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PubMed1999

Conjunctival squamous cell carcinoma in Tanzania.

AIMS: To assess changes in incidence of conjunctival squamous cell carcinoma over a 22 year period in Tanzania and to analyse possible reasons for change. METHODS: Retrospective analysis of records from a Tanzanian pathology department serving north and central Tanzania from 1976 to 1997; medical record analysis of cases of conjunctival squamous cell carcinoma presenting in the last 2 years of the study. RESULTS: There was a sharp rise in the incidence of conjunctival squamous cell carcinoma in the last 3 years of the study (1995-7). The mean age of patients presenting with the condition over the full period was 44.7 years (95% confidence interval 42.4-46.9 years). In the final 2 years of the study the mean length of history on presentation was 3.1 months (2.1-4.0 months). Several patients had a previous history of chronic conjunctival disease such as allergic conjunctivitis and trachoma; one had had a conjunctival papilloma excised previously. Only five patients had been tested for HIV status, but of these four were positive. CONCLUSION: Tanzania is experiencing an epidemic of conjunctival squamous cell carcinoma similar to that seen in other African countries. Often the tumours are aggressive and occur in patients of relatively young age. The epidemic appears to be related to HIV infection, on a background of ultraviolet light exposure. Previous chronic conjunctival disease and exposure to human papillomavirus may also have a role.

Adolescent↗
PubMed2000

Treatment of conjunctival squamous cell carcinoma with topical 5-fluorouracil.

AIM: To evaluate the efficacy of topical 5-fluorouracil (5-FU) alone, without concurrent surgery or radiotherapy, for the treatment of conjunctival squamous cell carcinoma. METHODS: Eight patients affected by conjunctival squamous cell carcinoma (three recurrent cases, three incompletely excised, and two untreated cases) were treated with 1% 5-FU eye drops. Topical 1% 5-FU was administered four times daily for 4 weeks (one course). Clinical examination (biomicroscopy and photography) and morphological evaluation of conjunctival cytological specimens were used to monitor the efficacy of local chemotherapy, side effects, and recurrences. RESULTS: All patients showed clinical regression of conjunctival carcinoma after topical 1% 5-FU treatment. Neoplastic conjunctiva was completely replaced by normal epithelium within 3 months. Mean follow up was 27 months. One patient needed two courses of local chemotherapy for recurrent disease. An acute transient toxic keratoconjunctivitis was observed in all treated cases; it was easily controlled with topical therapy. No long term side effects were found. CONCLUSIONS: Topical 1% 5-FU is effective in the treatment of recurrent, incompletely excised, and selected untreated conjunctival squamous cell carcinomas. Topical 1% 5-FU has no major complications. This study suggests that topical conjunctival chemotherapy with 1% 5-FU may be useful, at least as adjunctive therapy, in the treatment of conjunctival squamous cell carcinoma.

Administration, Topical↗
PubMed2000

Eye cancer incidence in Singapore.

AIM: To describe the epidemiological characteristics of patients with primary intraocular, conjunctival, and orbital cancers seen in Singapore from 1968 to 1995. METHODS: Epidemiological data of all cancers diagnosed in Singapore are collected by the Singapore Cancer Registry. The data of all cases of Singapore residents with eye cancers (ICD-9, site 190) were retrieved for analysis. This includes intraocular, conjunctival, and orbital cancers but excludes cancer of the eyelids. RESULTS: There were 125 patients of which 67 (53.6%) were male and 58 (46.4%) were female. The average annual age standardised incidences for male and female Singapore residents were 1.89 and 1.81 per million respectively. The most common cancer was retinoblastoma (53.6%), followed by malignant melanoma (19.2%) and squamous cell carcinoma (11.2%). The most common cancer among patients younger than 15 years was retinoblastoma (95.7%) and that for those 15 years and older was malignant melanoma (42.6%). The most common subsite was the retina (53.6%), followed by conjunctiva (12.8%), orbit (8.8%), and lacrimal gland (6.4%). CONCLUSION: The annual age standardised incidence have been stable for the 28 years studied. Retinoblastoma is much more common than melanoma in Singapore. These expanded epidemiological characteristics serve to provide ophthalmologists and epidemiologists with a foundation to monitor future disease patterns in Singapore and provide a basis for comparison with other selected populations elsewhere.

Adolescent↗
PubMed2001

Reliability of impression cytology for the diagnosis of ocular surface squamous neoplasia employing the Biopore membrane.

AIM: To evaluate the accuracy of impression cytology employing a Biopore membrane device in the diagnosis of ocular surface squamous neoplasia (OSSN). METHODS: The histology of patients undergoing excision biopsy for the suspected diagnosis of OSSN over a 20 month period was compared with the reported cytology of impression cytology specimens obtained preoperatively using the Biopore membrane device. RESULTS: 25 excision biopsies were performed for suspected OSSN. There was accurate correlation in 20 out of the 25 cases (80%). In three cases (12%), there was poor correlation in that only a few dysplastic cells and hyperkeratosis were noted on cytology, whereas histology showed keratinising dysplasia in two cases and a moderately differentiated keratinising squamous cell carcinoma in the third. There were two cases (8%) of non-correlation--one keratinising dysplasia on histology, but anucleate keratin, squamous metaplasia, and rare atypical cells on cytology, and another case with very mild focal dysplasia on histology but squamous metaplasia on cytology. Review of the cytology showed that dysplastic cells were either rare or absent from the cytology specimens in these two cases; it was felt that these represented sampling problems rather than true false negatives. There were no false positives on cytology. Final diagnosis on histology was squamous cell carcinoma in one; carcinoma in situ in two; keratinising dysplasia in 15, non-keratinising dysplasia in seven. CONCLUSION: Impression cytology employing the Biopore membrane accurately predicts the histological diagnosis of OSSN. The presence of hyperkeratosis, inflammatory cells with only a few dysplastic cells, may indicate high grade keratinising dysplasia or squamous cell carcinoma. The method is both rapid and easy to perform in routine clinical practice. These findings suggest that there may be a role for its use in the initial assessment and follow up of patients with suspected OSSN.

Adult↗
PubMed2001

Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia.

AIM: To evaluate the efficacy of amniotic membrane transplantation (AMT) for the management of conjunctival malignant melanoma and primary acquired melanosis (PAM) with atypia. METHODS: Four consecutive patients with histologically proved invasive, primary conjunctival malignant melanoma were treated with wide surgical excision and AMT. Amniotic membrane grafts were harvested and processed under sterile conditions according to a standard protocol. The grafts were sutured to the margins of the surface defect. In one case, AMT was combined with a corneoscleral graft. RESULTS: A satisfactory result and rapid postoperative recovery with few, transient side effects was noted in three patients with limbal/epibulbar melanomas. In another patient with an extensive lesion, involving the epibulbar, forniceal, and palpebral conjunctiva, AMT following wide excision was complicated by symblepharon formation and restricted ocular motility. Monitoring of local recurrence was facilitated by the transparency of the thin graft in all cases. The postoperative follow up time varied between several months and 3 years. In one case, local recurrence of PAM was observed and treated using topical mitomycin. CONCLUSIONS: AMT is a useful technique for the reconstruction of both small and large surface defects that result from the surgical excision of conjunctival malignant melanoma and PAM. This method facilitates wide conjunctivectomy, although its role in repairing larger defects involving the fornix or palpebral conjunctiva still needs to be established. The transparency of amniotic membrane allows for monitoring of tumour recurrence, which is-together with superior cosmesis-an advantage over thicker (for example, buccal) mucous membrane grafts.

Administration, Topical↗
PubMed2001

Human papillomavirus in conjunctival papilloma.

AIM: To examine conjunctival papillomas for the presence of human papillomavirus (HPV) and koilocytosis. METHODS: Archival paraffin embedded tissue from 55 conjunctival papillomas was analysed for the presence of HPV by polymerase chain reaction and subsequent filter hybridisation. Histological sections of the 55 papillomas were evaluated for the presence of koilocytosis. RESULTS: HPV was present in 48 of 52 (92%) beta globin positive papillomas. HPV type 6/11 were found in 40 of 47 investigated papillomas and a double infection with HPV 6/11 and 16 was identified in a single papilloma. In six papillomas the HPV type could not be identified. Koilocytosis was present in 22 of 55 papillomas (40%). CONCLUSION: There is a strong association between HPV and conjunctival papillomas. HPV type 6/11 is the most common HPV type in conjunctival papilloma. The sensitivity of koilocytosis as an indicator of HPV in conjunctival papilloma is low.

Adult↗
PubMed2001

Impression cytology following mitomycin C therapy for ocular surface squamous neoplasia.

BACKGROUND/AIMS: Topical mitomycin C (MMC) therapy has been used for treatment of ocular surface squamous neoplasia (OSSN) since 1994. Relatively few studies have reported the cellular changes in ocular surface following MMC. METHODS: Impression cytology was studied in four patients with ocular surface squamous neoplasia, either primary or recurrence after previous excisional biopsy. The authors studied samples obtained using Millipore filters at intervals between 4 and 17 weeks after commencement of MMC, and compared them with pretreatment cytology. RESULTS: MMC induced changes of cytomegaly, cytoplasmic vacuolation, nucleomegaly with nuclear wrinkling, and binucleation or multinucleation were seen in some cells in all samples. However, nuclear/cytoplasmic (N/C) ratio in these enlarged cells was normal. These changes mimicked those seen following radiation therapy in uterine cervix. Changes of increased nuclear and cell size with increased N/C ratio were seen in some dysplastic cells. The predominant form of cell death was apoptosis with fewer cells showing necrosis. CONCLUSIONS: MMC appears to produce cell death in OSSN by apoptosis and necrosis. Cellular changes related to MMC mimic those caused by radiation-cytomegaly, nucleomegaly, and vacuolation. MMC related changes may persist in ocular surface epithelium for at least 8 months following MMC therapy.

Adult↗
PubMed2002

Inflamed juvenile conjunctival naevus: clinicopathological characterisation.

AIM: Inflamed juvenile conjunctival naevi (IJCN) are often erroneously suspected to be malignant because of rapid growth. Their clinical and histopathological features have not been characterised in series of patients. The aim of the study is to characterise IJCN clinically and histopathologically. METHODS: This is a retrospective non-randomised clinicopathological study. All patients younger than 20 years with conjunctival naevi which were excised between 1990 and 2000 were included. The clinical signs of the affected patients and the histopathological findings of the excised lesions were characterised. RESULTS: A total of 63 conjunctival naevi were resected. 25% of the patients had simple compound conjunctival naevi and 75% had compound naevi with prominent inflammatory histological features (discrete lymphocyte aggregates, plasma cells, and eosinophils). Epithelial cysts and solid epithelial islands were common in the IJCN. The IJCN were all located at or near the limbus, and characterised by recurrent periods of congestion and growth. 75% of the IJCN patients with complete medical records had a history of allergic disease. Marked conjunctival papillary reaction was present in all of the patients, indicating a possible conjunctival allergy. CONCLUSIONS: IJCN is a unique entity, different from simple compound conjunctival naevus. Its association with allergic conjunctivitis is suggestive, and despite periods of alarmingly rapid growth, is histologically benign.

Adolescent↗