E-POSTER

Dr Nikhil Balakrishnan (PG Student)Dr Kishor Badhe (Professor)

Dr Surekha V Bangal (Professor)

PAPPILOMATOUS SQUAMOUS CELL CARCINOMA AT THE

LIMBUS

INTRODUCTION• The average annual incidence of Squamous cell carcinoma is approximately 1 case per 700–

850 persons.

• Generally, the tumors occur in older adults.

• They affect all racial groups and both sexes.

• Risk factors include a history of repeated intense sunlight exposure, male sex, outdoor occupations, advanced age, cigarette smoking, a history of squamous cell carcinoma of the skin of the head and neck, blonde hair, light complexion, xeroderma pigmentosum, AIDS, and conjunctival infection by human papilloma virus 16 and 18.

• People with AIDS tend to develop tumors of the conjunctival and corneal SSE at a younger age. Their tumors tend to be substantially more aggressive than the typical conjunctival SCC.

• The pathogenesis of tumors appears to be disordered epithelial maturation induced by various irritants. Cytogenetic studies of conjunctival SCC have not revealed any consistent chromosomal abnormalities or gene mutations in tumor cells.

• Tumors of the conjunctival and corneal Stratified Squamous Epithelium appear most frequently as focal epibulbar lesions at the corneoscleral limbus temporally or nasally.

• When the disordered epithelial maturation involves the corneal epithelium, it frequently appears as a zone of translucent corneal epithelial clouding visible by slit-lamp biomicroscopy.

• Three morphologic patterns of Squamous Cell Carcinoma are most common.

• Other features indicative of probable malignant histology include prominent epibulbar vasculature of the lesion, corneoscleral or intraocular invasion, anterior orbital invasion, and spontaneous bleeding.

• Such tumors are regarded as malignant when they exhibit anaplasia, invasion of the substantia propria of the conjunctiva, underlying sclera or cornea, or both.

CASE REPORT• 40 year old male gives history of mass encroaching upon the cornea

of right eye temporally since one and a half year.

• Mass was gradually increasing in size and painless.

• Associated with redness and watering.

• History of allergy to dust.

• Patient was diagnosed to be HIV positive 1 year back and is on regular ART treatment (Zidovudine-Lamivudine-Nevirapine).

• Not associated with ocular trauma.

CLINICAL FEATURES• A 8x6 mm reddish brown

mass encroaching from the temporal conjunctiva onto the cornea of the right eye.(2mm on the cornea).

• Multiple dilated and tortuous feeder vessels present.

TREATMENT• Right eye temporal limbal mass was

excised under local anesthesia.

• Deep Keratectomy was performed and a deep conjunctival excision was done leaving a bare sclera.

• Cryotherapy to the bulbar conjunctiva adjacent to the incision around the lesion and to the sclera underlying the site of the excised limbal lesion was performed to reduce the likelihood of recurrence.

• Topical chemotherapy using mitomycin C (0.02%) drops were administered four times daily for 1 to 2 weeks after the corneal epithelium had healed.

HISTOPATHOLOGY• Report showed lining of Stratified

Squamous Epithelium(SSE) and a tumor arising from it and infiltrating the underlying stroma.

• Tumor Cells were arranged in a nest and scattered singly

• Individual tumor cells were enlarged, pleomorphic at places, spindle shaped with hyperchromatic, pleomorphic nuclei, irregular nuclear membrane and scanty cytoplasm.

• Abnormal mitotic figures were seen .

• Areas of hemorrhages, necrosis and infiltration by polymorphonuclear lymphoctes were seen.

POST OPERATIVE RESULTS• No symblepharon, restricted ocular

motility, or scleral melting was seen following Cryotherapy.

• Patient was followed up regularly.

• No recurrent intraepithelial neoplasia following prior excision was observed even upto 9 months following the excision.

• Preauricular lymph nodes were palpated on follow up to check for presence of metastasis.

CONCLUSION• Squamous Cell Carcinoma in patients with concurrent AIDS are

particularly likely to exhibit rapidly progressive malignant conjunctival and corneal neoplasms of the SSE and metastasis of those neoplasms.

• Patients whose conjunctival and corneal SSE tumors are excised completely by histopathological criteria are usually cured.

• Supplementation of excision with Cryotherapy and administration of Mitomycin C and 5- Fluorouracil prevents the likelihood of recurrence.

REFERENCES1. Albert and Jakobiec, Principles and Practice of Ophthalmology, 3 rd

Edition, Vol-3, Page 3584-3586.

2. Yanoff and Duker, Ophthalmology, 4th Edition, Page 196-198.

3. American Academy of Ophthalmology 2015 Edition, Page 2001.

4. www.ncbi.nlm.nih.gov>PMC1770993.

5. British Journal of Ophthalmology 2000:84: Page 268-272.