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Intraocular extension of conjunctival squamous cell carcinoma.
Ophthalmologica.
2007;221(3):200-3.
Conjunctival
squamous carcinoma, which is regarded as a low-grade malignancy,
usually originates at the limbus. Most cases remain superficial to the
sclera. Intraocular invasion is rarely reported. We describe a woman
misdiagnosed as conjunctivitis and pterygium before a clinical
diagnosis of conjunctival squamous cell carcinoma. The diagnosis was
made by histopathological examination of the biopsy specimen.
Examination revealed an elevated mass on the nasal limbus extending
intraocularly. White flaky mass occupied approximately 3/7 space of
the anterior chamber. Exenteration was performed for control of local
lesion. Histopathologic analysis confirmed that intraocular
involvement occurs through the emissary vessels near the area of
limbus. The case highlights the need for accurate diagnosis and prompt
intervention. A brief review of the clinical and histopathologic
features of conjunctival squamous cell carcinoma is also presented.
Multifocal
squamous cell carcinoma of the conjunctiva with intraocular
penetration in a patient with AIDS.Cornea.
2006 Jul;25(6):745-7.
PURPOSE: To
describe the clinical findings and to study the histopathology of
conjunctival masses in a patient with HIV infection. METHODS: A case
report. RESULTS: The histopathology from a 38-year-old Thai female
patient who presented with visual loss on the left eye was studied.
She had been diagnosed with AIDS 3 years before and was treated with
highly active antiretroviral therapy and anti-tuberculous drugs for 1
year. The left eye was blind and showed 2 separate whitish masses on
the bulbar conjunctiva in adjacent to the inferomedial limbus.
Multiple nodules under the conjunctiva were seen inferiorly.
Computerized tomography of the orbit revealed slight thickening of the
left lower eyelid but could not show any globe involvement. The
patient underwent orbital exenteration. Gross pathology showed
multiple areas of the tumor. Histopathology revealed dysplastic
squamous epithelium invading into the substantia propria of the
conjunctiva with intraocular penetration. The anterior surface of the
iris was filled with tumor cells containing keratin pearls.
CONCLUSION: Squamous cell carcinoma can be multifocal and aggressive
in HIV-infected patients. Rapid progression to intraocular penetration
can be observed.
Conjunctival
squamous cell carcinoma in patients with human immunodeficiency virus
infection seen at two hospitals in Kenya.East
Afr Med J. 2006 May;83(5):267-70.
OBJECTIVE: To
estimate the prevalence and pattern of conjuctival squamous cell
carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital
based cross sectional study. SETTING: Kenyatta National Hospital (KNH)
and Kikuyu Eye Unit (KEU) during the period November 2003 and May
2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS:
Four hundred and nine HIV positive patients aged 25 to 53 years were
screened. Male to Female ratio was 1:1. One hundred and three had
conjunctival growths. Thirty two had histologically proven conjunctiva
squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV
positive patients was 7.8%. The average duration of growth of the
conjunctival masses was 21.8 months. The average size of the lesions
at the time of presentation was 6.6 mm. Twenty two (68.8%) patients
had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern
of the histopathology results was: fifteen (46.9%) patients had poorly
differentiated squamous cell carcinoma; nine (28%) had moderately
differentiated squamous cell carcinoma; five patients (15.6%) had CIN;
two patients (6.3%) had dysplasia and one patient (3.1%) had a well
differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of
CSCC in HIV/AIDS patients was 7.8%. Patients present late with
advanced lesions. Recurrence rates from previous surgery are high. The
often uncharacteristic complaints and findings on presentation
complicate the clinical diagnosis. Active search for early
manifestations of CSCC in HIV / AIDS patients, complete surgical
excision and close follow up is necessary. Alternative treatment
methods and techniques like the topical use of antimetabolites should
be explored further.
Conjunctival squamous cell carcinoma of the orbit 40 years after
enucleation.Ophthal
Plast Reconstr Surg. 2006
Jul-Aug;22(4):299-301.
Conjunctival
squamous cell carcinoma developed in a 51-year-old man 40 years after
he had enucleation of his left eye because of an explosion injury. He
had worn several ocular prostheses for more than 40 years. Recently he
had noticed an increasing sanguineous conjunctival discharge, a
foreign body sensation, and swelling of his left lower eyelid.
Incisional biopsies of an underlying conjunctival mass revealed
squamous cell carcinoma. His work history did not involve exposure to
radiation, chemicals, or the sun. The authors concluded that squamous
cell carcinoma in this case was caused by chronic irritation as the
result of long-standing use of a poorly fitting ocular prosthesis.
Expression of
cell cycle-regulatory proteins, MIB-1, p16, p53, and p63, in squamous
cell carcinoma of conjunctiva: not associated with human
papillomavirus infection.Virchows
Arch. 2006 Mar;448(3):301-5.
Squamous cell
carcinoma (SCC), the most common primary malignant tumor of the
conjunctiva, has a variable clinical presentation and
immunohistochemical profile. Abundant cell cycles exist, including
MIB-1 (Ki67 antigen), p16, p53, and p63, within the conjunctiva SCC.
This investigation first reports the expressions of cell cycle markers
in SCC. A retrospective study was conducted between December 1976 and
June 2004, comprising 13 consecutive patients with conjunctiva SCC who
were treated with surgical excision. Detailed clinical parameters were
also reviewed. Overexpression of MIB-1, p16, p53, and p63 genes were
studied by immunohistochemistry. Genechip containing 39 subtypes was
used to elucidate human papillomavirus (HPV). The study group
contained 13 (100%) men, with a mean age of 68+/-18 years and
follow-up period of 20+/-17 months. The sample included four (33%) SCC
located in the left eye and two (17%) recurrent SCC. Overexpression of
the p53 and p63 was considerably higher than that of the p16 (P<0.01).
HPV DNA was not detected in any of the 13 cases. This work first
examined the immunohistochemical overexpression of cell cycle (MIB-1,
p16, p53, and p63) in SCC. This investigation then showed that the
expression of cell cycles in SCC was associated with key tumor
clinicopathological features. This approach can help distinguish the
potential roles of cell cycle in the development of SCC.
Squamous cell
carcinoma of the eyelid arising from palpebral conjunctiva.Eur
J Dermatol. 2006 Mar-Apr;16(2):187-9.
We reported a
58-year-old Japanese man with squamous cell carcinoma (SCC) of the
left upper eyelid arising from the palpebral conjunctiva. The tumor
had been incised by a former doctor under the diagnosis of chalazion.
Histopathological examination of the relapsed tumor revealed atypical
squamous cells invading towards the eyelid skin from the epithelium of
palpebral conjunctiva. We performed a total resection of the tumor and
reconstructed the upper eyelid by the technique of Mustarde's switch
flap. During 10 months of follow-up, neither local recurrence nor
metastasis has been detected and the reconstructed eyelids showed good
course in function and in appearance. SCC of the palpebral conjunctiva
is quite rare, however, it often resembles chronic conjunctivitis or
chalazion. It is important to consider the possibility of SCC in
addition to sebaceous carcinoma when we see a patient with an eyelid
lesion, even one which looks like a benign condition such as chronic
conjunctivitis or chalazion.
Expression of the
epidermal growth factor receptor in conjunctival squamous cell
carcinoma.Ophthal
Plast Reconstr Surg. 2006
Mar-Apr;22(2):113-5.
PURPOSE: To
determine whether the tyrosine kinase epidermal growth factor receptor
(EGFR) is expressed in squamous cell carcinoma of the conjunctiva.
METHODS: A retrospective, observational case series of 5 patients with
biopsy-proven conjunctival squamous cell carcinoma treated at one
institution between January 1996 and April 2004. Medical records and
tissue specimens from the 5 patients were reviewed. A control specimen
of normal conjunctiva was also obtained from one of the 5 patients.
Immunohistochemical analysis was performed using antibodies against
EGFR. RESULTS: Immunohistochemical staining showed that EGFR
expression was moderate to strong in all tissue specimens, both in the
normal mucosa and in the in situ and invasive components of the
conjunctival squamous cell carcinomas. CONCLUSIONS: An intense
expression of EGFR occurs in squamous cell carcinoma of the
conjunctiva. Further study is needed to determine whether an EGFR
inhibitor that targets this expression would have potential
therapeutic benefit in treating squamous cell carcinoma of the
conjunctiva.
Conjunctival
squamous cell carcinoma with perineural invasion resulting in death.Ophthalmic
Surg Lasers Imaging. 2005
May-Jun;36(3):249-51.
Conjunctival squamous cell carcinoma is generally a low-grade
malignancy. A 42-year-old man presented with histologic evidence of
extra-tumoral perineural invasion associated with an incompletely
excised limbal conjunctival squamous cell carcinoma. Despite further
surgery, close observation, plaque radiotherapy, and eyelid-sparing
orbital exenteration followed by external beam radiotherapy, the
patient developed intracranial perineural invasion with involvement of
the trigeminal and facial nerves, ultimately resulting in death.
Repeated magnetic resonance imaging with contrast failed to detect
perineural invasion until late in the course of disease. Awareness of
the possibility of perineural invasion in patients with conjunctival
squamous cell carcinoma and of its aggressive nature may be
life-saving. Nevertheless, even with initial aggressive tumor control,
some patients will show an aggressive tumor growth with recurrences.
Immunolocalization of the Epstein-Barr nuclear antigen-1 in
conjunctival squamous carcinomas and dysplasias.Hum
Pathol. 2005 Apr;36(4):325-9.
Epstein-Barr
virus (EBV) has been linked etiologically to infectious mononucleosis,
some non-Hodgkin as well as Hodgkin lymphomas, and lymphoepithelioma-like
carcinomas. Moreover, various EBV antigens have been identified by a
variety of techniques in a number of visceral carcinomas including
breast, prostate, colon and lung primaries. We have now demonstrated
by immunohistochemistry the presence of EBV nuclear antigen-1 (EBNA-1)
in 4 of 15 cases of conjuntival squamous carcinomas and related
dysplasias. At present, there is no significant evidence linking
etiologically EVB to this type of tumor and dysplasia. However, our
findings merit further investigation given the growing evidence that
EBV may enhance proliferation and aggressiveness of tumor systems as
well as the immortalization of non-neoplastic cells.
Differentiation
of pigmented conjunctival squamous cell carcinoma from melanoma. Ophthalmic
Surg Lasers Imaging. 2003
Sep-Oct;34(5):406-8.
A 69-year-old man
developed a pigmented conjunctival tumor that had a papillomatous
vascular configuration but no leukoplakia. Although the pigmentation
suggested melanoma clinically, histopathologic study of the resected
lesion disclosed squamous cell carcinoma, with scattered dendritic
melanocytes in the tumor. Conjunctival squamous cell carcinoma can be
pigmented, similar to melanoma. The papillomatous arrangement of blood
vessels in such tumors should strongly suggest squamous cell carcinoma
despite the absence of leukoplakia.
Risk
factors for conjunctival squamous cell neoplasia: a matched
case-control study.Br
J Ophthalmol. 2003 Apr;87(4):396-8.
AIMS: To identify
roles of human papillomavirus (HPV) infection and solar elastosis as
the risk factors for conjunctival squamous cell neoplasia (CSCN).
METHODS: 30 consecutive pathological specimens, ranging from
conjunctival intraepithelial neoplasia, carcinoma in situ, to invasive
squamous cell carcinoma were retrieved from tissue archives. 30
controls were disease free conjunctiva from age and sex matched
patients undergoing extracapsular cataract extraction. Two masked
pathologists studied haematoxylin and eosin stains on paraffin
embedded conjunctival tissues. Elastic stain for solar elastosis was
blindly interpreted in comparison with negative and positive controls.
HPV infection was studied by polymerase chain reaction and dot
hybridisation. RESULTS: The mean age of CSCN patients was 54.9 years.
The male to female ratio was 1:1. Solar elastosis was seen in 53.3% of
CSCN and in 3.3% of controls with an odds ratio of 16.0 (95% CI, 2.49
to 670.96; p value = 0.0003). HPV DNA were not detected in any of the
specimens. CONCLUSION: Solar elastosis is much more frequently found
in CSCN cases than in their matched controls and is a risk factor for
CSCN. These data are insufficient to conclude that HPV infection is a
risk factor for CSCN.
Squamous cell
carcinoma of the conjunctiva: clinicopathological features in 287
cases.Can
J Ophthalmol. 2002 Feb;37(1):14-9.
BACKGROUND:
Squamous cell carcinoma is the most frequently encountered malignant
tumour of the conjunctiva. The objective of this study was to describe
the clinicopathological features of patients with squamous cell
carcinoma of the conjunctiva seen at a large ophthalmologic hospital
in Mexico City. METHODS: We reviewed the clinical and pathological
files of all patients with documented squamous cell carcinoma of the
conjunctiva seen at the hospital between 1957 and 1996. RESULTS: A
total of 287 cases (286 patients) were reviewed. The mean age of the
patients was 60.4 (range 12 to 99) years; 55% were male. The clinical
diagnosis was accurate in 41% of cases. Typical keratinized squamous
cell carcinoma of the conjunctiva accounted for 98% of the lesions,
and there were small numbers of histologic variants: lymphoepithelioma-like
carcinoma (three cases), spindle cell carcinoma (two cases) and
mucoepidermoid carcinoma (one case). Evidence of local extension of
the tumour was found in 150 patients (52%), with the cornea being most
frequently involved (108 cases [38%]). Regional metastasis was found
in two patients, to a submandibular lymph node in one and to a
preauricular lymph node in the other. The most common form of
treatment was local resection (258 cases [90%]). The mean length of
follow-up was 7.7 (range 2 to 24) months. The recurrence rate was
5.2%. INTERPRETATION: We report a large series of patients with
squamous cell carcinoma of the conjunctiva. The incidence of local
extension was high. Three cases of lymphoepithelioma-like carcinoma, a
variant not previously reported in the conjunctiva, were encountered
and were confirmed by immunohistochemical reactions.
Squamous cell carcinoma
of the conjunctiva: a series of 26 cases.Br
J Ophthalmol. 2002 Feb;86(2):168-73.
AIM: To
retrospectively study 26 patients with squamous cell carcinoma (SCC)
of the ocular surface to determine pathological and clinical
characteristics of tumour associated with outcome. METHODS: Patients
with conjunctival SCC from St Vincent's Hospital and the private
ophthalmology practices of the authors were reviewed. RESULTS: Patents
were usually male (77%), elderly (69% > 60 years of age), with most
lesions (81%) occurring at the limbus. Seven patients (27%) suffered
recurrent ocular surface squamous neoplasia (OSSN) within 4-15 months
and two of these patients (8%) died of metastatic disease. Intraocular
invasion was noted in three patients (11%), while corneal and/or
scleral invasion was found in eight (30%). Orbital invasion was noted
in four patients (15%). Six required orbital exenteration.
Preoperative impression cytology of five patients with minimally
invasive disease showed OSSN in four (80%). In situ carcinoma could
not be differentiated from minimally invasive disease using impression
cytology. Preoperative diagnosis of SCC was made in 35% of cases.
Clinical accuracy was higher for larger lesions (>10 mm) and those
with hyperkeratosis. CONCLUSIONS: Conjunctival SCC occurs in sun
damaged ocular surface, usually at the limbus in elderly men.
Recurrence of OSSN is common with significantly increased risk for
older patients, lesions of large diameter, high proliferation index
(Ki-67 score), and positive surgical margins. Orbital exenteration may
be required for control of local disease and death from metastatic
disease occurs in a small percentage of patients.
Sclerokeratitis:
an unusual presentation of squamous cell carcinoma of the conjunctiva.Ophthalmology.
2001 Mar;108(3):553-8.
OBJECTIVE: To
describe three cases of squamous cell carcinoma of the conjunctiva
presenting with corneal and scleral inflammation, thinning, and
perforation without any tumor formation. DESIGN: Three case reports.
PARTICIPANTS: Three male subjects aged 76, 66, and 61 years.
INTERVENTION: The subjects had symptoms of external ocular
inflammation with focal corneal or scleral thinning and inflammation,
as well as interstitial keratitis in two cases. Initial diagnosis of
sclerokeratitis with limbal thinning was made in all three in addition
to a pterygium in case 2. MAIN OUTCOME MEASURES: Diagnosis of the
carcinoma was delayed for 2 to 24 months in two cases, whereas case 2
was diagnosed on excision of a pterygium from the involved area.
RESULTS: All subjects developed intraocular extension after further
scleral thinning and perforation without tumefaction. CONCLUSIONS:
Squamous cell carcinoma of the conjunctiva may be seen without a
distinct mass and can masquerade as sclerokeratitis, scleromalacia, or
interstitial keratitis. It seems that diffuse growth with inflammation
leads to thinning, necrosis, and perforation of the ocular wall with
resultant intraocular spread. Squamous cell carcinoma should be
considered in the differential diagnosis of corneal and scleral
thinning, perforation, and inflammation of unknown cause, especially
in the older male subject.
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