Article Text

Download PDFPDF

Inverted papilloma of the conjunctiva
  1. Ingvild Ramberg1,2,
  2. Nicolai Christian Sjö1,
  3. Jesper Hansen Bonde3,
  4. Steffen Heegaard1,2
  1. 1 Department of Pathology, Section for Eye Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  2. 2 Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  3. 3 Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
  1. Correspondence to Dr Steffen Heegaard; sthe{at}


Objective The purpose of the present study is to describe the clinical and histopathological features of conjunctival inverted papilloma, to analyse for the presence of human papillomavirus (HPV), and to determine if HPV infection is associated with this type of tumour and its inverted growth pattern.

Methods and Analysis Cases of conjunctival inverted papillomas were retrieved from the archives of the Department of Pathology, Rigshospitalet, Denmark. Patient records and pathology reports were reviewed. Formalin-fixed and paraffin-embedded tissue was analysed for the presence of HPV by immunohistochemistry, in situ hybridisation (ISH), PCR and HPV typed by sequencing.

Results A total of four cases were retrieved. The age at diagnosis ranged from 41 to 77 years, with an equal sex distribution. All lesions were localised to the bulbar conjunctiva and two of the cases were pigmented. Histopathological examination did not reveal areas of dysplasia. All lesions were p16-positive and p53-positive by immunohistochemistry. High-risk HPV 58 was demonstrated in one lesion by ISH and PCR.

Conclusion Here we present four cases of conjunctival inverted papilloma, which is an exceedingly rare tumour with only 11 previously reported cases in the literature. Both clinically and histopathologically, the tumours show distinct features compared with exophytic conjunctival papillomas. Furthermore, this is the first description of high-risk HPV 58 in a conjunctival tumour. The biological behaviour of the tumour is uncertain due to its rareness. However, a complete removal of the lesion and a careful observation are recommended. The finding of HPV 58 underlines the necessity of this precaution.

  • inverted papilloma
  • human papillomavirus
  • HPV
  • conjunctiva

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors IR: contributed to data collection and interpretation, and manuscript drafting. NCS: contributed to conception and design, data collection, and manuscript drafting. JHB: contributed to data analysis and interpretation, and has revised the manuscript critically. SH: contributed to conception, design and data interpretation, and has revised the manuscript critically. All authors have approved the final version of the manuscript.

  • Funding This study was supported by Arvid Schrøder and Ketty Lydia Larsen Schrøder Foundation, the Synoptik Foundation, and the Danish Eye Research Foundation.

  • Competing interests IR: none declared. NCS: none declared. JHB attended meetings with various HPV device manufacturers. JHB has received honoraria from Hologic/Gen-Probe, Roche, Qiagen, Genomica and BD Diagnostics for lectures. Hvidovre Hospital has ongoing contracts with BD Diagnostics, Genomica, Self-Screen and EU Horizon 2020. SH: none declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted according to the Declaration of Helsinki, and was approved by the Regional Scientific Ethics Committee of the Capital Region, Denmark (H-16044879) and the Danish Data Protection Agency (RH-2013-30-1035).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.