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Rogers CM, Knickelbein KE, Scott EM, Ledbetter EC. In vivo confocal microscopic features of canine primary corneal squamous cell carcinoma. Vet Ophthalmol 2024. [PMID: 39300706 DOI: 10.1111/vop.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/04/2024] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE To describe the in vivo confocal microscopy (IVCM) findings in dogs with primary corneal squamous cell carcinoma (SCC). ANIMALS Eight dogs with primary corneal SCC. PROCEDURES Dogs diagnosed with primary corneal SCC by histopathology were examined with a modified Heidelberg Retina tomograph and Rostock Cornea Module prior to surgical intervention. The findings from the IVCM examination were correlated with clinical details from ophthalmic examinations and diagnostic test results. RESULTS Eight eyes from eight dogs with unilateral primary corneal SCC were examined. Corneal lesions were characterized with IVCM by abnormal epithelial cells that were polygonal and enlarged with marked morphological variability and anisocytosis within individual corneas. The abnormal cells displayed variable reflectivity, but most had highly reflective cellular borders and moderately reflective cytoplasm. Cells that were markedly and diffusely hyperreflective were also occasionally observed possibly representing keratinization and dyskeratosis. On IVCM, neoplastic cells were grouped into cords, clusters, and sheets, and nests of neoplastic cells often invaded the underlying corneal stroma. Keratin pearls were a frequent finding and appeared as circular whirls of neoplastic epithelial cells arranged around concentric layers of hyperreflective amorphous material within a dark cyst-like space. Abundant blood vessels and scattered leukocytes were present in all tumors. There was a high degree of morphologic agreement between IVCM analysis and histopathological findings in all cases. CONCLUSIONS The distinguishing features of primary corneal SCC during IVCM examine were similar to those seen in histopathologic examination of tumor sections, including enlarged and pleomorphic squamous epithelial cells, anisocytosis, keratin pearl formation, and dense vascularization.
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Affiliation(s)
- Callie M Rogers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Kelly E Knickelbein
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Erin M Scott
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Eric C Ledbetter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Alharbi I, Alfawaz AM, Otaif W, Al-Dahmash SA, Alkatan HM. Variable presentations of six conjunctival/limbal ocular surface squamous neoplasia (OSSN) cases: How good is our clinical judgment evidenced by the correlation to the histopathological findings and diagnosis? Int J Surg Case Rep 2024; 116:109359. [PMID: 38330700 PMCID: PMC10864213 DOI: 10.1016/j.ijscr.2024.109359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) may have atypical or unusual presentations and may attain large sizes especially in cases of delayed presentation resulting in late diagnosis, treatment, and eventual guarded visual prognosis. We are reporting an interesting cases series of OSSN with variable clinical presentations to highlight the importance of the pre-operative clinical judgment and tissue diagnosis. PRESENTATION OF CASES Six patients (4 females and 2 males; mean age 59 years; range 42-79 years) were included with suspicious conjunctival lesions. The maximum dimension of the lesions was 17 mm. The initial suspected pre-operative clinical diagnosis -other than OSSN- included pterygium/pinguecula (n = 2), benign squamous papilloma (n = 1), cyst versus pyogenic granuloma (n = 1), and lymphoma (n = 1). This work has been reported in line with the PROCESS criteria. DISCUSSION The final histopathological diagnosis was unexpectedly invasive squamous cell carcinoma (SCC) in 4, one SCC in-situ, and squamous dysplasia in one. The primary treatment included MMC 0.02 % for 2 cycles for chemo-reduction in one of the cases where OSSN was suspected. Excisional biopsy was performed eventually for all lesions with application of one or more of the following modalities: MMC 0.02 %, absolute alcohol 99 %, and cryotherapy to the conjunctival margin. No tumor recurrence was noted in any of the patients after an average period of follow-up of 26 months. Even though the outcome was good, tumor-related morbidity and delay in the referral by general ophthalmologists are to be considered. CONCLUSION Conjunctival OSSN has wide presentation clinically and can be challenging in terms of diagnosis. Histopathological evaluation is essential for a definitive diagnosis and treatment. Accurate clinical diagnosis might affect the management plan with consideration for topical therapeutic modalities, however, these cases are best managed by wide excision using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctiva with consideration of topical chemotherapy.
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Affiliation(s)
- Ibrahim Alharbi
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia
| | - Abdullah M Alfawaz
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Wael Otaif
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia
| | - Saad A Al-Dahmash
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Pathology Department, College of Medicine, King Saud University, Saudi Arabia.
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Gurnani B, Kaur K. Molecular and epigenetic mechanisms governing ocular surface squamous neoplasia: opportunities for diagnostics. Expert Rev Mol Diagn 2023:1-15. [PMID: 38131180 DOI: 10.1080/14737159.2023.2298681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) is the most common ocular malignancy; the pathophysiology is influenced by molecular, genetic, and epigenetic mechanisms. The incidence of OSSN is associated with the anatomy and physiology of the ocular surface, limbal stem cell configuration, limbal vulnerability, cancer stem cells, dysplasia, neoplasia, angiogenesis, invasion, and metastasis. The key etiological factors involved are human papillomavirus (HPV), human immunodeficiency virus (HIV), immunosuppression, p53 tumor suppressor gene, hypovitaminosis A, and failure of Deoxyribonucleic acid (DNA) repair mechanisms. AREAS COVERED This special report is a focussed attempt to understand the molecular mechanism, genetic and epigenetic mechanism, and diagnostic modalities for OSSN. EXPERT OPINION While these mechanisms contribute to genome instability, promoter-specific hypermethylation might facilitate and promote tumor formation by silencing tumor suppressor genes. OSSN understanding has improved with increased literature available on various genetic, molecular, and epigenetic mechanisms, although the exact genetic and epigenetic mechanisms still need to be elucidated. It is important to note that the molecular mechanisms of OSSN can vary among individuals, and further research is required to elucidate the underlying processes fully. Understanding these mechanisms is crucial for the development of targeted therapies and improved management of OSSN.
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Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, Refractive Services, Trauma, External Diseases, Contact Lens and Ocular Surface, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
| | - Kirandeep Kaur
- Children Eye Care Centre, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, India
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Alvarado-Castillo B, Santa Cruz-Pavlovich FJ, Gonzalez-Castillo C, Vidal-Paredes IA, Garcia-Benavides L, Rosales-Gradilla ME, Navarro-Partida J. Safety and efficacy of topical interferon alpha 2B and mitomycin C for localized conjunctival intraepithelial neoplasia: long-term report of their pharmacological safety and efficacy. BMC Ophthalmol 2023; 23:335. [PMID: 37501105 PMCID: PMC10373405 DOI: 10.1186/s12886-023-03092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Ocular surface squamous neoplasia (OSSN) comprises a wide spectrum of squamous tumors, from which corneal/conjunctival intraepithelial neoplasia (CIN) is the most common one. The classic treatment is complete excision, but recurrence rates are high. Antineoplastic drugs such as mitomycin C (MMC) and interferon alpha 2b (IFNα2b) have been used as adjuvants or as primary treatment. To evaluate the efficacy and safety of topical IFNα2b and MMC in patients with CIN, a phase IIb double-blind clinical trial was performed. METHODS Patients diagnosed with localized CIN were evaluated by slit lamp and impression cytology and were randomly given MMC 0.04% or INF2b (1 million IU/mL) 4 times daily until neoplasia resolution. Time of resolution and frequency of adverse effects were analyzed to determine the pharmacological efficacy and safety of both medications. RESULTS Seventeen patients were included. Nine patients were treated with MMC and 8 with IFNα2b. All patients responded to treatment. The resolution time in days was 59.11 ± 24.02 in patients treated with MMC and 143.50 ± 47.181 in those treated with IFNα2b (p < 0.001). In the MMC group, one recurrence was reported (11%). There were no recurrences at 2 years of follow-up in the IFNα2b group. Regarding adverse effects, one or more mild adverse reaction occurred in 77% of patients managed with MMC and in 50% of patients managed with IFNα2b (p > 0.05). No serious adverse effects were reported. CONCLUSIONS Topical chemotherapy with MMC and IFNα2b demonstrate pharmacological safety and efficacy. Therefore, these drugs could be considered as primary therapies for localized CIN .
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Affiliation(s)
- Beatriz Alvarado-Castillo
- Instituto Mexicano del Seguro Social, Centro Medico Nacional de Occidente, Guadalajara, Jalisco, México
| | - Francisco J Santa Cruz-Pavlovich
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, México
| | - Celia Gonzalez-Castillo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, México
| | - Isaac Alejandro Vidal-Paredes
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, México
| | - Leonel Garcia-Benavides
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, México
| | | | - Jose Navarro-Partida
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, México.
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Shahraki K, Shahraki K, Ghasemi Boroumand P, Sheervalilou R. Promotor methylation in ocular surface squamous neoplasia development: epigenetics implications in molecular diagnosis. Expert Rev Mol Diagn 2023; 23:753-769. [PMID: 37493058 DOI: 10.1080/14737159.2023.2240238] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Cancer is heavily influenced by epigenetic mechanisms that include DNA methylation, histone modifications, and non-coding RNA. A considerable proportion of human malignancies are believed to be associated with global DNA hypomethylation, with localized hypermethylation at promoters of certain genes. AREA COVERED The present review aims to emphasize on recent investigations on the epigenetic landscape of ocular surface squamous neoplasia, that could be targeted/explored using novel approaches such as personalized medicine. EXPERT OPINION While the former is thought to contribute to genomic instability, promoter-specific hypermethylation might facilitate tumorigenesis by silencing tumor suppressor genes. Ocular surface squamous neoplasia, the most prevalent type of ocular surface malignancy, is suggested to be affected by epigenetic mechanisms, as well. Although the exact role of epigenetics in ocular surface squamous neoplasia has mostly been unexplored, recent findings have greatly contributed to our understanding regarding this pathology of the eye.
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Affiliation(s)
- Kourosh Shahraki
- Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Kianoush Shahraki
- Department of Ophthalmology, Zahedan University of Medical Sciences, Zahedan, Iran
- Cornea Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Ghasemi Boroumand
- ENT, Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran
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Sharma A, Daigavane S, Bhake A. Invasive Acantholytic Ocular Surface Squamous Neoplasia: A Rare Case. Cureus 2023; 15:e39219. [PMID: 37337502 PMCID: PMC10276922 DOI: 10.7759/cureus.39219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is a spectrum of intraepithelial and invasive neoplastic lesions of the conjunctiva and cornea. OSSN is a rare but potentially sight-threatening ocular malignancy that can be challenging to diagnose due to its clinical and histopathological resemblance to benign ocular surface lesions. However, OSSN can lead to significant ocular and systemic morbidity, including vision loss and metastasis. Various risk factors have been identified, including ultraviolet radiation exposure, human papillomavirus infection, and immunosuppression. The histopathological analysis of the lesion is of utmost importance in diagnosing and further managing squamous cell carcinoma. The acantholytic variant of squamous cell carcinoma is uncommon. Here, we present the case of a 69-year-old male who presented with an invasive mass of progressive growth on the left eyeball extending into the visual axis. The patient underwent extended enucleation, and a histopathological analysis demonstrated a rare acantholytic variant of squamous cell carcinoma.
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Affiliation(s)
- Avi Sharma
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arvind Bhake
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Stevens SM, Reyes-Capo DP, Patel U, Choudhary A, Khzam RA, Tang V, Galor A, Karp CL, Dubovy S. Clinical and Optical Coherence Tomography Comparison Between Ocular Surface Squamous Neoplasia and Squamous Metaplasia. Cornea 2023; 42:429-434. [PMID: 35439777 PMCID: PMC9547982 DOI: 10.1097/ico.0000000000003039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the clinical characteristics and high-resolution optical coherence tomography (HR-OCT) findings between corneal squamous metaplasia and ocular surface squamous neoplasia (OSSN). METHODS A retrospective case-control study of 8 patients, 4 with histologically confirmed squamous metaplasia and 4 with histologically confirmed OSSN, who presented to the Miami Veterans Administration Medical Center and Bascom Palmer Eye Institute between 2016 and 2020 was performed. Clinical characteristics, HR-OCT findings, and pathology were evaluated and compared. RESULTS Four patients with squamous metaplasia and 4 with OSSN were evaluated. In the metaplasia group, 75% were male, 2 were White, and 2 were Black. In the OSSN group, all 4 were White males. All lesions were opalescent and occurred at the limbus; however, the borders were more smooth and rounded in the metaplastic lesions compared with OSSN. HR-OCT findings were indistinguishable between the 2 groups. CONCLUSIONS There is overlap in clinical characteristics and HR-OCT findings between corneal squamous metaplasia and OSSN, highlighting one limitation of HR-OCT. As such, if a corneal opacity has some but not all HR-OCT findings of OSSN, squamous metaplasia should also be considered. A biopsy may be indicated to further evaluate and guide treatment.
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Affiliation(s)
- Shanlee M. Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | | | - Umangi Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anjalee Choudhary
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Rayan Abou Khzam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Vincent Tang
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
- Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L. Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
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Lee JK, Son BK, Jin KH. A Case of Combination Therapy of IFN-β1b and Mitomycin-C on Recurred Ocular Surface Squamous Neoplasia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.8.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report a case of combination therapy with interferon β1b (IFN-β1b) and mitomycin-C (MMC) for recurrent ocular surface squamous neoplasia (OSSN).Case summary: A 72-year-old female presented with a white mass at the medial conjunctiva of the right eye. A gelatinous, nodular white lesion was observed near the medial limbus of the right eye. On histological examination, it was diagnosed as squamous cell carcinoma in situ. A white nodule was found at the resection site 1 year after the resection. IFN-β1b (1 mIU/mL) and 0.02% MMC were administered daily with a diagnosis of recurrent OSSN. IFN-β1b was instilled four times a day for 1 month, while MMC was instilled four times a day for 4 weeks. After 1 month of the combination treatment, the lesion disappeared. MMC was stopped, while IFN-β1b was reduced to twice daily instillation, maintained for 1 month, and then stopped. On examination 12 months after discontinuation of the combination treatment, there were no recurrences or drug-related complications.Conclusions: Combination therapy with IFN-β1b and MMC for recurrent OSSN after surgical resection was relatively safe with no major complications.
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Suleiman DE, Liman AA, Waziri GD, Iliyasu Y, Ahmed SA. Clinicopathological characteristics of ocular surface squamous neoplasia: a 10-year review form a referral tertiary centre in Nigeria. Int Ophthalmol 2022; 42:3905-3911. [PMID: 35802299 DOI: 10.1007/s10792-022-02411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is a heterogeneous group of proliferative squamous lesions on the ocular surface with varying biologic behaviours. This study aims to report the clinical profile and pathological characteristics of cases of OSSN seen at a tertiary referral centre in North West Nigeria. METHODS A retrospective review of all cases of OSSN diagnosed over a 10-year period was done. RESULTS OSSN accounted for 68 out of 91 ocular surface lesions affecting twice as many males as females and a peak incidence in the 30-39 years age group. They frequently presented as higher-grade and higher-stage lesions with invasive squamous cell carcinoma being the most frequently diagnosed OSSN. They also frequently showed an association with HIV infection and a relatively long duration of symptoms before presentation. CONCLUSION OSSN occurs in a relatively young age group in our environment. Certain clinical and epidemiological features appear to predict the occurrence of higher-grade lesions, and this may help in the clinical prediction of likely pathologic grade and/or biologic behaviour of these lesions.
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Affiliation(s)
- Dauda Eneyamire Suleiman
- Department of Histopathology, College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi, 7204212, Nigeria.
| | - Almustapha Aliyu Liman
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Garba Dahiru Waziri
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Yawale Iliyasu
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Clinical Sciences, Kaduna State University, Kaduna, Nigeria
| | - Saad Aliyu Ahmed
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
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Peterson C, Parikh RN, Ahmad MT, Campbell AA, Daoud Y, Mahoney N, Siadati S, Eberhart CG. Detection of Human Papillomavirus in Squamous Lesions of the Conjunctiva Using RNA and DNA In-Situ Hybridization. Int J Mol Sci 2022; 23:ijms23137249. [PMID: 35806252 PMCID: PMC9266440 DOI: 10.3390/ijms23137249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
In-situ hybridization provides a convenient and reliable method to detect human papillomavirus (HPV) infection in formalin-fixed paraffin-embedded tissue. Cases of conjunctival papillomas, conjunctival intraepithelial neoplasia (CIN), conjunctival carcinoma in situ (cCIS), and invasive squamous cell carcinoma (SCC), in which low-risk (LR) and/or high-risk (HR) HPV types were evaluated by RNA or DNA in-situ hybridization, were retrospectively identified. LR HPV types were frequently detected in conjunctival papillomas (25/30, 83%), including 17/18 (94%) with RNA probes, compared to 8/12 (75%) with DNA probes. None of the CIN/cCIS or SCC cases were positive for LR HPV by either method. HR HPV was detected by RNA in-situ hybridization in 1/16 (6%) of CIN/cCIS cases and 2/4 (50%) of SCC cases, while DNA in-situ hybridization failed to detect HPV infection in any of the CIN/cCIS lesions. Reactive atypia and dysplasia observed in papillomas was generally associated with the detection of LR HPV types. Collectively, our findings indicate RNA in-situ hybridization may provide a high-sensitivity approach for identifying HPV infection in squamous lesions of the conjunctiva and facilitate the distinction between reactive atypia and true dysplasia. There was no clear association between HPV infection and atopy in papillomas or dysplastic lesions.
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Affiliation(s)
- Cornelia Peterson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Rupin N. Parikh
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Meleha T. Ahmad
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Ashley A. Campbell
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Yassine Daoud
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Nicholas Mahoney
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Sepideh Siadati
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Charles G. Eberhart
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
- Correspondence: ; Tel.: +1-(410)-502-5185
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11
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Geng W, Wang JS, Shi BJ, Xie HT, Zhang MC. Topical Chemotherapy for Treating Ocular Surface Squamous Neoplasia with a Combination of Interferon α-2b and 5-Fluorouracil. Ophthalmol Ther 2022; 11:1563-1576. [PMID: 35704159 PMCID: PMC9253210 DOI: 10.1007/s40123-022-00535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction This study evaluated the efficacy of combined interferon α-2b (IFNα2b) and 5-fluorouracil (5-FU) as primary treatment for ocular surface squamous neoplasia (OSSN). Methods In this retrospective study, 27 eyes with OSSN followed by topical application of combined IFNα2b and 5-FU were examined. Reported outcome measures were tumor response, visual acuity, time to complete resolution, recurrence and treatment complications. Results Twenty-six patients (17 male, 9 female) had a mean age of 63.9 (median, 67; range 22–83) years. Complete tumor response was observed in 24 eyes (88.9%). Three eyes (11.1%) showed partial response to the chemotherapy agents and later underwent surgical tumor removal. The median time to complete resolution was 6 (mean, 6.1; range, 3–11) weeks. Of these, the patients received between one to three cycles of 5-FU therapy (median, 2; mean, 1.8). Complications noted were transient irritation at 5-FU cycle (11 eyes, 40.7%). There was no tumor recurrence at mean follow-up of 16.1 (median, 12; range 6–38) months. Conclusions Combination therapy of IFNα2b and 5-FU was a safe and effective treatment, inducing a short duration of administration and low recurrence rate for OSSN. Trial Registration Retrospectively registered, UHCT22048.
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Affiliation(s)
- Wen Geng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bing-Jie Shi
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Zhang KY, Aurit S, Silberstein P. Racial and socioeconomic disparities in ocular surface squamous neoplasia: a National Cancer Database analysis. Ophthalmic Epidemiol 2022; 29:319-327. [PMID: 33977826 DOI: 10.1080/09286586.2021.1925307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A retrospective population-based study to investigate racial and socioeconomic disparities in patients diagnosed with ocular surface squamous neoplasia (OSSN). METHODS To explore racial disparity, we selected OSSN patients with known age, insurance, gender and zip code-level income and education from the National Cancer Database (NCDB). Comparisons of clinical and socioeconomic variables stratified by race were made with the chi-square or Mann-Whitney tests. Survival outcome was examined a Cox regression model. RESULTS Of the 2,402 identified patients from 2004 to 2015, 117 were black. Unadjusted differences were found between groups in regard to age, histology, insurance, income, and education. Black patients in comparison to white patients were younger (mean age: 62 years vs. 70 years; p < .001), represented a higher proportion of Medicaid use (10.3% vs. 3.2%; p < .001) or uninsured (10.3% vs. 2.7%; p < .001), and were more likely to reside in areas of low educational attainment (32.5% vs. 16.1% of whites; p < .001). Multivariate analysis found significantly higher risk of death in patients who were male (HR: 1.66, 95% CI 1.37-2.01) or black (HR: 1.57, 95% CI 1.03-2.38). CONCLUSION Disparities in socioeconomic factors were observed in black patients with OSSN. OSSN occurred earlier in blacks, who were also socioeconomically disadvantaged and faced higher risk of death.
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Affiliation(s)
- Kevin Y Zhang
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sarah Aurit
- Division of Clinical Research and Evaluative Sciences, Creighton University Medical Centre, Omaha, Nebraska, USA
| | - Peter Silberstein
- Department of Medicine, Henry Lynch Cancer Centre, Creighton University Medical Centre, Omaha, Nebraska, USA
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13
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Tananuvat N, Niparugs M, Wiwatwongwana D, Lertprasertsuk N, Mahanupap P. Ocular surface squamous neoplasia in Northern Thailand: a 16-year review. BMC Ophthalmol 2022; 22:121. [PMID: 35279126 PMCID: PMC8918314 DOI: 10.1186/s12886-022-02340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To evaluate clinical characteristics, treatments, and outcomes in patients with ocular surface squamous neoplasia (OSSN) at a tertiary center in Northern Thailand.
Methods
Patients diagnosed with either corneal-conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from May 2000 to December 2015, were recruited. The patients’ demographics, symptoms, clinical characteristics, cytopathology, treatments, and outcomes were reviewed.
Results
Overall 171 eyes from 168 patients, 92 eyes were CIN and 79 eyes were SCC. Males were affected in 65.5%. The mean age was 58.8 ± 16.8 (29–99) years. In most cases (60.3%), the tumors were located at the limbus. The most common clinical characteristic was papilliform appearance (46.2%). Human immunodeficiency virus (HIV) infection was found in 37 (22.0%) patients with a mean age of 40.5 ± 7.7 years. The treatments and outcomes were evaluated in 136 eyes whose main initial treatment was wide excision with adjunctive cryotherapy (47.8%), followed by topical mitomycin C (30.9%). The mean follow-up time after treatment was 20.8 ± 2.2 (3–110) months and the recurrence occurred in 18 eyes (13.2%) during the follow-up period. The mean recurrence-free time (months) for CIN was significantly longer than that of SCC (81.3 ± 10.0 [95%CI 61.5 – 101.1] vs 33.2 ± 4.6 [95%CI 24.0 – 42.3], p = 0.030). SCC was the only significant risk factor that influences the recurrence of the tumors with the adjusted hazard ratio of 5.69 (p = 0.005).
Conclusion
OSSN in Northern Thailand usually involved a limbal area and presented as a papilliform mass. HIV infection should be suspected in young patients. CIN had better outcomes after treatments than invasive SCC.
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14
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Helayel HB, Fairaq R, Al Najashi AA, AlMutlak M. Treatment challenges associated with a superiorly located bulbar conjunctival mass—case report and review of the literature. Am J Ophthalmol Case Rep 2022; 25:101304. [PMID: 35128156 PMCID: PMC8807977 DOI: 10.1016/j.ajoc.2022.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This report describes a recurrent case of ocular surface squamous neoplasia in a middle-aged and immunocompetent patient. Observations The summary of clinical presentation, workup, and medical and surgical intervention are described, followed by a brief overview of the treatment challenges associated with superiorly located conjunctival lesions. Conclusions In cases where topical chemotherapeutic drops cannot penetrate the lesion, the location of conjunctival lesions can sometimes pose a challenge. Hence, injections in such cases might be preferred. However, histopathology still plays a significant role in achieving a definitive diagnosis.
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15
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Kiseleva TN, Saakyan SV, Makukhina VV, Lugovkina KV, Milash SV, Musova NF, Zharov AA. [Use of optical coherence tomography angiography in assessment in conjunctival vascular architecture in health and pathology]. Vestn Oftalmol 2022; 138:32-42. [PMID: 36573946 DOI: 10.17116/oftalma202213806132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Investigation of the capabilities of anterior segment (AS) optical coherence tomography angiography (OCTA) in evaluation of conjunctival vascular architecture in healthy individuals and in various pathological conditions. MATERIAL AND METHODS The study included 17 healthy volunteers (34 eyes; the control group) and 62 patients (68 eyes) with conjunctival lesions of various nature. All participants underwent AS-OCT and AS-OCTA with assessment of qualitative (vessels pattern, lumen, pathologic tortuosity) and quantitative parameters (vessel density (VD, %) in the lesion area). Mean VD (MVD) and local VD (LVD) were determined, as well as VD in perifocal tissues (PVD). RESULTS OCTA scans in 8 conjunctival sectors showed mostly radial pattern of the vascular architecture, with vessel lumen remaining the same over their entire visible length. Larger-sized vessels in deeper conjunctival layers were discovered in most cases. The lowest VD value (33.3%) was registered in the superotemporal quadrant, and the highest (38.9%) - in the nasal. Tortuosity of the vessels with course disruption, uneven lumen over the length of the vessels and increase in VD were observed in the area of conjunctival lesions in all cases excluding congenital abnormalities, pingueculae and conjunctival melanocytic intraepithelial neoplasia. The malignant nature of the tumors was indicated by dense vessel distribution and difficulties for visualization of intravascular space, and confirmed by pathohistological analysis. An increase in the number of areas with a lace-like pattern was characteristic for melanomas, with mean VD of more than 50% in the most vascularized areas. CONCLUSION AS-OCTA is an informative method for the visualization of vessels in healthy conjunctiva and in conjunctival pathology. Local VD in the lesion area should be measured when the vessels are unevenly distributed.
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Affiliation(s)
- T N Kiseleva
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - S V Saakyan
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V V Makukhina
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - K V Lugovkina
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - S V Milash
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - N F Musova
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - A A Zharov
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia
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16
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Multani EK, Bajwa D, Multani PK, Nobakht E, Raj D, Paul RS, Paul RS. EYE DISEASE IN KIDNEY TRANSPLANTATION: CLINICAL CHALLENGES IN A UNIQUE PATIENT POPULATION. Surv Ophthalmol 2021; 67:1252-1269. [PMID: 34954092 DOI: 10.1016/j.survophthal.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
Eye disease is common among kidney transplant recipients and their management is challenging. Chronic kidney disease is associated with ocular complications, both independently and in the context of various systemic disorders. In addition, chronic immunosuppression predisposes kidney transplant recipients to an array of long-term ocular issues. This may be broadly categorized into infections, malignancies, and other immunosuppression-specific side effects. The interdependence of kidney disease, transplant pharmacotherapy and ocular health therefore requires a multispecialty approach. Although the kidney transplant population has grown along with the burden of associated oculopathies, systematic guidelines targeting this patient group are lacking. This evidenced-based narrative review summarizes the pertinent issues that may present in the ophthalmic and optometric clinical settings, with emphasis on collaborative management and directions for future research.
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Affiliation(s)
- Eisha K Multani
- MY EYE DR OPTOMETRISTS LLC, 1330 CONNECTICUT AVE NW, WASHINGTON DC, 20037, UNITED STATES
| | - Dalvir Bajwa
- THE NEWCASTLE UPON TYNE HOSPITALS, NHS FOUNDATION TRUST, ROYAL VICTORIA INFIRMARY, QUEEN VICTORIA ROAD, NEWCASTLE UPON TYNE NE1 4LP, UNITED KINGDOM
| | - Priyanika K Multani
- INLAND VISION CENTER OPTOMETRY, 473 E CARNEGIE DR, SUITE 100, SAN BERNADINO, CA 92408
| | - Ehsan Nobakht
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Dominic Raj
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Rohan S Paul
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Rohan S Paul
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES.
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Chauhan A, Gupta L, Chauhan S. Pseudoepitheliomatous Hyperplasia: A Diagnostic Dilemma. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_198_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractPseudoepitheliomatous hyperplasia (PEH) is a benign reactive inflammatory reaction of the epithelial cells to various conditions. It is a diagnostic dilemma which simulates malignancy, especially squamous cell carcinoma (SCC). Many articles of PEH involving the oral mucosa are available on the internet, but ocular involvement is infrequent. The ocular lesion in our case resembled SCC but turned out to be PEH. We report a rare case of PEH in a 20-year-old male.
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Affiliation(s)
- Anubhav Chauhan
- Department of Ophthalmology, Dr Yashwant Singh Parmar Govt. Medical College, Nahan, District Sirmour, Himachal Pradesh, India
| | - Lalit Gupta
- Department of Ophthalmology, Dr Yashwant Singh Parmar Govt. Medical College, Nahan, District Sirmour, Himachal Pradesh, India
| | - Shveta Chauhan
- Pine Castle, Near Mist Chamber, Khalini, Shimla, Himachal Pradesh, India
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18
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Kounatidou NE, Palioura S. An update in the management of ocular surface squamous neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1932465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Chowdhury Z, Nongrum B, Rajbongshi C. Synchronous eyelid oncocytoma and conjunctival intraepithelial neoplasia. AUTOPSY AND CASE REPORTS 2021; 11:e2020235. [PMID: 34277494 PMCID: PMC8101682 DOI: 10.4322/acr.2020.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Oncocytoma of the eyelid is a rare neoplasm. Oncocytoma associated with an ocular surface squamous neoplasm, namely conjunctival intraepithelial neoplasia, is very hard to find in the literature. Herein we report a case of a 53-year-old male who presented with a swelling in the right lower lid over the last 6 years, along with a growth in the conjunctiva of the same eye for the last 2 years and encroaching upon the cornea for the last 4 months. Excision biopsy of the lower lid mass showed histopathological features consistent with oncocytoma. The conjunctival tissue revealed conjunctival intraepithelial neoplasia 3 (severe dysplasia). This case documents a rare synchronous dual ocular neoplasia, a very unlikely coexistence of oncocytoma with conjunctival intraepithelial neoplasia.
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Affiliation(s)
- Zachariah Chowdhury
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Pathology, Shillong, Meghalaya, India
| | - Benjamin Nongrum
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Ophthalmology, Shillong, Meghalaya, India
| | - Chandana Rajbongshi
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Pathology, Shillong, Meghalaya, India
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20
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Höllhumer R, Michelow P, Williams S. Diagnosis and staging of ocular surface squamous neoplasia. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour. The diagnosis of OSSN is based on clinical suspicion and confirmed by various diagnostic modalities, of which histology is the gold standard. With the move to less invasive management options such as topical chemo- or immunotherapy, less invasive diagnostic options have come to the fore.Aim: The purpose of this article was to review the current staging and diagnostic modalities for OSSN with a focus on less invasive modalities.Method: A literature review was performed for publications on ocular surface neoplasia and diagnostic modalities.Results: Histology is the gold standard for diagnosing OSSN. Cytology has been shown to be a simple, repeatable and minimally invasive diagnostic modality, which also allows for additional testing such as polymerase chain reaction. Anterior segment optical coherence tomography provides a non-contact method of evaluating the ocular surface, with OSSN showing a thickened hyper-reflective epithelium, abrupt transition zone and demarcation line. Vital dyes are used less commonly with high sensitivity, but lower specificity for OSSN. Finally, confocal microscopy provides en-face images of the ocular surface, with OSSN showing a classic ‘starry night’ appearance.Conclusion: Histology remains the gold standard for diagnosis; however, with the increasing use of topical therapy for OSSN, there has been an increase in the uptake of less invasive diagnostic modalities.
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21
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Saffra NA, Emborgo TS, Iacob CE, Kirsch DS. Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a case report. J Med Case Rep 2020; 14:174. [PMID: 33004066 PMCID: PMC7529473 DOI: 10.1186/s13256-020-02510-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background New York City has a heterogeneous population with many undocumented and uninsured immigrants from equatorial areas who have a higher incidence of ocular surface squamous neoplasia. To the best of our knowledge, this is the first documented selection of this cost-effective treatment of ocular surface squamous neoplasia (the use of absolute ethanol along the corneal margin, primary excision, double freeze-thaw cryopexy, and primary conjunctival closure) for an undocumented and uninsured New York City patient. Case presentation A 35-year-old man from Ecuador presented to a New York City emergency department due to worsening discomfort of a long-standing left eye pterygium. A slit-lamp examination of the left eye demonstrated a nasally located conjunctival mass measuring 6 × 8 mm extending onto the cornea (3 mm superiorly and 6 mm inferiorly on the cornea). Histological diagnosis confirmed squamous cell carcinoma in situ arising from the pterygium. Surgical excision with adjunctive absolute alcohol with additive double freeze-thaw cryopexy was performed. Our patient has remained free of tumor recurrence at year 2 postoperative visit. Conclusions Our case highlights the need to choose a cost-effective treatment for ocular surface squamous neoplasia in an at-risk population among undocumented and uninsured patients. Areas in the world with similar types of populations or treatment challenges may need to consider this approach as a primary treatment option.
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Affiliation(s)
- Norman A Saffra
- Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, NY, USA. .,Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Trisha S Emborgo
- Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, NY, USA
| | - Codrin E Iacob
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - David S Kirsch
- Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, NY, USA
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22
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Nair AG, Gopinathan I, Jain V. Squamous cell carcinoma of the lacrimal punctum: A rare presentation. Indian J Ophthalmol 2020; 68:2245-2247. [PMID: 32971665 PMCID: PMC7728029 DOI: 10.4103/ijo.ijo_2308_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Akshay Gopinathan Nair
- Ophthalmic Plastic and Ocular Oncology Services, Advanced Eye Hospital and Institute, Navi Mumbai; Ophthalmic Plastic and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
| | | | - Vandana Jain
- Ophthalmic Plastic and Ocular Oncology Services, Advanced Eye Hospital and Institute, Navi Mumbai, Maharashtra, India
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23
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Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa. PLoS One 2020; 15:e0237453. [PMID: 32780766 PMCID: PMC7418961 DOI: 10.1371/journal.pone.0237453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests. METHODS This observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy. DISCUSSION There is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.
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24
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Mudhar HS, Milman T, Zhang PJL, Shields CL, Eagle RC, Lally SE, Shields JA, Salvi SM, Rundle PA, Tan J, Rennie IG. Conjunctival 'mucoepidermoid carcinoma' revisited: a revision of terminology, based on morphologic, immunohistochemical and molecular findings of 14 cases, and the 2018 WHO Classification of Tumours of the Eye. Mod Pathol 2020; 33:1242-1255. [PMID: 31932683 DOI: 10.1038/s41379-020-0456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
In 2018, the consensus meeting for the WHO Classification of Tumours of the Eye decided that conjunctival mucoepidermoid carcinoma should be reclassified as adenosquamous carcinoma, as this represented a better morphological fit. To examine the applicability of this terminology, we studied the clinical, histopathological, immunohistochemical and molecular pathology of 14 cases that were originally diagnosed as conjunctival mucoepidermoid carcinoma. There were 7 (50%) females and 7 (50%) males. The median age was 64 years. The left eye was affected in 8 and the right eye in 6 patients. In-situ carcinoma was present in 11/14 (79%) cases and comprised in-situ squamous cell carcinoma (SCC) and conjunctival intraepithelial neoplasia with mucinous differentiation (CIN-Muc). Invasive carcinoma was present in 11/14 (79%) cases. Group 1 (1/11 cases, 9%) comprised invasive SCC only. Group 2 (6/11 cases, 55%) comprised SCC with mucinous differentiation, manifesting as scattered intracellular mucin, occasionally together with intercellular mucin, with no evidence of true glandular differentiation. Group 3 (3/11 cases. 27%) comprised true adenosquamous carcinoma. Group 4 (1/11 cases, 9%) comprised pure adenocarcinoma. Thirteen of 14 cases (93%) underwent FISH for MAML2 translocation and none were rearranged. Two cases harboured high-risk HPV (type 16 and 18). The combined findings confirm that all lesions in our study were not mucoepidermoid carcinoma, but represented predominantly SCC with mucinous differentiation and adenosquamous carcinoma. We, therefore, recommend future revision of the WHO classification to include SCC with mucinous differentiation alongside adenosquamous carcinoma.
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Affiliation(s)
- Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J L Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol L Shields
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph C Eagle
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara E Lally
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A Shields
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sachin M Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Paul A Rundle
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Jennifer Tan
- Oculoplastic Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Ian G Rennie
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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25
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Moshtaghion SM, Abolhosseini M, Rezaei Kanavi M, Hosseini SB, Rezaei Kanavi M. Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study. Eur J Ophthalmol 2020; 31:943-950. [PMID: 32506955 DOI: 10.1177/1120672120932093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. METHODS IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen's Kappa coefficient (CKC). RESULTS Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. CONCLUSION Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.
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Affiliation(s)
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Central Eye Bank of Iran, Tehran, Iran
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Darwich R, Ghazawi FM, Le M, Rahme E, Alghazawi N, Zubarev A, Moreau L, Sasseville D, Burnier MN, Litvinov IV. Epidemiology of invasive ocular surface squamous neoplasia in Canada during 1992-2010. Br J Ophthalmol 2020; 104:1368-1372. [PMID: 31949098 DOI: 10.1136/bjophthalmol-2019-314650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/03/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented ocular surface malignancy. It is classified as invasive OSNN (IOSSN) when the underlying stroma are infiltrated by dysplastic squamous epithelial cells through the basement membrane. Here, we present the descriptive epidemiology and geographical distribution of IOSSN in Canada. METHODS We determined the incidence and geographical distribution of IOSSN cases diagnosed between 1992 and 2010 using two independent population-based cancer registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer. RESULTS The mean annual age-standardised incidence rate (WHO 2000-2025) of IOSSN for 1992-2010 was 0.45 cases per million individuals per year with an average annual percent increase in incidence of 4.5%. IOSSN localisation to the conjunctiva was documented in at least 57% of the reported cases. IOSSN exhibited a male predilection ratio of 3.3:1.0 with a mean age at diagnosis of 69 years. Incidence rates of IOSSN across Canadian provinces and cities showed no significant differences from the crude national average. CONCLUSIONS Our results, particularly concerning IOSSN patient age and male predilection, corroborate with data reported from the USA. Additional studies are needed to determine whether the observed increase in incidence rate over the study period (1992-2010) is significant.
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Affiliation(s)
- Rami Darwich
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle Le
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nebras Alghazawi
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Andrei Zubarev
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Miguel N Burnier
- The Henry C Witelson Ocular Pathology Laboratory, McGill University, Montreal, Quebec, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
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Cruzado-Sanchez D, Tellez WA, Villarreal-Aguilar B, Melendez M, Olivera A, Moran F, Serpas-Frias S, Cordero-Garcia R. Conjunctival squamous cell carcinoma: prognostic factors for the recurrence and metastasis and clinicopathological characteristics at an oncological hospital in Peru. Br J Ophthalmol 2019; 104:1010-1015. [PMID: 31604702 DOI: 10.1136/bjophthalmol-2019-314058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS Conjunctival squamous cell carcinoma (CSCC) is the most frequent malignant tumour of the conjunctiva, with scarce recurrence and infrequent metastasis. The purpose of this study is to describe the clinical and pathological characteristics of this neoplasm and to identify the prognostic factors for recurrence and metastasis in a cancer hospital in Peru. MATERIALS AND METHOD A longitudinal, retrospective study of 176 consecutive patients diagnosed with SCC of the conjunctiva. Sociodemographic and clinical characteristics were evaluated. In addition, Kaplan-Meier curves were performed, and Cox regression was used to determine prognostic factors for recurrence and metastasis over time. RESULT Only 12.5% presented tumour size ≤5 mm. The highest proportion according to the histopathological type was the well-differentiated infiltrative forms (40.9%), and according to tumour, node, metastases (TNM), stage T3 was the most frequent (31.3%). The most performed initial treatment was orbital exenteration (38.6%). The proportion of recurrence was 6.8% and 8.0% for metastasis. The annual survival rate was 7% and the annual metastasis rate was 6%; for recurrence after 5 years, the survival rate was 11% and the metastasis rate was 14%. No prognostic factor evaluated was significant. CONCLUSION This is the most extensive patient study in Latin America with CSCC, with a high proportion of advanced histopathological grade, TNM stages, and radical treatments such as exenteration. Recurrence rates on average are similar to other reported studies, and it describes the rates of metastasis that have been poorly described in the literature.
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Affiliation(s)
- Deivy Cruzado-Sanchez
- Ophthalmic Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Walter Andree Tellez
- Sociedad Cientifica de estudiantes de medicina villarrrealinos (SOCEMVI), Unversidad Nacional Federico Villarreal (UNFV), Lima, Peru
| | - Beltran Villarreal-Aguilar
- Sociedad científica de estudiantes de medicina de la Universidad Peruana de Ciencias Aplicada (SOCIEMUPC), Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | - Monica Melendez
- Ophthalmic Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Anibal Olivera
- Ophthalmic Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Fiorella Moran
- Ophthalmic Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Solon Serpas-Frias
- Ophthalmic Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
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Aliakbar Navahi R, Hosseini SB, Kanavi MR, Rakhshani N, Aghaei H, Kheiri B. Comparison of toluidine blue 1% staining patterns in cytopathologically confirmed ocular surface squamous neoplasias and in non-neoplastic lesions. Ocul Surf 2019; 17:578-583. [DOI: 10.1016/j.jtos.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 02/24/2019] [Accepted: 04/30/2019] [Indexed: 11/15/2022]
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Abstract
CONTEXT - Human papillomavirus (HPV) has a well-known role in the pathogenesis of squamous cell carcinoma and precursor lesions of the cervix, anogenital region, and head and neck, but its role in the development of squamous neoplasms of the eye, particularly the conjunctiva, remains unclear. OBJECTIVE - To review recent evidence implicating HPV in the pathophysiology of ocular lesions. DATA SOURCES - Published articles obtained from a PubMed search of the English literature were the primary sources for this review. CONCLUSIONS - The low-risk HPV types 6 and 11 appear to play a role in the development of at least a subset of conjunctival squamous papillomas. The role of HPV in the pathogenesis of pterygium and ocular surface squamous neoplasia is less well defined. There is evidence to suggest that HPV may be a cofactor in the development of these lesions, acting in concert with ultraviolet radiation and/or human immunodeficiency virus infection in a subgroup of cases.
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Affiliation(s)
| | - Kymberly A Gyure
- From the Department of Pathology, West Virginia University School of Medicine, Morgantown
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30
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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Human Papilloma Virus Vaccination and Incidence of Ocular Surface Squamous Neoplasia. Int Ophthalmol Clin 2018; 57:57-74. [PMID: 27898614 DOI: 10.1097/iio.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical Management of Ocular Surface Squamous Neoplasia: A Review of the Current Evidence. Ophthalmol Ther 2018; 7:247-262. [PMID: 30030703 PMCID: PMC6258579 DOI: 10.1007/s40123-018-0140-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/24/2022] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented malignancy of the ocular surface and is represented in a wide range of histologic diagnoses, ranging from mild epithelial dysplasia to invasive squamous carcinoma. Although surgical excision is still the gold standard for OSSN treatment, interest in conservative medical approaches is steadily growing. We have reviewed all of the literature on OSSN published in English in the MEDLINE database up to May 2018, using the keywords “ocular surface squamous neoplasia,” “squamous conjunctival carcinoma,” and “conjunctival carcinoma in situ,” with the aim to provide a comprehensive review of the most recent evidence on this distinct clinical entity.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Alessandro Marchese
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Modorati
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
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Rajeh A, Barakat F, Khurma S, AlRawashdeh K, Ababneh OH, AlNawaiseh I, Mehyar M, Abdeen G, Jaradat I, Mohammad M, Yousef YA. Characteristics, management, and outcome of squamous carcinoma of the conjunctiva in a single tertiary cancer center in Jordan. Int J Ophthalmol 2018; 11:1132-1138. [PMID: 30046529 DOI: 10.18240/ijo.2018.07.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate the features and outcome of management of malignant conjunctival squamous tumors in King Hussein Cancer Center (a referral tertiary cancer center in the Middle East). METHODS Retrospective case series of 31 eyes for 31 patients with conjunctival squamous neoplasia. Main outcome measures included: age, gender, laterality, tumor location, pathological features, tumor stage, treatment modality, and outcome. RESULTS Twenty (65%) patients were males and median age was 58y. Twenty-two (71%) eyes had the tumor in the nasal quadrant. Tumor invasion to nearby structures was seen in 19 (61%) eyes, including the cornea, fornix, eyelid, and orbit in 17 (55%), 1 (3%), 2 (6%), and 3 (10%) eyes, respectively. Eye salvage was achieved by surgical excision with cryotherapy followed by topical chemotherapy in 28 (90%) eyes, and orbital exenteration was necessary in 3 (10%) eyes due to orbital tumor invasion. Tumor recurrence was seen in 7 (23%) eyes, and the significant predictive factors for recurrence were tumor extension onto the nearby structures (P=0.04), tumor invasiveness (P=0.038), and tumor TNM stage (P=0.031). No significant change in visual acuity was seen, and disease related mortality was 6% (2 patients, both had orbital invasion by invasive squamous carcinoma). CONCLUSION Conjunctival squamous carcinoma is more common in males. Advanced American Joint Committee on Cancer (AJCC) T-stage, tumor local invasion, more pathologically aggressive tumors, and surgical treatment alone (without adjuvant therapy) are associated with higher risk for recurrence, and orbital invasion is the most important poor prognostic factor for metastasis and death. Treatment strategies should be affected by tumor characteristics at presentation.
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Affiliation(s)
- Ata Rajeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Fareed Barakat
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Samer Khurma
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Khaleel AlRawashdeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Osama H Ababneh
- Department of Ophthalmology, The University of Jordan and Jordan University Hospital, Amman 11941, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Ghadeer Abdeen
- Department of Medical Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
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Kumar SV, Joshi D. Ocular surface squamous neoplasia. Med J Armed Forces India 2018; 74:273-275. [PMID: 30093772 DOI: 10.1016/j.mjafi.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/05/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sonali V Kumar
- Classified Specialist (Ophthalmology), Command Hospital (Air Force), Bengaluru, India
| | - D Joshi
- Professor & Head (Ophthalmology), INHS Asvini, Colaba, Mumbai, India
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35
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Rathi SG, Ganguly Kapoor A, Kaliki S. Ocular surface squamous neoplasia in HIV-infected patients: current perspectives. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:33-45. [PMID: 29559813 PMCID: PMC5857154 DOI: 10.2147/hiv.s120517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. In this article, we discuss the current perspectives of OSSN associated with HIV infection, focusing mainly on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of these tumors in patients with HIV. Upsurge in the incidence of OSSN with the HIV pandemic most severely affected sub-Saharan Africa, due to associated risk factors, such as human papilloma virus and solar ultraviolet exposure. OSSN has been reported as the first presenting sign of HIV/AIDS in 26%-86% cases, and seropositivity is noted in 38%-92% OSSN patients. Mean age at presentation of OSSN has dropped to the third to fourth decade in HIV-positive patients in developing countries. HIV-infected patients reveal large aggressive tumors, higher-grade malignancy, higher incidence of corneal, scleral, and orbital invasion, advanced-stage T4 tumors, higher need for extended enucleation/exenteration, and increased risk of tumor recurrence. Current management of OSSN in HIV-positive individuals is based on standard treatment guidelines described for OSSN in the general population, as there is little information available about various treatment modalities or their outcomes in patients with HIV. OSSN can occur at any time in the disease course of HIV/AIDS, and no significant trend has been discovered between CD4 count and grade of OSSN. Furthermore, the effect of highly active antiretroviral therapy on OSSN is controversial. The current recommendation is to conduct HIV screening in all cases presenting with OSSN to rule out undiagnosed HIV infection. Patient counseling is crucial, with emphasis on regular follow-up to address high recurrence rates and early presentation to an ophthalmologist for of any symptoms in the unaffected eye. Effective evidence-based interventions are needed to allow early diagnosis and treatment, as well as prevention of the disease.
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Affiliation(s)
- Shweta Gupta Rathi
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Anasua Ganguly Kapoor
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
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Mendoza PR, Craven CM, Ip MH, Wilson MW, Coroneo MT, Grossniklaus HE. Conjunctival Squamous Cell Carcinoma with Corneal Stromal Invasion in Presumed Pterygia: A Case Series. Ocul Oncol Pathol 2018; 4:240-249. [PMID: 30643769 DOI: 10.1159/000485425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/15/2017] [Indexed: 12/29/2022] Open
Abstract
Aim To describe 4 cases of conjunctival squamous cell carcinoma (SCC) with corneal stromal invasion. Methods Retrospective, clinicopathologic case series. Results All patients had prior resections of presumed pterygia. The degree of corneal involvement dictated the extent of surgical management. One eye with localized invasion was treated with lamellar keratoplasty and plaque brachytherapy. Another case with widespread invasion warranted penetrating keratoplasty and eventual enucleation. Two cases were treated medically prior to surgical intervention: one with localized invasion was treated with topical interferon and retinoic acid; another with significant inflammation was treated with doxycycline and fluorometholone. The patient who underwent keratoplasty and brachytherapy had no recurrence after 7 years of follow-up. Those initially treated medically had resections of recurrence but ultimately required enucleation. Histologically, specimens demonstrated SCC invading the deep corneal stroma, with 2 tumors of the mucoepidermoid type. Conclusions This series demonstrates the importance of maintaining clinical suspicion of conjunctival squamous neoplasia in pterygia. We recommend that all excised pterygia be submitted for histopathologic evaluation and be carefully evaluated for dysplasia and variants of SCC associated with increased risk of intraocular invasion. Undetected ocular surface squamous neoplasia may give rise to potentially vision- and eye-threatening invasive corneal SCC.
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Affiliation(s)
- Pia R Mendoza
- Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | | | - Matthew H Ip
- Department of Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matthew W Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Minas T Coroneo
- Department of Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, NSW, Australia
| | - Hans E Grossniklaus
- Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.,Department of Ophthalmology, Emory University, Atlanta, GA, USA
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Tanaka S, Kohanim S. The Role of Confocal Microscopy in Diagnosing Ocular Surface Tumors. Int Ophthalmol Clin 2017; 57:75-85. [PMID: 27898615 DOI: 10.1097/iio.0000000000000146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Mishra DK, Veena U, Kaliki S, Kethiri AR, Sangwan VS, Ali MH, Naik MN, Singh V. Differential Expression of Stem Cell Markers in Ocular Surface Squamous Neoplasia. PLoS One 2016; 11:e0161800. [PMID: 27584160 PMCID: PMC5008752 DOI: 10.1371/journal.pone.0161800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
Ocular Surface Squamous Neoplasm (OSSN) is the neoplasia arising from the conjunctiva, cornea and limbus. OSSN ranges from mild, moderate, severe dysplasia, carcinoma in situ (CIS) to squamous cell carcinoma (SCC). Recent findings on cancer stem cells theory indicate that population of stem-like cell as in neoplasia determines its heterogeneity and complexity leading to varying tumor development of metastatic behavior and recurrence. Cancer stem cell markers are not much explored in the cases of OSSN. In the present study, we aim to evaluate the expression of stem cells using stem cell markers mainly p63, ABCG2, c-KIT (CD117) and CD44 in OSSN tissue, which could have prognostic significance. The present study tries for the first time to explore expression of these stem markers in the cases of OSSN. These cases are subdivided into two groups. One group comprises of carcinoma in situ (n = 6) and the second group comprises of invasive carcinoma (n = 6). The mean age at presentation was 52 years; with 53 years for CIS group and 52 years for SCC group. From each group section from the paraffin block were taken for the IHC staining of p63, c-Kit, ABCG2 and CD44. Our experiments show high expression of P63 and CD44 in the cases of CIN and SCC. Both CIS and SCC displayed positive staining with p63, with more than 80% cells staining positive. However minimal expression of c-kit in both CIN and SCC. But surprisingly we got high expression of ABCG2 in cases of carcinoma in situ as compared to that of invasive squamous cell carcinoma. More than 50% of cells showed CD44 positivity in both CIS and SCC groups. Our results show for the first time that these four stem cells especially the limbal epithelium stem cells play a vital role in the genesis of OSSN but we need to explore more cases before establishing its clinical and biological significance.
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Affiliation(s)
- Dilip Kumar Mishra
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Uppala Veena
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhinav Reddy Kethiri
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal University, Manipal, Karnataka, India
| | - Virender S. Sangwan
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammed Hasnat Ali
- Clinical Epidemiology and Bio-Statistics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Milind N. Naik
- The Operation Eyesight Universal Institute for Eye cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Singh
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal University, Manipal, Karnataka, India
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Dandala PP, Malladi P, Kavitha. Ocular Surface Squamous Neoplasia (OSSN): A Retrospective Study. J Clin Diagn Res 2015; 9:NC10-3. [PMID: 26675568 DOI: 10.7860/jcdr/2015/16207.6791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is a term used to describe neoplastic epithelial abnormalities of conjunctiva and cornea, ranging from Squamous Dysplasia to Invasive Squamous Cell Carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries like India. AIM To analyse demographic characteristics and compare the clinical presentation, treatment outcomes, and histopathology features of Ocular Surface Squamous Neoplasia (OSSN). DESIGN Retrospective cross-sectional study. MATERIALS AND METHODS We analysed 113 cases of OSSN who presented to the out-patient department of Sarojini Devi Eye Hospital, Regional Institute of Ophthalmology over a period of three years from February 2012 to January 2015. RESULTS In patients, who presented with OSSN age ranged from 18 to 78 years, mean age being 45.20 years. Males were predominantly affected accounting for 65.48%. A nodule at the limbus is the commonest presentation. About 23% of the patients tested positive for HIV in whom mean age of presentation was 34 years. Among HIV positive patients 78.26% had SCC. CONCLUSION Increased incidence of OSSN was observed in males and people with outdoor occupations. Nodular type of lesion is the commonest variety. HIV positive individuals have an increased incidence of OSSN with invasive characteristics. Hence, ophthalmologists need to be aware of this association and a thorough workup is warranted for all patients presenting with OSSN, especially in the younger age group. Our study Also suggests that OSSN may be the first manifestation of underlying HIV infection.
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Affiliation(s)
- Padma Prabha Dandala
- Assistant Professor, Department of Ophthalmology, Osmania Medical College , Hyderabad, India
| | - Padma Malladi
- Assistant Professor, Department of Ophthalmology, Osmania Medical College , Hyderabad, India
| | - Kavitha
- Assistant Professor, Department of Pathology, Osmania Medical College , Hyderabad, India
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40
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Asena L, Dursun Altınörs D. Topical Bevacizumab for the Treatment of Ocular Surface Squamous Neoplasia. J Ocul Pharmacol Ther 2015; 31:487-90. [PMID: 26114378 DOI: 10.1089/jop.2014.0158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine the efficacy and safety of topical bevacizumab treatment in patients with ocular surface squamous neoplasia (OSSN). METHODS Six eyes of 6 patients with primary OSSN confirmed by impression cytology received topical 5 mg/mL bevacizumab 4 times daily for a period of 8 weeks. Patients were evaluated in 2-week intervals. Digital photography images were obtained at each visit and changes in the size of the lesions were analyzed by image analysis software. RESULTS The mean age of the patients was 66 ± 13 (± SD) years. Four tumors were nasal in origin and 2 tumors were temporal. The mean reduction observed in the lesion area was 43% ± 24.2% (range, 20%-71%) in the first month and 68% ± 29.7% (range, 42%-100%) in the second month when compared with the baseline area. Four patients required tumor excision at the end of the treatment period. Surgical treatment was not necessary in 2 patients due to complete disappearance of the tumor, which was confirmed by impression cytology. The visual acuity was stable in all patients and no systemic or visual side effects were observed during the study period. CONCLUSIONS Topical bevacizumab is effective as a neoadjuvant therapy combined with surgical excision for the treatment of OSSN. Topical bevacizumab may be used before surgery to decrease the size of the excision. Excision may be unnecessary in responsive patients.
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Affiliation(s)
- Leyla Asena
- Department of Ophthalmology, Faculty of Medicine, Başkent University , Ankara, Turkey
| | - Dilek Dursun Altınörs
- Department of Ophthalmology, Faculty of Medicine, Başkent University , Ankara, Turkey
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Evisceración modificada en un caso de carcinoma epidermoide invasivo de conjuntiva. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Asnaghi L, Alkatan H, Mahale A, Othman M, Alwadani S, Al-Hussain H, Jastaneiah S, Yu W, Maktabi A, Edward DP, Eberhart CG. Identification of multiple DNA copy number alterations including frequent 8p11.22 amplification in conjunctival squamous cell carcinoma. Invest Ophthalmol Vis Sci 2014; 55:8604-13. [PMID: 25491297 DOI: 10.1167/iovs.14-14920] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Little is known about the molecular alterations that drive formation and growth of conjunctival squamous cell carcinoma (cSCC). We therefore sought to identify genetic changes that could be used as diagnostic markers or therapeutic targets. METHODS The DNA extracted from 10 snap-frozen cSCC tumor specimens and 2 in situ carcinomas was analyzed using array-based comparative genomic hybridization (aCGH), and further examined with NanoString and quantitative PCR. RESULTS The number of regions of DNA loss ranged from 1 to 23 per tumor, whereas gains and amplifications ranged from 1 to 15 per tumor. Most large regions of chromosomal gain and loss were confirmed by NanoString karyotype analysis. The commonest alteration was amplification of 8p11.22 in 9 tumors (75%), and quantitative PCR analysis revealed 100-fold or greater overexpression of ADAM3A mRNA from 8p11.22 locus. In addition, recurring losses were observed at 14q13.2 and 22q11.23, both lost in 5 (42%) of the 12 tumors, and at 12p13.31, lost in 4 (33%) of the 12 samples. Of the eight loci associated with the DNA damage repair syndrome xeroderma pigmentosum, three showed loss of at least one allele in our aCGH analysis, including XPA (9q22.33, one tumor), XPE/DDB2 (11p11.2, one tumor) and XPG/ERCC5 (13q33.1, three tumors). CONCLUSIONS Conjunctival SCC contains a range of chromosomal alterations potentially important in tumor formation and growth. Amplification of 8p11.22 and overexpression of ADAM3A suggests a potential role for this protease. Our findings also suggest that defects in DNA repair loci are important in sporadic cSCC.
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Affiliation(s)
- Laura Asnaghi
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
| | - Hind Alkatan
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Alka Mahale
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Maha Othman
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Saeed Alwadani
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States Department of Ophthalmology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Wayne Yu
- Microarray Core Facility, Sidney Kimmel Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
| | - Azza Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Deepak P Edward
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia Department of Ophthalmology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States Department of Ophthalmology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
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