Conjunctival Squamous Cell Carcinoma with Corneal Stromal Invasion in Presumed Pterygia: A Case Series

Mendoza, Pia R.; Craven, Caroline; Ip, Matthew H.; Wilson, Matthew W.; Coroneo, Minas T.; Grossniklaus, Hans E.

doi:10.1159/000485425

Cited by 11 publications

(4 citation statements)

References 43 publications

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“…The local invasion was seen across the lesion categories through corneal involvement and adhesion to the underlying sclera. Pterygia though considered as degenerative lesions with no malignant potential [20, 40] share similar features with OSSN lesions with regard to site of development, clinical features, etiologic factors, and propensity to invade with high recurrence rates following excision [41, 42]. Unlike preinvasive lesions, invasive OSSN and advanced lesions were easily distinguished from benign lesions by size and a greater tendency to extend to the adjacent structures.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

et al. 2021

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Aim: 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. Methods: 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. χ2 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. Results: 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 (p = 0.007), redness (p = 0.034), excessive tearing (p = 0.0001), discharge (p = 0.011), bleeding (p = 0.007), reduced vision (p = 0.0001), fungating lesion (p = 0.001), and blindness (p = 0.005); location at temporal limbus (p = 0.0001), inferior limbus (p = 0.0001), or circumlimbal (p = 0.001); and extension to cornea (p = 0.006) and forniceal palpebral conjunctiva (p = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (p = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; p = 0.0001; phi: 0.237 [p = 0.0001]). Conclusion: 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.

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Section: Discussionmentioning

confidence: 99%

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

et al. 2021

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“…SND, along with other ocular surface diseases, can mask typical symptoms and slit-lamp findings of ocular surface squamous neoplasia (OSSN), thus making it more difficult to diagnose this condition 8. There have been a number of reports in the literature of OSSN discovered incidentally on biopsy, including in suspected SND 8,44. In one study, HR-OCT identified concomitant SND and OSSN in an individual prior to surgical removal.…”

Section: Snd and Co-morbid Ocular Surface Diseasesmentioning

confidence: 99%

Salzmann nodular degeneration: prevalence, impact, and management strategies

Paranjpe

Monsalve

Dubovy

et al. 2019

OPTH

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Purpose This review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases. Method PubMed review of 44 articles published between 1976 and 2018. Results SND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman’s layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithelial–stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules – primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokeratectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0–31%). Conclusion The pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.

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“…Based on histopathological findings from a subset of “atypical” pterygiums, a careful histopathological review of all excised lesions is recommended. Moreover, as demonstrated by the growing number of case reports in the literature where presumed pterygiums were found to be more serious, neoplastic processes advocate for a careful histopathological assessment of all pterygiums [ 5 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series

Bergeron

Ito

Dossous

et al. 2021

Journal of Ophthalmology

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Pterygium is a common lesion consisting of fleshy conjunctival growth extending towards the cornea. There is no documented risk of malignant transformation; however, concomitant disease is not rare, and its link to sunlight exposure indicates a risk of other malignancies. The purpose of our study is to describe histopathological features of resected pterygiums and to recognize patients at risk of other conjunctival diseases. One hundred and forty-nine formalin-fixed and paraffin-embedded pterygium samples were subjected to histopathological analysis. Histological H&E sections were obtained and digitalized using a Zeiss Axio Scan.Z1 slide scanner. Thirteen predefined morphological features were used to record histopathological changes in the epithelium and substantia propria. Neovascularization was observed in 54% of the samples. Sun damage, comprising solar elastosis and stromal plaque, was present in 81% of the samples. Variation in epithelial thickness was the most common change, with acanthosis and atrophy being observed in 62% and 26% of the samples, respectively. In our series, 21% (31/149) of pterygiums showed mild to moderate dysplasia, a finding that may be associated to ocular surface squamous neoplasia (OSSN). Moreover, 32% (47/149) of the cases showed melanocytic hyperplasia, which could represent primary acquired melanosis (PAM). There is a positive correlation between dysplasia and chronic inflammation p = 0.012 and an inverse correlation with epithelial atrophy p = 0.001 and neovascularization p = 0.05 . Similarly, a positive correlation is observed between goblet cell hyperplasia and melanocytic hyperplasia p = 0.02 . Our findings show that pterygiums harbour histological features that may be suggestive of OSSN or PAM in 53% of our patients. Whilst being on the benign side of the spectrum, these two entities are known for their potential progression to malignancy. A recommendation is made for all surgically excised pterygiums to be sent for histopathological diagnosis, and clear guidelines for reporting of these lesions should be established. Associated histopathological findings suggestive of other concomitant diseases should be identified to insure adequate follow-up of these patients.

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Conjunctival Squamous Cell Carcinoma with Corneal Stromal Invasion in Presumed Pterygia: A Case Series

Cited by 11 publications

References 43 publications

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

<p>Salzmann nodular degeneration: prevalence, impact, and management strategies</p>

Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series

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