Histopathological and clinical features of inverted papilloma of the conjunctiva reported in the literature to date and in the present series
| Age (years) | Sex | Duration of symptoms | Clinical appearance and/or clinical diagnosis | Localisation | Treatment | Histopathology | Recurrence | |
| Bhushan et al 3 | 11 | M | 4 years | Well-defined, pigmented lesion, 1.5×1 cm. | Limbus, superotemporal conjunctiva, left eye. | Excisional biopsy. | Subepithelial and intraepithelial inflammation. No nuclear atypia, mitosis or necrosis. HPV testing not performed. | None (follow-up 2 years). |
| Chang et al 4 | 34 | F | Unknown | Papillomatous appearance with no significant pigmentation, enlarged over 2 months and then excised. | Tarsal conjunctiva of the upper lid, nasal one-third, left eye. | Excision (incomplete). | Mixed exophytic and endophytic. Goblet cells and cyst formation. HPV positive by ISH. | Lost to follow-up. |
| Heuring et al 5 | 96 | F | At least 6 months | 25×15×15 mm, reddish tumour with papillary surface. | Nasal bulbar conjunctiva, right eye. | Excision. | Carcinomatous foci in the peripheral areas. HPV testing not performed. | Recurrence after 4 months. |
| Jakobiec et al 6 | 42 | F | 2 years | Cystic lesion. | Nasal epibulbar conjunctiva. | Excision, free margins. | Goblet cells and cysts. HPV testing not performed. | None (follow-up 1 year). |
| 51 | F | >4 years | Lightly pigmented and vascularised lesion, 7×4 mm. | Nasal juxtalimbal conjunctiva, right eye. | Excision. | Acanthotic epithelium. Goblet cells and cystic spaces. HPV testing not performed. | None (follow-up 2 years). | |
| Kalantzis et al 7 | 31 | M | 1 year | Fleshy mass, 1.1×0.9×0.3 cm, coexisting with an exophytic papilloma in the same eye. | Superior epibulbar conjunctiva, right eye. | Excision. | Numerous mucin-secreting goblet cells. Negative for the presence of HPV 6, 11 and 16 by PCR. | None (follow-up 1 year). |
| Lassalle et al 10 | 48 | M | Unknown | 10×8×7 mm, sessile tumour. | Inferior palpebral conjunctiva, right eye. | Local chemotherapy with Mitomycin followed by surgical resection. | Carcinomatous transformation within the papilloma with infiltration of the orbicularis muscle. Few goblet cells and cysts. HPV negative by microarray. | None (2 years follow-up). |
| Stagner et al 8 | 63 | M | Unknown | Red-pink papillary lesion, 1.5×0.6×0.1 cm, extending up to the corneal limbus. | Inferonasal epibulbar conjunctiva, right eye. | Excision and cryotherapy. | No goblet cells or cystic formation. HPV negative by PCR for high-risk HPV types. | None (follow-up 6 months). |
| Streeten et al 9 | 68 | F | 1 year | Dark, slightly elevated oval mass, 7×3×4 mm. | Semilunar fold, left eye. | Excision, one edge had only a small free margin. | Goblet cells and cysts filled with mucous. No mitotic activity. HPV testing not performed. | None (follow-up 8 months). |
| 49 | M | 2 months | Elevated, broad-based papillary tumour. | Superior tarsal conjunctiva, left eye. | Excision. | Mixed exophytic and endophytic. HPV testing not performed. | None (follow-up 6 years). | |
| 73 | F | 2 years | Cyst-like lesion. | Caruncle, right eye. | Excision. | Few goblet cells and small number of cystic spaces with mucous. HPV testing not performed. | None (follow-up 1 year). | |
| Present case 1 | 41 | F | >20 years | Unpigmented, cystic lesion. | Inferonasal bulbar conjunctiva, left eye. | Excision, free margins. | Many goblet cells. No signs of dysplasia. No mitotic activity. HPV-negative. | None (follow-up 16 years). |
| Present case 2 | 77 | M | Unknown | Pigmented lesion. Clinically mistaken to be a nevus. | Superonasal bulbar conjunctiva, right eye. | Excision, free margins. | Non-keratinising, acanthotic epithelium. Pigmentation of the epithelial cells in the basal layers. No signs of dysplasia. HPV-negative. | None (follow-up 13 years). |
| Present case 3 | 63 | M | 1 year | Pigmented lesion. Clinically diagnosed as a nevus. | Medial bulbar conjunctiva, right eye. | Excision, free margins. | Non-keratinising epithelium. Pigmentation of the epithelial cells. Goblet cells. No signs of dysplasia. HPV 58-positive by PCR, CLART2 and ISH. | None (follow-up 11 years). |
| Present case 4 | 51 years | F | Several years | Clinically diagnosed as a pinguecula. | Lateral limbus. | Excision, free margins. | Small cystic cavities. No sign of dysplasia. HPV-negative. | None (follow-up 4 years). |
F, female; HPV, human papillomavirus; ISH, in situ hybridisation; M, male.