSN). METHODS: A 32-year-old Hispanic man presented with a 6-month history of worsening foreign body sensation, localized conjunctival hyperemia, and a progressively enlarging "bump" located in the temporal aspect of his right eye. The patient denied any prior ocular trauma or surgery to the affected eye. Evaluation consisted of slit lamp examination and surgical excision of the mass with histopathologic studies. RESULTS: Slit lamp examination revealed the presence of a 6 x 5 x 1 mm elevated conjunctival fleshy mass that extended into the corneal limbus in the right eye. The lesion exhibited intrinsic pigmentation and vascularization as well as the presence of a dilated feeder vessel. Based on clinical findings, a diagnosis of OSSN was suspected. An excisional biopsy was performed with cryotherapy application to the surgical margins. Histopathologic study of the lesion revealed hyperkeratosis, parakeratosis, irregular acanthosis, and a band-like infiltrate of predominantly lymphocytes hugging the epithelium, consistent with the diagnosis of lichen planus. CONCLUSION: Ocular lichen can present as a focal conjunctival lesion. Excisional biopsy allowed us to make the diagnosis of this rare entity, which presented as a simulating lesion with clinical features consistent with ocular surface squamous neoplasia.
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机译：目的：描述一例结膜扁平苔藓模拟眼表鳞状上皮增生（OSSN）的病史和临床表现。方法：一名32岁的西班牙裔男子出现了6个月的异物感恶化，局部结膜充血和右眼颞侧逐渐增大的“肿块”病史。患者拒绝对患眼进行任何眼外伤或手术。评价包括裂隙灯检查和肿块的手术切除以及组织病理学研究。结果：裂隙灯检查显示存在6 x 5 x 1 mm的结膜肉质肿块，并扩展到右眼的角膜缘。病变表现出固有的色素沉着和血管化，以及扩张的饲养血管的存在。根据临床发现，怀疑诊断为OSSN。对手术切缘进行冷冻治疗并进行切除活检。病变的组织病理学研究显示，角化过度，角化不全，不规则棘皮症以及主要包扎上皮的淋巴细胞呈带状浸润，与扁平苔藓的诊断一致。结论：眼部地衣可表现为局灶性结膜病变。切除活检使我们能够诊断出这种罕见的实体，表现为模拟病变，其临床特征与眼表鳞状鳞癌相一致。
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