Conjunctival squamous cell carcinoma in patients with Human Immunodeficiency Virus infection seen at two hospitals in Kenya

Abstract

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.

Intraepithelial and invasive squamous neoplasms of the conjunctiva in Ibadan, Nigeria: a clinicopathological study of 46 cases

“…The observation in this study that 51% of patients with invasive SCC were females is in contrast to studies from the industrialised nations of the world where up to 65-77% of patients affected are males [7,23,40]. The culture in our environment where women are usually outdoor traders and workers with long hours of exposure to sunlight during the day and are therefore apt to suffer actinic damage in the conjunctiva might account for this.…”

Elevated risk for squamous cell carcinoma of the conjunctiva among adults with AIDS in the United States

“…5 MSM have an elevated prevalence of high-risk HPV types and HPV-associated anal cancers, but we did not find a higher risk for SCCC among MSM compared to the other HIVexposure groups. Cutaneous HPV types (e.g., HPV 5,8,[19][20][21][22][23][24][25] and 36-38) have also been proposed to be etiologically important, given their postulated role in nonmelanoma skin cancer, 20 but they are too prevalent to play a determining role in a disease as rare as SCCC.…”

The Role of Infectious Agents in the Etiology of Ocular Adnexal Neoplasia

“…172 A case series from Kenya documented a prevalence of 7.8% among HIV positive patients. 38 Incidence of squamous cell carcinomas has been shown to be increasing in sub-Saharan African countries including Zimbabwe, where one study notes a nine-fold increase in cases over a 5-year period. 39 Pola and colleagues in Zimbabwe reported an increase of prevalence of conjunctival squamous cell carcinoma among tumors of the conjunctiva, increasing from 33% in 1996 to 57.9% in 2000; the prevalence was higher in women than men.…”