Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

Abstract

<b><i>Aim:</i></b> This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians. <b><i>Methods:</i></b> Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ<sup>2</sup> and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer’s V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance. <b><i>Results:</i></b> In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33–41) years (ranges 18–81). Patients with invasive OSSN were more likely to present with pain (<i>p</i> = 0.007), redness (<i>p</i> = 0.034), excessive tearing (<i>p</i> = 0.0001), discharge (<i>p</i> = 0.011), bleeding (<i>p</i> = 0.007), reduced vision (<i>p</i> = 0.0001), fungating lesion (<i>p</i> = 0.001), and blindness (<i>p</i> = 0.005); location at temporal limbus (<i>p</i> = 0.0001), inferior limbus (<i>p</i> = 0.0001), or circumlimbal (<i>p</i> = 0.001); and extension to cornea (<i>p</i> = 0.006) and forniceal palpebral conjunctiva (<i>p</i> = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (<i>p</i> = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; <i>p</i> = 0.0001; phi: 0.237 [<i>p</i> = 0.0001]). <b><i>Conclusion:</i></b> OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.

Histopathological Patterns of Ophthalmic Lesions and Associated Factors in Jimma University Medical Center, Jimma, South West Ethiopia: a 5-year Retrospective Cross-sectional Study, 2021

“…Regarding the presentation of illness a growth of mass was the commonest accounting for 72% of all cases followed by foreign body sensation and proptosis. This nding is in alignment with a study from Zambia (17) and in contrary to the nding from Kano, Nigeria (18) and Malaysia (15) that showed that leukocoria and proptosis as prominent symptoms. This discrepancy from the current study stems from the later researches having a predominance of an intraocular location while conjunctival tumors are entertained more in the current study.…”

Epstein–Barr Virus, But Not Human Papillomavirus, Is Associated With Preinvasive and Invasive Ocular Surface Squamous Neoplasias in Zambian Patients

“…We collected blood samples from all the patients for HIV, CD4, and plasma HIV viral load (VL) testing at recruitment, described previously ( 26 ). Most patients tested HIV positive (n = 177, 72.8%) ( Table 1 ).…”

“…The University of Zambia Biomedical Research Ethics Committee (UNZABREC IRB # 015-05-17), the Zambia National Health Research Authority, and the University of Nebraska-Lincoln’s Institutional Review Board (IRB # 20170817442FB) approved this study. Using a cross-sectional study design ( Figure 1 ), we prospectively recruited patients 18 years and older who presented with an ocular surface tumor at the University Teaching Hospital in Lusaka, Zambia, between November 2017 and March 2020, as previously described ( 26 ). Consenting patients with a diagnosis of preinvasive and invasive OSSN and with adequate FFPE tissue for immunohistochemistry (IHC) were included in this analysis.…”

“…Clinical staging of the tumors followed the eighth edition of the American Joint Committee on Cancer Staging manual (2018) ( 27 ). Following clinical assessment and histologic confirmation of OSSN diagnosis, tumor samples were collected and processed as previously described ( 26 ). Two pathologists reviewed and examined hematoxylin and eosin (H&E)- and mucicarmine-stained slides.…”

Molecular markers of the progression of conjunctival neoplastic epithelial lesions and its correlation with P16 and HPV expression

“…Squamous cell carcinoma of the conjunctiva is the end-stage of a spectrum of disease referred to as ocular surface squamous neoplasia (OSSN). 2,5 Some conjunctival tumours are directly related to excessive exposure to the sun. Others, such as conjunctival squamous neoplasia (CoIN), have been found to be related to infection by human papillomavirus and HIV.…”