HPV-Positive Squamous Cell Carcinoma of the Conjunctiva and Lacrimal Sac
A patient with a history of right penetrating keratoplasty for neurotrophic keratopathy following herpes simplex virus (HSV) stromal keratitis and right conjunctival intraepithelial neoplasia (CIN) presented with an expanding right medial canthal mass. Pathology from a lacrimal sac biopsy showed invasive, moderately differentiated, non-keratinizing squamous cell carcinoma (SCC) that stained positive for p63 and p40 and negative for CEA. The right CIN and lacrimal sac mass were noncontiguous, separate SCCs that were both positive for HPV. Whole exome sequencing demonstrated distinct deletions and gains mirrored in both tumors, with the lacrimal sac SCC appearing to have evolved from the conjunctival SCC. The pathology and sequencing data suggest a mutual genetic and histopathologic heritage between the conjunctival and lacrimal sac SCCs, which may hint at the potential for direct and insidious extension of cancer cells from CIN to the lacrimal sac.
Presentation Date: 09/11/2025
Issue Date: 03/06/2026
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