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Knutsson KA, Tombolini B, Paganoni G, Rama P, Bandello F. Unusual presentation of ocular surface squamous neoplasia in a young healthy patient: A case report. Eur J Ophthalmol 2024:11206721241256150. [PMID: 38780357 DOI: 10.1177/11206721241256150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE To report an unusual case of ocular surface squamous neoplasia (OSSN) associated with human papilloma virus (HPV)-16 infection with an atypical morphology in a young otherwise healthy patient. CASE DESCRIPTION A 17 year-old healthy male was referred to our department for evaluation of a corneal infiltrate with anterior stromal neovascularization in the right eye. One year before, the patient underwent an excision of a corneo-conjunctival lesion that was located inferiorly in the same eye. Histopathological analysis had shown moderate and severe dysplasia of the conjunctival epithelium and resulted positive for HPV-16. We performed a diagnostic incisional biopsy of the limbal conjunctiva and of the corneal epithelium for histological examination and molecular testing for HPV and Chlamydia by using polymerase chain reaction (PCR). Histopathologic evaluation demonstrated low-grade dysplasia of conjunctiva. PCR testing of the corneal epithelium was positive for HPV-16, similarly to the first biopsy performed by another centre. The patient was successfully treated with topical interferon alfa-2b (1,000,000 IU/ml) for a total of six months. After the treatment, the corneal infiltrate improved dramatically with regression of neovascularization and improvement of corneal transparency and vision. DISCUSSION The present report described an atypical presentation of HPV-related OSSN due to its unusual morphology, young age of onset and absence of associated comorbidity. CONCLUSION Conservative treatment with topical interferon-alpha 2b could be used to treat successfully HPV-16 positive OSSN, with no corneal irregularity or potential loss of vision compared to surgical excision.
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Affiliation(s)
- Karl Anders Knutsson
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Tombolini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Paganoni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Department of Ophthalmology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gurnani B, Kaur K. Molecular and epigenetic mechanisms governing ocular surface squamous neoplasia: opportunities for diagnostics. Expert Rev Mol Diagn 2023:1-15. [PMID: 38131180 DOI: 10.1080/14737159.2023.2298681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) is the most common ocular malignancy; the pathophysiology is influenced by molecular, genetic, and epigenetic mechanisms. The incidence of OSSN is associated with the anatomy and physiology of the ocular surface, limbal stem cell configuration, limbal vulnerability, cancer stem cells, dysplasia, neoplasia, angiogenesis, invasion, and metastasis. The key etiological factors involved are human papillomavirus (HPV), human immunodeficiency virus (HIV), immunosuppression, p53 tumor suppressor gene, hypovitaminosis A, and failure of Deoxyribonucleic acid (DNA) repair mechanisms. AREAS COVERED This special report is a focussed attempt to understand the molecular mechanism, genetic and epigenetic mechanism, and diagnostic modalities for OSSN. EXPERT OPINION While these mechanisms contribute to genome instability, promoter-specific hypermethylation might facilitate and promote tumor formation by silencing tumor suppressor genes. OSSN understanding has improved with increased literature available on various genetic, molecular, and epigenetic mechanisms, although the exact genetic and epigenetic mechanisms still need to be elucidated. It is important to note that the molecular mechanisms of OSSN can vary among individuals, and further research is required to elucidate the underlying processes fully. Understanding these mechanisms is crucial for the development of targeted therapies and improved management of OSSN.
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Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, Refractive Services, Trauma, External Diseases, Contact Lens and Ocular Surface, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
| | - Kirandeep Kaur
- Children Eye Care Centre, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, India
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Walia JY, Harocopos GJ, Hong AR. High-risk human papillomavirus-associated corneal/conjunctival intraepithelial neoplasia in a young patient. Am J Ophthalmol Case Rep 2023; 32:101942. [PMID: 37877005 PMCID: PMC10590763 DOI: 10.1016/j.ajoc.2023.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
Purpose To report a case of high-risk human papillomavirus (HPV)-associated corneal/conjunctival intraepithelial neoplasia (CIN) in a 17-year-old fair-skinned male with no other risk factors. Observations A 17-year-old Caucasian male presented with an 18-month history of left eye pain, redness, itchiness, and decreased vision. Examination revealed a leukoplakic nasal limbal/peripheral corneal lesion resistant to topical antibiotic and anti-inflammatory treatments. Excisional biopsy confirmed the diagnosis of CIN, and RNA in situ hybridization testing for high-risk HPV types 16/18 was positive. Subsequent testing of the patient for human immunodeficiency virus (HIV) returned negative. Conclusions and Importance The median age of CIN diagnosis in the United States is in the sixth decade of life and is usually associated with a history of ultraviolet (UV) light exposure. There are reports of CIN in young patients with systemic immunodeficiency, immunosuppression, xeroderma pigmentosum, atopic dermatitis, asthma, and vaping. Here we present a case of high-risk HPV-associated CIN in a young, fair-skinned patient with no other identifiable risk factors.
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Affiliation(s)
- Jessica Y. Walia
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - George J. Harocopos
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Augustine R. Hong
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Quhill H, Magan T, Thaung C, Sagoo MS. Prevalence of co-existent neoplasia in clinically diagnosed pterygia in a UK population. Eye (Lond) 2023; 37:3757-3761. [PMID: 37237231 PMCID: PMC10697954 DOI: 10.1038/s41433-023-02594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) and pterygia share risk factors and co-exist in only a minority of cases. Reported rates of OSSN in specimens sent as pterygium for histopathological analysis vary between 0% and nearly 10%, with the highest rates reported in countries with high levels of ultraviolet light exposure. As there is a paucity of data in European populations, the aim of this study was to report the prevalence of co-existent OSSN or other neoplastic disease in clinically suspected pterygium specimens sent to a specialist ophthalmic pathology service in London, United Kingdom. METHODS We performed a retrospective review of sequential histopathology records of patients with excised tissue submitted as suspected "pterygium" between 1997 and 2021. RESULTS In total, 2061 specimens of pterygia were received during the 24-year period, with a prevalence of neoplasia in those specimens of 0.6% (n = 12). On detailed review of the medical records of these patients, half (n = 6) had the pre-operative clinical suspicion of possible OSSN. Of those cases without clinical suspicion pre-operatively, one was diagnosed with invasive squamous cell carcinoma of the conjunctiva. CONCLUSION In this study, rates of unexpected diagnoses are reassuringly low. These results may challenge accepted dogma, and influence future guidance for the indications for submitting non-suspicious pterygia for histopathological analysis.
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Affiliation(s)
- Hibba Quhill
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Ocular Oncology Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Tejal Magan
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Thaung
- Department of Eye Pathology, UCL Institute of Ophthalmology, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Nergiz D, Süren E, Süren D. The role of HPV in the etiopathogenesis of pterygium and the relationship with recurrence. Int Ophthalmol 2023; 43:3793-3801. [PMID: 37422852 DOI: 10.1007/s10792-023-02791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The primary aim of this study was to determine the prevalence of HPV in pterygium with polymerase chain reaction (PCR) testing and to investigate the relationship with clinicopathological factors. A secondary aim was to evaluate the relationship between HPV and the recurrence of pterygium. METHODS The study included 60 patients. PCR analysis was used to determine the presence of HPV. All the patients were followed up in respect of the development of recurrence. Analyses were performed of patient age, pterygium site, specimen and pterygium size, histopathological findings, HPV status, operation technique and postoperative follow-up findings. In the HPV-positive patients, the relationship between HPV subtypes and other factors was evaluated. To determine the risk factors affecting recurrence rates, multivariate Cox regression analysis was applied subsequent to univariate analysis. In the Cox regression model, HPV status, age, sex, specimen size, size and site of pterygium were included among factors that may affect recurrences rates. RESULTS Of the total 60 patients, the HPV-PCR test result could not be analysed in 14 because of an insufficient sample. Of the 46 patients with sufficient material for HPV-PCR analysis, the HPV-PCR result was positive in 15 (32.6%). The HPV subtype most often determined was type 16. No statistically significant relationship was determined between HPV positivity and HPV subtype and age or sex. Recurrence was determined in 10% of all the patients. Of the cases determined with recurrence, 66.7% were HPV positive. According to Kaplan-Meier analysis, the recurrence rates in HPV-positive and HPV-negative patients were 26.7% and 6.5%, respectively. A statistically significant difference was found between two groups in terms of recurrence rates (p: 0.046). According to the results of multivariate Cox regression analysis, though not statistically significant, the risk of recurrence was increased 6.18 times in HPV-positive patients with pterygium compared to HPV-negative ones. CONCLUSION HPV infection may have a role in the development of pterygium and recurrence, but may not be sufficient alone. HPV probably has a role in the development of pterygium by acting together with several co-factors in the multi-stage process.
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Affiliation(s)
- Döndü Nergiz
- Department of Pathology, Antalya Training and Research Hospital, Kazım Karabekir Street, 07050, Muratpaşa, Antalya, Turkey.
| | - Elçin Süren
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Dinç Süren
- Department of Pathology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
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Effectiveness and safety of injectable human papilloma virus vaccine administered as eyedrops. Vaccine 2023; 41:92-100. [PMID: 36402660 DOI: 10.1016/j.vaccine.2022.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022]
Abstract
Mucosal vaccines have the advantages of ease of administration and the induction of strong mucosal immunity and a systemic immune response. Recently, the eye mucosa has been shown to be an effective and safe alternative vaccination route against influenza, Toxoplasma gondii infection, and hemolytic uremic syndrome in mice. In this study, we showed that the commercially available human papilloma virus (HPV) vaccine, Cervarix, induced significant immune reactions in terms of anti-HPV antigen (Ag)-specific immunoglobulin G (IgG) and IgA antibody production following eyedrop (ED) vaccination in mice. The HPV ED vaccines (EDV) provoked no signs of inflammation within 24 h, as indicated by the inflammatory cytokine mRNA levels and infiltration of mononuclear cells in inoculation sites. Moreover, the morphology of the cornea and retina and intraocular pressure of mice did not change after the HPV EDV. The functions of photoreceptor cells, including rod and cone cells, were normal following the HPV EDV inoculation in mice. These results suggest that Cervarix EDV could be a potent, safe, and effective mucosal vaccine against HPV-associated cancers.
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Yeoh CHY, Lee JJR, Lim BXH, Sundar G, Mehta JS, Chan ASY, Lim DKA, Watson SL, Honavar SG, Manotosh R, Lim CHL. The Management of Ocular Surface Squamous Neoplasia (OSSN). Int J Mol Sci 2022; 24:ijms24010713. [PMID: 36614155 PMCID: PMC9821412 DOI: 10.3390/ijms24010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.
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Affiliation(s)
- Clarice H. Y. Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jerome J. R. Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | - Blanche X. H. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Gangadhara Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Jodhbir S. Mehta
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
| | - Anita S. Y. Chan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
- Histopathology, Pathology Department, Singapore General Hospital, Singapore 169608, Singapore
| | - Dawn K. A. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Stephanie L. Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW 2000, Australia
| | | | - Ray Manotosh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Chris H. L. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Peterson C, Parikh RN, Ahmad MT, Campbell AA, Daoud Y, Mahoney N, Siadati S, Eberhart CG. Detection of Human Papillomavirus in Squamous Lesions of the Conjunctiva Using RNA and DNA In-Situ Hybridization. Int J Mol Sci 2022; 23:ijms23137249. [PMID: 35806252 PMCID: PMC9266440 DOI: 10.3390/ijms23137249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
In-situ hybridization provides a convenient and reliable method to detect human papillomavirus (HPV) infection in formalin-fixed paraffin-embedded tissue. Cases of conjunctival papillomas, conjunctival intraepithelial neoplasia (CIN), conjunctival carcinoma in situ (cCIS), and invasive squamous cell carcinoma (SCC), in which low-risk (LR) and/or high-risk (HR) HPV types were evaluated by RNA or DNA in-situ hybridization, were retrospectively identified. LR HPV types were frequently detected in conjunctival papillomas (25/30, 83%), including 17/18 (94%) with RNA probes, compared to 8/12 (75%) with DNA probes. None of the CIN/cCIS or SCC cases were positive for LR HPV by either method. HR HPV was detected by RNA in-situ hybridization in 1/16 (6%) of CIN/cCIS cases and 2/4 (50%) of SCC cases, while DNA in-situ hybridization failed to detect HPV infection in any of the CIN/cCIS lesions. Reactive atypia and dysplasia observed in papillomas was generally associated with the detection of LR HPV types. Collectively, our findings indicate RNA in-situ hybridization may provide a high-sensitivity approach for identifying HPV infection in squamous lesions of the conjunctiva and facilitate the distinction between reactive atypia and true dysplasia. There was no clear association between HPV infection and atopy in papillomas or dysplastic lesions.
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Affiliation(s)
- Cornelia Peterson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Rupin N. Parikh
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Meleha T. Ahmad
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Ashley A. Campbell
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Yassine Daoud
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Nicholas Mahoney
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
| | - Sepideh Siadati
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Charles G. Eberhart
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (R.N.P.); (M.T.A.); (A.A.C.); (Y.D.); (N.M.)
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
- Correspondence: ; Tel.: +1-(410)-502-5185
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Tananuvat N, Niparugs M, Wiwatwongwana D, Lertprasertsuk N, Mahanupap P. Ocular surface squamous neoplasia in Northern Thailand: a 16-year review. BMC Ophthalmol 2022; 22:121. [PMID: 35279126 PMCID: PMC8918314 DOI: 10.1186/s12886-022-02340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To evaluate clinical characteristics, treatments, and outcomes in patients with ocular surface squamous neoplasia (OSSN) at a tertiary center in Northern Thailand.
Methods
Patients diagnosed with either corneal-conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from May 2000 to December 2015, were recruited. The patients’ demographics, symptoms, clinical characteristics, cytopathology, treatments, and outcomes were reviewed.
Results
Overall 171 eyes from 168 patients, 92 eyes were CIN and 79 eyes were SCC. Males were affected in 65.5%. The mean age was 58.8 ± 16.8 (29–99) years. In most cases (60.3%), the tumors were located at the limbus. The most common clinical characteristic was papilliform appearance (46.2%). Human immunodeficiency virus (HIV) infection was found in 37 (22.0%) patients with a mean age of 40.5 ± 7.7 years. The treatments and outcomes were evaluated in 136 eyes whose main initial treatment was wide excision with adjunctive cryotherapy (47.8%), followed by topical mitomycin C (30.9%). The mean follow-up time after treatment was 20.8 ± 2.2 (3–110) months and the recurrence occurred in 18 eyes (13.2%) during the follow-up period. The mean recurrence-free time (months) for CIN was significantly longer than that of SCC (81.3 ± 10.0 [95%CI 61.5 – 101.1] vs 33.2 ± 4.6 [95%CI 24.0 – 42.3], p = 0.030). SCC was the only significant risk factor that influences the recurrence of the tumors with the adjusted hazard ratio of 5.69 (p = 0.005).
Conclusion
OSSN in Northern Thailand usually involved a limbal area and presented as a papilliform mass. HIV infection should be suspected in young patients. CIN had better outcomes after treatments than invasive SCC.
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Zhu C, Weiss M, Scribbick FW, Johnson DA, Kheirkhah A. Occurrence of Occult Neoplasia in Pterygium Specimens among Hispanic and Non-Hispanic Patients. Curr Eye Res 2022; 47:978-981. [PMID: 35180019 DOI: 10.1080/02713683.2022.2035403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia (OSSN) in pterygium specimens. METHODS This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of OSSN were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult OSSN in pterygium specimens. RESULTS There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 71% and non-Hispanic in 29%. Among all specimens, 18 (3.6%) were positive for occult OSSN. The prevalence of occult OSSN in pterygium specimens was higher in Hispanics compared to Non-Hispanics (4.8% versus 0.7%, respectively, P = 0.025). The prevalence of occult OSSN in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (P = 0.57). There were also no statistically significant differences between those with or without occult OSSN regarding age or sex. CONCLUSIONS A significant but low rate of occult OSSN was found in pterygium specimens. The percentage of those with OSSN in pterygium specimens was significantly greater in Hispanics compared to Non-Hispanics. As treatment and prognosis of pterygium and OSSN differ, histopathologic evaluation of all pterygium specimens is warranted.
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Affiliation(s)
- Christopher Zhu
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Menachem Weiss
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Frank W Scribbick
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
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11
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García RLB, Jimenez J, Gubbay C, Castañeda JF, Granados Á. Squamous cell carcinoma of the conjunctiva. Case report. Int J Surg Case Rep 2022; 91:106785. [PMID: 35093703 PMCID: PMC8808077 DOI: 10.1016/j.ijscr.2022.106785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The prevalence of squamous cell carcinoma of the eyeball is low, and this is a rare condition. There are multiple therapeutic strategies for the treatment and depend on the degree of local involvement and extension of the tumor which, in turn, will have an impact on the patient's prognosis. Presentation of case We present a case of a patient with a mass of progressive growth on the left eyeball whit vision damage. The biopsy showed a squamous cell carcinoma of the conjunctiva, and imaging studies showed orbital invasion cT4bN0cM0, so surgery was indicated. The surgery was done with macroscopic margins of 5 mm. After resection, a radial free flap reconstruction was performed. Adjuvant treatment with radiotherapy was performed without complications. After six months, the patient manifested an improvement in his quality of life, and there is no evidence of relapse. Discussion The prevalence of squamous cell carcinoma of the conjunctiva is low. The most important risk factor is exposure to UV rays. Most are derived from conjunctival intraepithelial neoplasms. There are topical management protocols with chemotherapeutic agents and in patients with ocular or orbital invasion, enucleation and exanteration are the treatments of choice. Conclusion The squamous cell carcinoma of the conjunctive is rare. The management in the locally advanced tumors is surgical. The use of a radial free flap reconstruction is one of the reconstructive strategies to take into account, and the knowledge of additional strategies required to control the disease is important to ensure an optimal treatment. Squamous cell carcinoma is the most frequent tumor of the eyeball. The most important risk factor is the exposure to UV rays (damage in repairing DNA). There are topical management protocols with multiple chemotherapeutic agents. In patients with ocular or orbital invasion, the surgery is the GOLD standard of care. Adjuvant therapies are useful tools in the oncological management of these patients.
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Affiliation(s)
- Rogers Leonardo Baquero García
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia.
| | - Julián Jimenez
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Carlos Gubbay
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Juan Fernando Castañeda
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Álvaro Granados
- San Jose Hospital, Professor at Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), Colombia
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Shifera AS, Pockrandt C, Rincon N, Ge Y, Lu J, Varabyou A, Jedlicka AE, Sun K, Scott AL, Eberhart C, Thorne JE, Salzberg SL. Identification of microbial agents in tissue specimens of ocular and periocular sarcoidosis using a metagenomics approach. F1000Res 2021; 10:820. [PMID: 36212901 PMCID: PMC9515606 DOI: 10.12688/f1000research.55090.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Metagenomic sequencing has the potential to identify a wide range of pathogens in human tissue samples. Sarcoidosis is a complex disorder whose etiology remains unknown and for which a variety of infectious causes have been hypothesized. We sought to conduct metagenomic sequencing on cases of ocular and periocular sarcoidosis, none of them with previously identified infectious causes. Methods: Archival tissue specimens of 16 subjects with biopsies of ocular and periocular tissues that were positive for non-caseating granulomas were used as cases. Four archival tissue specimens that did not demonstrate non-caseating granulomas were also included as controls. Genomic DNA was extracted from tissue sections. DNA libraries were generated from the extracted genomic DNA and the libraries underwent next-generation sequencing. Results: We generated between 4.8 and 20.7 million reads for each of the 16 cases plus four control samples. For eight of the cases, we identified microbial pathogens that were present well above the background, with one potential pathogen identified for seven of the cases and two possible pathogens for one of the cases. Five of the eight cases were associated with bacteria ( Campylobacter concisus, Neisseria elongata, Streptococcus salivarius, Pseudopropionibacterium propionicum, and Paracoccus yeei), two cases with fungi ( Exophiala oligosperma, Lomentospora prolificans and Aspergillus versicolor) and one case with a virus (Mupapillomavirus 1). Interestingly, four of the five bacterial species are also part of the human oral microbiome. Conclusions: Using a metagenomic sequencing we identified possible infectious causes in half of the ocular and periocular sarcoidosis cases analyzed. Our findings support the proposition that sarcoidosis could be an etiologically heterogenous disease. Because these are previously banked samples, direct follow-up in the respective patients is impossible, but these results suggest that sequencing may be a valuable tool in better understanding the etiopathogenesis of sarcoidosis and in diagnosing and treating this disease.
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Affiliation(s)
| | - Christopher Pockrandt
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Natalia Rincon
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Yuchen Ge
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Lu
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ales Varabyou
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Anne E. Jedlicka
- Genomic Analysis and Sequencing Core Facility, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Sun
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L. Scott
- Department of Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Charles Eberhart
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer E. Thorne
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven L. Salzberg
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
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13
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Hamed-Azzam S, Edison N, Briscoe D, Frenkel S, Mukari A, Strauss M, Camacho H, Elmalah I, Krausz J. Role of oncogenic viruses in the development ocular surface squamous neoplasia. Int Ophthalmol 2021; 41:3599-3605. [PMID: 34173153 DOI: 10.1007/s10792-021-01933-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The pathogenesis of ocular surface squamous neoplasia is not fully understood. Therefore, we evaluated the role of oncogenic viruses in the pathogenesis of ocular surface squamous neoplasia in Israel. METHODS Patients with ocular surface squamous neoplasia were enrolled in this retrospective study. The specimens were taken during 2004-2015 from two big centers: Emek Medical Center, Afula and the Hadassah Medical Center, Jerusalem. All the specimens (totally 26) were analyzed by immunohistochemistry for evidence of oncogenic viruses that included Human Papilloma virus, Herpes Simplex virus and Cytomegalovirus infection and 14 samples were examined by polymerase chain reaction. In addition, all the samples were examined for Epstein Barr virus infection by immunohistochemistry and Epstein Barr encoding region test. RESULTS Twenty-six patients were included with a mean age of 61.81 [Formula: see text] 3.83 years (mean [Formula: see text]. Immunohistochemistry staining and Epstein Barr encoding region test did not detect any of the oncogenic viruses in the 26 samples. Human Papilloma virus-16 and -18, and Herpes Simplex virus were detected by polymerase chain reaction in 14.2%, 7% and 7%, respectively. CONCLUSION We conclude from our study that oncogenic viruses may play a role in the pathogenesis of ocular surface squamous neoplasia in Israel.
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Affiliation(s)
- Shirin Hamed-Azzam
- Department of Ophthalmology, Baruch Padeh Medical Center, Dov Hoz 0, Tiberias, Poriya, Israel.
| | - Natalia Edison
- The Institute of Tissue Diagnostics and Cancer Research, Emek Medical Center, Afula, Israel
| | - Daniel Briscoe
- Department of Ophthalmology, Emek Medical Center, Afula, Israel
| | - Shahar Frenkel
- Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Mukari
- Department of Ophthalmology, Emek Medical Center, Afula, Israel
| | - Meirav Strauss
- Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Hector Camacho
- Department of Ophthalmology, Emek Medical Center, Afula, Israel
| | - Irit Elmalah
- The Institute of Tissue Diagnostics and Cancer Research, Emek Medical Center, Afula, Israel
| | - Judit Krausz
- The Institute of Tissue Diagnostics and Cancer Research, Emek Medical Center, Afula, Israel
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14
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Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol 2021; 13:25158414211020152. [PMID: 34104871 PMCID: PMC8170279 DOI: 10.1177/25158414211020152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
Pterygium is a relatively common ocular surface disease. The clinical aspects and
the treatment options have been studied since many years ago, but many
uncertainties still exist. The core pathologic pathway and the role of heredity
in the development of pterygium are still attractive fields for the researchers.
The role of pterygium in corneal irregularities, in addition to the refractive
properties of pterygium removal, has been increasingly recognized through
numerous studies. The association between pterygium and ocular surface neoplasia
is challenging the traditional beliefs regarding the safe profile of the
disease. The need for a comprehensive clinical classification system has
encouraged homogenization of trials and prediction of the recurrence rate of the
pterygium following surgical removal. Evolving surgical methods have been
associated with some complications, whose diagnosis and management are necessary
for ophthalmic surgeons. According to the review, the main risk factor of
pterygium progression remains to be the ultraviolet exposure. A major part of
the clinical evaluation should consist of differentiating between typical and
atypical pterygia, where the latter may be associated with the risk of ocular
surface neoplasia. The effect of pterygium on astigmatism and the aberrations of
the cornea may evoke the need for an early removal with a purpose of reducing
secondary refractive error. Among the surgical methods, conjunctival or
conjunctival-limbal autografting seems to be the first choice for ophthalmic
surgeons because the recurrence rate following the procedure has been reported
to be lower, compared with other procedures. The use of adjuvant options is
supported in the literature, where intraoperative and postoperative mitomycin C
has been the adjuvant treatment of choice. The efficacy and safety of
anti–vascular endothelial growth factor agents and cyclosporine have been
postulated; however, their exact role in the treatment of the pterygium requires
further studies.
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Affiliation(s)
- Toktam Shahraki
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, 16666, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Kasetsuwan N, Bhattarakosol P, Reinprayoon U, Chantaren P, Thammachotiruj L, Maneerat N. Prevalence of Human Papillomavirus Genotypes in Pterygia from Thai Individuals. Ophthalmic Epidemiol 2021; 29:85-90. [PMID: 33736562 DOI: 10.1080/09286586.2021.1900278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Pterygium, a common ocular growth, has an unknown pathogenesis and aetiology. Environmental factors such as ultraviolet light, genetic factors and viral infections may be implicated in the development of pterygia. Human papillomavirus (HPV), an oncogenic virus, has previous been detected in individuals with pterygia. The aim of this study was to assess the prevalence of HPV genotypes in pterygia from Thai individuals.Methods: DNA was extracted from 389 pterygia. HPV was detected by nested PCR and HPV genotyping was conducted using reverse hybridization. The DNA sequences of HPV-L1 genes were analyzed.Results: HPV was detected in only 6.8% (25/389) of pterygia from Thai individuals. The majority (16/25, 64%) of strains were genotyped as HPV-16 and the remainder (9/25, 36%) could not be typed. Four pterygia showed evidence of coinfection by HPV-16 and either HPV-18 (2/25, 8%) or HPV-58 (2/25, 8%). Nine of 11 samples showed the same HPV-16 L1 gene sequence that was identical to a HPV-16 reference sequence in GenBank. The remaining two samples each bore silent single nucleotide mutations (T1078G and T1081A) that did not result in amino acid changes.Conclusion: HPV, especially HPV-16, may be one of the pathogens causing pterygia in Thai individuals. Genotyping data suggested that HPV-16 from pterygia may be similar in sequence to HPV-16 causing cervical cancer.
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Affiliation(s)
- Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Cornea and Stem Cell Transplantation, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Parvapan Bhattarakosol
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Applied Medical Virology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Patchima Chantaren
- Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Luckana Thammachotiruj
- Department of Microbiology, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Nipaporn Maneerat
- Department of Ophthalmology, Chaophaya Abhaibhubejhr Hospital, Prachinburi, Thailand
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16
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Relative gene expression analysis of human pterygium tissues and UV radiation-evoked gene expression patterns in corneal and conjunctival cells. Exp Eye Res 2020; 199:108194. [PMID: 32822701 DOI: 10.1016/j.exer.2020.108194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
A sight threatening, pterygium is a common ocular surface disorders identified by fibrovascular growth of the cornea and induced by variety of stress factors, like ultraviolet (UV) exposure. However, the genes involved in the etiopathogenesis of this disease is not well studied. Herein, we identified the gene expression pattern of pterygium and examined the expression of pterygium-related genes in UV-B-induced human primary cultured corneal epithelial cells (HCEpCs), telomerase immortalized human corneal epithelial (hTCEpi), primary conjunctival fibroblast (HConFs) and primary pterygium fibroblast cells (HPFCs). A careful analysis revealed that the expression of 10 genes was significantly modulated (by > 10-fold). Keratin 24 (KRT24) and matrix metalloproteinase 9 (MMP-9) were dramatically upregulated by 49.446- and 24.214-fold, respectively. Intriguingly, UV-B exposure (50 J/m2) induced the upregulation of the expressions of MMP-9 in corneal epithelial cells such as HCEpCs and hTCEpi. Furthermore, UV-B exposure (100 and/or 200 J/m2) induced the upregulation of the expressions of MMP-9 in fibroblast such as HConFs and HPFCs. The exposure of HCEpCs to 100 and 200 J/m2 UV-B induced significant expressions of KRT24 mRNA. Nevertheless, no expression of KRT24 mRNA was detected in HConFs and HPFCs. The findings provide evidence that the progression of pterygium may involve the modulation of extracellular matrix-related genes and vasculature development and the up-regulation of KRT24 and MMP-9 by UV stress. UV radiation may promote the modulation of these pterygium-related genes and induce the initiation and progression of human pterygium.
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17
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Westekemper H, Manthey A, Bechrakis N. [Diagnosis and Therapy of Benign and Malignant Tumors of the Conjunctiva]. Klin Monbl Augenheilkd 2020; 237:1143-1159. [PMID: 32777832 DOI: 10.1055/a-1211-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this paper is to give an overview of different benign and malignant epibulbar tumors. Categories can be made of the age of manifestation (paediatric tumors versus tumors of adults), the originating cell types (squamous cell tumors, melanocytic tumors, lymphomas or germ cell tumors) or genesis (proliferative, infectious or degenerating tumors). Most epibulbar tumors show lesions on the conjunctiva or the cornea. These can be flesh coloured or pigmented efflorescences with leucoplakias or hyperkeratosis. Especially malignant tumors show atypical growth of blood vessels, are often prominent and can have ulcerations or bleeding. In case of tumor growth, change in pigmentations or atypical bleedings a malign tumor can be suspected. The diagnosis should be confirmed using histopathological evaluation after an incisional or excisional biopsy. Molecular pathologic techniques extend the diagnostic tools and have an implication on the therapy of metastatic tumors. Therapeutic options of the malignant tumors (apart from lymphomas) are chirurgical excision preferably with a no touch technique and afterwards an adjuvant therapy consisting of radiation or cryotherapy. A topical chemotherapy with Mitomycin C, 5-Fluorouracil or Interferon α2b can be effective to reduce persisting precancerosis and reduce recurrences. In case of a suspected malignant tumor it is advisable to refer the patient to an ophthalmo-oncologic center to plan and ensure interdisciplinary therapy.
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18
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Westekemper H, Manthey A, Bechrakis N. Benigne und maligne Bindehauttumoren in Diagnostik und Therapie. AUGENHEILKUNDE UP2DATE 2020. [DOI: 10.1055/a-1061-9973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungBindehauttumoren betreffen in Diagnostik und Therapie alle Bereiche der augenärztlichen Praxis. Das beginnt mit der klinischen Kontrolle von Bindehautnävi und anderen benignen Tumoren, der Einschätzung von entzündlichen Pseudotumoren und ihrer Abgrenzung zu Präkanzerosen oder vernarbenden Erkrankungen und mündet in der hochspezialisierten und interdisziplinären Führung onkologischer Patienten mit Lymphomen, hochmalignen Melanomen oder invasiven Plattenepithelkarzinomen.
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19
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Hung KH, Hsiao CH, Tan HY, Chen HC, Ma DHK, Lin HC, Yeh LK. Clinical demographics of pterygium excision and prevalence of conjunctival intraepithelial neoplasia: a 15-year review. Int Ophthalmol 2020; 40:1781-1788. [PMID: 32198608 DOI: 10.1007/s10792-020-01347-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To find clinical demographics of pterygium surgery and prevalence of conjunctival intraepithelial neoplasia (CIN) in pterygium specimen. METHODS This is a retrospective, institutional study. The records of patients who had received pterygium excision from 2000 to 2014 were reviewed. Patients after complete ophthalmic "examinations", surgical procedures, and pathological reports were enrolled. Surgical procedures, pathology, external eye photography, prevalence of CIN in specimen, and demographic data were described. RESULTS Of 1787 pterygium cases, 928 were male and 859 were female. The mean age was 65.19 ± 14.21 years. Of these 1787 cases, 1435 (80.3%) cases had primary pterygium excision, while the others (n = 352; 19.7%) had pterygium excision for recurrence. Four cases presented CIN within pterygium tissue (0.22%). The mean age of pterygium patients with CIN was 57.75 ± 7.80 years. In stratified data, our patients who received primary and secondary pterygium excision were found prevalent in the eighth (28.2%) and seventh (26.1%) decade, respectively. Twelve percent of patients who underwent secondary pterygium excision had a recurrence and required another surgery. Patients requiring amniotic membrane transplantation (AMT) during primary pterygium excision were significantly younger (median, 58 years) than those (median, 67 years) without the assistance of AMT (p < 0.001). Similarly, AMT was utilized in younger patients (median, 56 years) during secondary pterygium excision, compared to those without AMT (median, 64 years) (p = 0.001). CONCLUSION CIN combined with pterygium is very rare. However, the possibility of the development of ocular surface squamous neoplasia in pterygium tissue should not be ignored. Meticulous pathological investigation of the surgical samples is important.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hsin-Chiung Lin
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC.
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC.
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20
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Carrilho C, Miu C, Kim Y, Karki S, Balmaceda A, Challa B, Diamond S, Monteiro E, Marole E, Lorenzoni C, Zambujo Y, Liu YT, Schooley RT, Lin JH. p16 Expression Correlates with Invasive Ocular Surface Squamous Neoplasms in HIV-Infected Mozambicans. Ocul Oncol Pathol 2020; 6:123-128. [PMID: 32258020 PMCID: PMC7109427 DOI: 10.1159/000502096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/12/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND p16 immunohistochemistry is widely used to diagnose human papillomavirus (HPV)-related squamous neoplasms of cervix, anogenital, head, and neck tissues. The incidence of these HPV-related squamous neoplasms is markedly increased in the HIV-infected population. Ocular surface squamous neoplasia (OSSN) is also more common in HIV-infected patients. However, the expression pattern of p16 in OSSN among HIV-infected patients is unclear. Here, we examined the expression of p16 in OSSN surgical excisions collected from a large HIV-infected cohort from -Mozambique. METHODS OSSN surgical tissue specimens were collected from 75 Mozambican patients. Formalin-fixed, paraffin-embedded tissue blocks from these OSSNs were sectioned, stained with hematoxylin and eosin (H&E), and p16 expression by immunohistochemistry. H&E slides were reviewed to determine if OSSNs were noninvasive conjunctival intraepithelial neoplasms or invasive squamous cell carcinomas (SCC). Cases were classified as p16 positive or negative based on diffuse nuclear and cytoplasmic expression of p16 in neoplastic cells. RESULTS p16 positivity was found in a minority of OSSN cases (14/75). p16 positivity was significantly associated with the invasive SCC type of OSSN in HIV-infected patients (p value of 0.026). CONCLUSIONS The majority of OSSNs in our HIV-infected cohort do not express p16. However, those cases that are p16-positive are significantly more likely to be the invasive SCC form of OSSN. We propose that p16 expression may identify more aggressive OSSNs in HIV-infected populations.
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Affiliation(s)
- Carla Carrilho
- Department of Pathology, Eduardo Mondlane University, Maputo, Mozambique
- Service of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Chau Miu
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Yeji Kim
- Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Susan Karki
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Alexandra Balmaceda
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Bindu Challa
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Scott Diamond
- Department of Pathology, University of California Los Angeles, Los Angeles, California, USA
| | - Eliane Monteiro
- Service of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Evelia Marole
- Service of Ophthalmology, Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Eduardo Mondlane University, Maputo, Mozambique
- Service of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Ministério da Saúde, Programa Nacional de Controlo do Cancro, Maputo, Mozambique
| | - Yolanda Zambujo
- Service of Ophthalmology, Maputo Central Hospital, Maputo, Mozambique
| | - Yu-Tsueng Liu
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Robert T. Schooley
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jonathan H. Lin
- Service of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Ophthalmology, Stanford University, Stanford, California, USA
- Department of Pathology, Stanford University, Stanford, California, USA
- VA Palo Alto Healthcare System, Palo Alto, California, USA
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21
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Henriksen JR, Ramberg I, Mikkelsen LH, Heegaard S. The role of infectious agents in cancer of the ocular region. APMIS 2020; 128:136-149. [PMID: 32003084 DOI: 10.1111/apm.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
The purpose of the study was to investigate the association between infectious agents and the development of cancer in the ocular adnexa. A comprehensive literary study was carried out, reviewing and summarizing previous reports on the topic. A broad range of malignancies of the ocular adnexa are associated with infectious agents. A strong association and possible causal relationship between the infectious agent and the development of ocular adnexal cancer are seen in Merkel cell carcinoma (Merkel cell polyomavirus), Burkitt lymphoma (Epstein-Barr virus) and Kaposi sarcoma (human herpesvirus 8). Infection with Chlamydia psittaci has been associated with the development of extranodal marginal zone B-cell lymphoma in Italy. Human papillomavirus infection has been associated with the development of squamous cell carcinomas of the ocular adnexa, although with a highly variable reported prevalence. By exploring the role of infectious agents in the ocular adnexa and the mechanism by which they contribute to oncogenesis, the diagnostics, management and prevention of these malignancies may also improve. Antibiotic treatment and vaccines against infectious agents may be valuable in future treatment. Additionally, the presence of infectious agents within the tumours may have a prognostic or predictive value.
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Affiliation(s)
- Josephine Raun Henriksen
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ingvild Ramberg
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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22
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Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. Cornea 2019; 38:1239-1244. [PMID: 31299663 PMCID: PMC6750146 DOI: 10.1097/ico.0000000000001995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique.
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Javanmard D, Moein M, Esghaei M, Naseripour M, Monavari SH, Bokharaei-Salim F, Sadeghipour A. Molecular evidence of human papillomaviruses in the retinoblastoma tumor. Virusdisease 2019; 30:360-366. [PMID: 31803802 DOI: 10.1007/s13337-019-00540-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Retinoblastoma tumor (RB) is one of the most prevalent ocular cancers among children. RB may be caused by inherited mutations in RB1 gene as well as some environmental risk factors. Human papillomaviruses (HPV) are suspected as a risk factor of RB due to their pRb inactivating protein. This study evaluated the molecular prevalence of HPV among the RB tumor specimens in Iran. The RB tumor samples were tested for detection of HPV-L1 gene using a nested-PCR approach, and then followed by sequencing and phylogenetic analysis to reveal HPV types. Overall, there were 61 RB tumor samples; 54/61 (88.5%) had unilateral and 7/61 (11.5%) bilateral RB; 55/61 cases (90.2%) had sporadic non-familial RB tumor. HPV-DNA was detected in 6/61 (9.8%) of patients' tumors; the HPV positive RB cases all had unilateral and unfamiliar sporadic RB tumor. HPV type 16 was the most prevalent type identified across the RB tumor samples (3/61, 4.9%). The rate of detected HPV among the RB specimens seems to be considerable. Further investigations are required to elucidate the exact association between HPV and progression to RB.
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Affiliation(s)
- Davod Javanmard
- 1Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Moein
- 1Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esghaei
- 1Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Naseripour
- 2Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farah Bokharaei-Salim
- 1Department of Virology, Iran University of Medical Sciences, Tehran, Iran.,3HIV Laboratory of National Center, Deputy of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Sadeghipour
- 4Department of Pathology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Abstract
CONTEXT - Human papillomavirus (HPV) has a well-known role in the pathogenesis of squamous cell carcinoma and precursor lesions of the cervix, anogenital region, and head and neck, but its role in the development of squamous neoplasms of the eye, particularly the conjunctiva, remains unclear. OBJECTIVE - To review recent evidence implicating HPV in the pathophysiology of ocular lesions. DATA SOURCES - Published articles obtained from a PubMed search of the English literature were the primary sources for this review. CONCLUSIONS - The low-risk HPV types 6 and 11 appear to play a role in the development of at least a subset of conjunctival squamous papillomas. The role of HPV in the pathogenesis of pterygium and ocular surface squamous neoplasia is less well defined. There is evidence to suggest that HPV may be a cofactor in the development of these lesions, acting in concert with ultraviolet radiation and/or human immunodeficiency virus infection in a subgroup of cases.
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Affiliation(s)
| | - Kymberly A Gyure
- From the Department of Pathology, West Virginia University School of Medicine, Morgantown
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25
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Mammas IN, Dalianis T, Doukas SG, Zaravinos A, Achtsidis V, Thiagarajan P, Theodoridou M, Spandidos DA. Paediatric virology and human papillomaviruses: An update. Exp Ther Med 2019; 17:4337-4343. [PMID: 31186676 PMCID: PMC6507507 DOI: 10.3892/etm.2019.7516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Tina Dalianis
- Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden
| | - Sotiros G. Doukas
- Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, CT 06519, USA
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, 1516 Nicosia, Cyprus
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals NHS Trust, TR1 3LQ Cornwall, UK
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women and Children's Health, Noble's Hospital, IM4 4RJ Douglas, Isle of Man, British Isles
| | - Maria Theodoridou
- First Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, 115 27 Athens, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Chalkia AK, Bontzos G, Spandidos DA, Detorakis ET. Human papillomavirus infection and ocular surface disease (Review). Int J Oncol 2019; 54:1503-1510. [PMID: 30896784 PMCID: PMC6438422 DOI: 10.3892/ijo.2019.4755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/15/2019] [Indexed: 11/14/2022] Open
Abstract
Human papillomavirus (HPV) infection has been implicated as a primary cause of lesions in the anogenital region, skin, oropharynx and respiratory tract. Additionally, the role of HPV in the pathogenesis of ocular surface disease has also been extensively studied. Conjunctival papilloma development has been strongly associated with the HPV infection of certain subtypes. On the other hand, the role of HPV in conjunctival pterygium, conjunctival intraepithelial neoplasia (CIN) and ocular surface squamous neoplasia (OSSN) remains controversial. Genetic predisposition and environmental factor is important in HPV hosts as regards the pathogenesis of ocular surface disease. Several studies have indicate a synergic role of HPV with ultraviolet radiation in pterygium establishment. A higher recurrence risk rate and more aggressive disease of ophthalmic pterygium is observed in cases of HPV infection. The purpose of this review was to provide a systematic review of the literature and to assist in a better understanding of the role of HPV in ocular surface disease.
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Affiliation(s)
- Aikaterini K Chalkia
- Department of Ophthalmology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Red Cross Hospital, 11526 Athens, Greece
| | - Demetrios A Spandidos
- Department of Virology, Medical School, University of Crete, 71110 Heraklion, Greece
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Merz LE, Afriyie O, Jiagge E, Adjei E, Foltin SK, Ludwig ML, McHugh JB, Brenner JC, Merajver SD. Clinical characteristics, HIV status, and molecular biomarkers in squamous cell carcinoma of the conjunctiva in Ghana. Health Sci Rep 2019; 2:e108. [PMID: 30809594 PMCID: PMC6375545 DOI: 10.1002/hsr2.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/02/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Conjunctival squamous cell carcinoma (CSCC) varies in incidence geographically from 0 to 1 case per 100 000 per year globally. Additionally, the incidence of CSCC is known to increase 49% for every 10° decrease in latitude. Since the onset of the AIDS epidemic, there has been a trend of increasing incidence of CSCC in Africa, and despite relatively stable levels of ultraviolet (UV) exposure, there is an observed 12 times greater risk of developing CSCC when individuals are infected with HIV. In this study, we aim to analyze the clinical characteristics and biomarkers of CSCC in Ghana. METHODS In this study, a registry review of patients from January 2011 to May 2016 with CSCC at Komfo-Anokye Teaching Hospital in Kumasi, Ghana, was performed (n = 64). Tumor blocks of the CSCC were analyzed for the expression of various biomarkers. RESULTS In this study, the median age of onset of CSCC is 46.5 years old (range of 20-90 y old). Fifty one and a half percent (n = 33) of the cohort is female. There is a low rate of smoking and alcohol use in our CSCC cohort. Thirty-nine percent (n = 12) of Ghanaian men with CSCC are HIV-, while only 12% (n = 4) of women are HIV-. Fifteen patients had metastasis to lymph nodes or other tissues, and we observed a statistically significant relationship between HIV infection and metastasis (P = 0.027, chi-squared test). We observed no statistically significant relationship between known prognostic CSCC biomarkers and HIV status, age, or tumor stage. CONCLUSION Better characterization of CSCC could have a profound impact on the prevention, early identification, and treatment of CSCC in Africa. A retrospective chart analysis and collection of tumor samples can be challenging in this region due to methods of record keeping and stigma attached to clinical data such as HIV testing and smoking and alcohol use. As a result, in this study, data were often incomplete leading to inconclusive results and analysis that should be interpreted with caution. Future studies should consider a prospective study design that gathers clinical data in a standardized format and ensures fresh tissue from CSCC tumors.
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Affiliation(s)
- Lauren E. Merz
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | | | - Susan K. Foltin
- Department of Otolaryngology—Head and Neck SurgeryMichigan MedicineAnn ArborMichiganUSA
| | - Megan L. Ludwig
- Department of Otolaryngology—Head and Neck SurgeryMichigan MedicineAnn ArborMichiganUSA
- Program in Cellular and Molecular BiologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - J. Chad Brenner
- Department of Otolaryngology—Head and Neck SurgeryMichigan MedicineAnn ArborMichiganUSA
- Program in Cellular and Molecular BiologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal Medicine, Rogel Cancer CenterMichigan MedicineAnn ArborMichiganUSA
| | - Sofia D. Merajver
- Department of Internal Medicine, Rogel Cancer CenterMichigan MedicineAnn ArborMichiganUSA
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
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Metabolomics analysis in pterygium tissue. Int Ophthalmol 2019; 39:2325-2333. [DOI: 10.1007/s10792-018-01069-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
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29
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Shrestha T, Choi W, Kim GE, Yang JM, Yoon KC. Human papilloma virus identification in ocular surface squamous neoplasia by p16 immunohistochemistry and DNA chip test: A strobe-compliant article. Medicine (Baltimore) 2019; 98:e13944. [PMID: 30633172 PMCID: PMC6336645 DOI: 10.1097/md.0000000000013944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to identify the association between human papilloma virus (HPV) infection and ocular surface squamous neoplasia (OSSN) using p16 immunohistochemistry (IHC) and deoxyribonucleic acid (DNA) chip test.Thirty-eight patients who underwent surgical excision of OSSN were retrospectively studied using tissue samples. The IHC was performed to assess the expression of p16 and DNA chip test was used to detect 24 HPV serotypes.Among the 38 OSSN samples, 32 cases (84.2%) were histopathologically categorized as pre-invasive type and 6 cases (15.8%) as invasive type. The IHC for p16 showed strong positivity in 12 cases (31.6%), whereas it was negative in 26 cases (68.4%). On the other hand, only one case (2.6%) of invasive OSSN was positive for the HPV16 serotype, as assessed by DNA chip test.In OSSN, p16 expression was positive in approximately 1/3rd of the cases, whereas the majority of the 24 HPV serotypes were negative for p16. Our findings suggest that only a weak association exists between HPV infection and OSSN.
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Affiliation(s)
- Tina Shrestha
- Department of Ophthalmology and Research Institute of Medical Sciences
- Department of ophthalmology, Dhulikhel hospital, Kathmandu university school of medical science, Nepal
| | - Won Choi
- Department of Ophthalmology and Research Institute of Medical Sciences
| | - Ga Eon Kim
- Department of Pathology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju
| | - Jee Myung Yang
- Department of Ophthalmology and Research Institute of Medical Sciences
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences
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30
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Abstract
The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.
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Affiliation(s)
- Raffaele Nuzzi
- S.C.U. Ophthalmology Unit, "City of Health and Science" University Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy,
| | - Federico Tridico
- S.C.U. Ophthalmology Unit, "City of Health and Science" University Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy,
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31
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Squamous Cell Carcinoma Invading a Transplanted Cornea: Eye- and Vision-Sparing Palladium-103 Plaque Radiation Therapy for a Functionally Monocular Patient. Cornea 2018; 37:1468-1470. [PMID: 30179892 DOI: 10.1097/ico.0000000000001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a unique approach to eye and vision sparing for a patient with squamous cell carcinoma invading through a penetrating keratoplasty (PK) wound. METHODS A 56-year-old functionally monocular man was found to have squamous cell carcinoma with intraocular invasion through a PK wound. Eye- and vision-salvaging palladium-103 plaque radiation was performed. An amniotic membrane graft was used to buffer and thus protect the cornea during the 7-day treatment. Leaded eye glasses were worn during the day to block emitted radiation and allow functional vision during irradiation. RESULTS At 3.5 years status posttreatment, the tumor has regressed, PK has become progressively hazy (within the irradiated zone), and his vision is stable at 20/320. The epicorneal tumor has disappeared, and the intraocular tumor nodules are more highly reflective, but persistent. There has been no intraocular tumor progression, worsening of his glaucoma, or evidence of intraocular radiation vasculopathy. CONCLUSIONS Transcorneal intraocular tumor invasion was controlled using palladium-103 ophthalmic plaque radiation therapy applied through the natural and donor cornea. Definitive treatment resulted in local tumor control and preservation of vision.
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32
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Human Papilloma Virus Vaccination and Incidence of Ocular Surface Squamous Neoplasia. Int Ophthalmol Clin 2018; 57:57-74. [PMID: 27898614 DOI: 10.1097/iio.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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33
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Rajeh A, Barakat F, Khurma S, AlRawashdeh K, Ababneh OH, AlNawaiseh I, Mehyar M, Abdeen G, Jaradat I, Mohammad M, Yousef YA. Characteristics, management, and outcome of squamous carcinoma of the conjunctiva in a single tertiary cancer center in Jordan. Int J Ophthalmol 2018; 11:1132-1138. [PMID: 30046529 DOI: 10.18240/ijo.2018.07.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate the features and outcome of management of malignant conjunctival squamous tumors in King Hussein Cancer Center (a referral tertiary cancer center in the Middle East). METHODS Retrospective case series of 31 eyes for 31 patients with conjunctival squamous neoplasia. Main outcome measures included: age, gender, laterality, tumor location, pathological features, tumor stage, treatment modality, and outcome. RESULTS Twenty (65%) patients were males and median age was 58y. Twenty-two (71%) eyes had the tumor in the nasal quadrant. Tumor invasion to nearby structures was seen in 19 (61%) eyes, including the cornea, fornix, eyelid, and orbit in 17 (55%), 1 (3%), 2 (6%), and 3 (10%) eyes, respectively. Eye salvage was achieved by surgical excision with cryotherapy followed by topical chemotherapy in 28 (90%) eyes, and orbital exenteration was necessary in 3 (10%) eyes due to orbital tumor invasion. Tumor recurrence was seen in 7 (23%) eyes, and the significant predictive factors for recurrence were tumor extension onto the nearby structures (P=0.04), tumor invasiveness (P=0.038), and tumor TNM stage (P=0.031). No significant change in visual acuity was seen, and disease related mortality was 6% (2 patients, both had orbital invasion by invasive squamous carcinoma). CONCLUSION Conjunctival squamous carcinoma is more common in males. Advanced American Joint Committee on Cancer (AJCC) T-stage, tumor local invasion, more pathologically aggressive tumors, and surgical treatment alone (without adjuvant therapy) are associated with higher risk for recurrence, and orbital invasion is the most important poor prognostic factor for metastasis and death. Treatment strategies should be affected by tumor characteristics at presentation.
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Affiliation(s)
- Ata Rajeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Fareed Barakat
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Samer Khurma
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Khaleel AlRawashdeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Osama H Ababneh
- Department of Ophthalmology, The University of Jordan and Jordan University Hospital, Amman 11941, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Ghadeer Abdeen
- Department of Medical Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan
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34
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Human Papillomavirus–Driven Squamous Lesions: High-Risk Genotype Found in Conjunctival Papillomas, Dysplasia, and Carcinoma. Am J Dermatopathol 2018. [DOI: 10.1097/dad.0000000000001139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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35
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Iovieno A, Piana S, Chiesi L, Fodero C, Fontana L. Human papillomavirus (HPV)-associated trilateral squamous neoplasia in immunocompetent individual. Int Ophthalmol 2017; 38:1347-1350. [DOI: 10.1007/s10792-017-0573-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/20/2017] [Indexed: 01/20/2023]
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36
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Salceanu SO, Constantin C, Cijevschi I, Ursu RG, Grigorovici M, Iancu LS. Human papillomavirus 52 positive squamous cell carcinoma of the conjunctiva. Indian J Ophthalmol 2016; 63:166-9. [PMID: 25827551 PMCID: PMC4399129 DOI: 10.4103/0301-4738.154406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Human papillomavirus (HPV) infection is strongly associated with several human cancers; the most known genotypes involved being HPV 16 and HPV 18. We report the detection of HPV 52 in a sample taken from a 47-year-old patient with squamous cell carcinoma of the conjunctiva of the left eye. The method used for the detection of HPV was real time polymerase chain reaction. The evolution was favorable after surgical removal of the tumor and the patient was explained that long-term follow-up is essential to avoid recurrence.
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Affiliation(s)
| | | | | | - Ramona Gabriela Ursu
- Department of Microbiology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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37
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Sayed-Ahmed IO, Palioura S, Galor A, Karp CL. Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 12:11-19. [PMID: 28184236 DOI: 10.1080/17469899.2017.1263567] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Topical chemotherapy has gained popularity among clinicians for the treatment of ocular surface squamous neoplasia (OSSN). The principal topical chemotherapy agents used in the management of OSSN are interferon-α2b, 5-fluorouracil, and mitomycin C. High-resolution optical coherence tomography (HR-OCT) is a non-invasive technique that can differentiate OSSN from other ocular surface lesions. AREAS COVERED This review highlights the current regimens and diagnostic modalities used in managing OSSN. A review of the literature was performed using the keywords "conjunctival intraepithelial neoplasia", "ocular surface squamous neoplasia", "optical coherence tomography", "interferon-α2b", "5-fluorouracil" and "mitomycin C". EXPERT COMMENTARY Topical chemotherapy for OSSN can be used as primary therapy, for chemoreduction prior to surgical excision, and postoperatively to prevent tumor recurrence. It has the advantage of treating microscopic disease as well as large tumors. HR-OCT provides an "optical biopsy" that can assist in diagnosis and guide management of OSSN lesions.
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Affiliation(s)
- Ibrahim O Sayed-Ahmed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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38
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Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study. Trop Med Int Health 2016; 21:1522-1530. [PMID: 27714903 PMCID: PMC5574019 DOI: 10.1111/tmi.12792] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine modifiable risk factors of ocular surface squamous neoplasia (OSSN) in Kenya using disease-free controls. METHODS Adults with conjunctival lesions were recruited at four eye care centres in Kenya and underwent excision biopsy. An equal number of controls having surgery for conditions not affecting the conjunctiva and unrelated to ultraviolet light were group-matched to cases by age group, sex and eye care centre. Associations of risk factors with OSSN were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Continuous variables were compared using the t-test or the Wilcoxon-Mann-Whitney U-test depending on their distribution. RESULTS A total of 131 cases and 131 controls were recruited. About two-thirds of participants were female, and the mean age of cases and controls was 42.1 years and 43.3 years, respectively. Risk factors for OSSN were HIV infection without antiretroviral therapy (ART) use (OR = 48.42; 95% CI: 7.73-303.31) and with ART use (OR = 19.16; 95% CI: 6.60-55.57), longer duration of exposure to the sun in the main occupation (6.9 h/day vs. 4.6 h/day, OR = 1.24; 95% CI: 1.10-1.40) and a history of allergic conjunctivitis (OR = 74.61; 95% CI: 8.08-688.91). Wearing hats was protective (OR = 0.22; 95% CI: 0.07-0.63). CONCLUSION Measures to prevent and control HIV, reduce sun exposure such as wearing hats and control allergic conjunctivitis are recommended.
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Affiliation(s)
- Stephen Gichuhi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | | | | | - Hillary Rono
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Kitale District Hospital, Kitale, Kenya
| | | | | | | | - Timothy Onyuma
- Department of Pathology, MP Shah Hospital, Nairobi, Kenya
| | - Walter G Jaoko
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Mandeep S Sagoo
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK.,St. Bartholomew's Hospital, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Moorfields Eye Hospital, London, UK
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Evaluation for High-risk HPV in Squamous Cell Carcinomas and Precursor Lesions Arising in the Conjunctiva and Lacrimal Sac. Am J Surg Pathol 2016; 40:519-28. [PMID: 26735858 DOI: 10.1097/pas.0000000000000581] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High-risk human papilloma virus (HR-HPV) is a well-established causative agent of oropharyngeal squamous cell carcinoma (SCC). In addition, HR-HPV has occasionally been reported to be present in dysplastic and malignant lesions of the conjunctiva and lacrimal sac, although its overall incidence and etiological role in periocular SCC are controversial. Sequential surgical samples of 52 combined cases of invasive SCC (I-SCC) and SCC in situ (SCCIS) from 2 periocular sites (conjunctiva and lacrimal sac) diagnosed over a 14-year period (2000 to 2014) were selected for evaluation, and relevant patient characteristics were documented. p16 immunohistochemistry was performed as a screening test. All p16-positive cases were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by polymerase chain reaction (PCR). Of 43 ocular surface squamous neoplasias (OSSNs), 30% (n=13; 8 SCCIS and 5 I-SCC cases) were positive for HR-HPV. HPV-positive OSSNs occurred in 8 men and 5 women with a mean age of 60 years (range, 39 to 94 y). HPV type-16 was detected in all conjunctival cases evaluated by PCR. All 5 conjunctival I-SCCs were nonkeratinizing (n=4) or partially keratinizing (n=1) and managed by simple excision. In contrast, HPV-negative conjunctival I-SCCs were predominantly keratinizing (11 keratinizing and 2 nonkeratinizing). Of 9 lacrimal sac I-SCCs (LSSCCs), 66.7% (n=6) were positive for HR-HPV by p16 and DNA ISH; HPV subtypes were HPV-16 (n=5) and HPV-58 (n=1). In addition, 2 p16-positive cases with negative DNA ISH results were HR-HPV positive (HPV-16 and HPV-33) when evaluated by PCR, suggesting that the rate of HR-HPV positivity among the LSSCCs may be as high as 89% (n=8). The combined group of HR-HPV-positive LSSCCs was seen in 4 men and 4 women with a mean age of 60 years (range, 34 to 71 y). Seven of the 8 HPV-positive LSSCCs (87.5%) had a nonkeratinizing or partially keratinizing histomorphology, whereas 1 case (12.5%) was predominantly keratinizing. The presence of HR-HPV in 30% of OSSNs and at least 66.7% of LSSCCs suggests the possibility of an etiologic role for HR-HPV at these sites.
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Hamed-Azzam S, Edison N, Briscoe D, Mukari A, Elmalah I. Identification of human papillomavirus in pterygium. Acta Ophthalmol 2016; 94:e195-7. [PMID: 25864511 DOI: 10.1111/aos.12729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/01/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the involvement of human papillomavirus in the pathogenesis of primary and recurrent pterygium in northern Israel. METHODS A retrospective study examined 100 randomly chosen pterygium specimens with solar elastosis, from 100 patients who underwent pterygium surgery during 2012-2013 at the Emek Medical Center. All the specimens were analysed for evidence of human papillomavirus infection by immunohistochemistry. RESULTS Human papillomavirus was not detected in any of the 100 pterygia samples by immunohistochemistry. These used samples were taken from 100 patients with mean age of 51.5 years and a primary: recurrent ratio of 8.09:1. CONCLUSION We conclude from our study that human papillomavirus infection does not appear to be an important pathogenic factor of pterygium in Israel.
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Affiliation(s)
| | - Natalia Edison
- The Tissue Diagnostics and Cancer Research Institute; Emek Medical Center; Afula Israel
| | - Daniel Briscoe
- Department of Ophthalmology; Emek Medical Center; Afula Israel
| | - Abed Mukari
- Department of Ophthalmology; Emek Medical Center; Afula Israel
| | - Irit Elmalah
- The Tissue Diagnostics and Cancer Research Institute; Emek Medical Center; Afula Israel
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Kheir WJ, Tetzlaff MT, Pfeiffer ML, Mulay K, Ozgur O, Morrell G, Esmaeli B. Epithelial, non-melanocytic and melanocytic proliferations of the ocular surface. Semin Diagn Pathol 2016; 33:122-32. [DOI: 10.1053/j.semdp.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wanyonyi L, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Toluidine Blue 0.05% Vital Staining for the Diagnosis of Ocular Surface Squamous Neoplasia in Kenya. JAMA Ophthalmol 2016; 133:1314-21. [PMID: 26378623 DOI: 10.1001/jamaophthalmol.2015.3345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Clinical features are unreliable for distinguishing ocular surface squamous neoplasia (OSSN) from benign conjunctival lesions. OBJECTIVE To evaluate the adverse effects, accuracy, and interobserver variation of toluidine blue 0.05% vital staining in distinguishing OSSN, confirmed by histopathology, from other conjunctival lesions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study in Kenya from July 2012 through July 2014 of 419 adults with suspicious conjunctival lesions. Pregnant and breastfeeding women were excluded. EXPOSURES Comprehensive ophthalmic slitlamp examination was conducted. Vital staining with toluidine blue 0.05% aqueous solution was performed before surgery. Initial safety testing was conducted on large tumors scheduled for exenteration looking for corneal toxicity on histology before testing smaller tumors. We asked about pain or discomfort after staining and evaluated the cornea at the slitlamp for epithelial defects. Lesions were photographed before and after staining. MAIN OUTCOMES AND MEASURES Diagnosis was confirmed by histopathology. Six examiners assessed photographs from a subset of 100 consecutive participants for staining and made a diagnosis of OSSN vs non-OSSN. Staining was compared with histopathology to estimate sensitivity, specificity, and predictive values. Adverse effects were enumerated. Interobserver agreement was estimated using the κ statistic. RESULTS A total of 143 of 419 participants (34%) had OSSN by histopathology. The median age of all participants was 37 years (interquartile range, 32-45 years) and 278 (66%) were female. A total of 322 of the 419 participants had positive staining while 2 of 419 were equivocal. There was no histological evidence of corneal toxicity. Mild discomfort was reported by 88 (21%) and mild superficial punctate keratopathy seen in 7 (1.7%). For detecting OSSN, toluidine blue had a sensitivity of 92% (95% CI, 87%-96%), specificity of 31% (95% CI, 25%-36%), positive predictive value of 41% (95% CI, 35%-46%), and negative predictive value of 88% (95% CI, 80%-94%). Interobserver agreement was substantial for staining (κ = 0.76) and moderate for diagnosis (κ = 0.40). CONCLUSIONS AND RELEVANCE With the high sensitivity and low specificity for OSSN compared with histopathology among patients with conjunctival lesions, toluidine blue 0.05% vital staining is a good screening tool. However, it is not a good diagnostic tool owing to a high frequency of false-positives. The high negative predictive value suggests that a negative staining result indicates that OSSN is relatively unlikely.
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Affiliation(s)
- Stephen Gichuhi
- London School of Hygiene and Tropical Medicine, London, England2Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | - Timothy Onyuma
- Department of Pathology, MP Shah Hospital, Nairobi, Kenya
| | - Walter G Jaoko
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Mandeep S Sagoo
- University College London Institute of Ophthalmology, London, England10Moorfields Eye Hospital, London, England11St Bartholomew's Hospital, London, England
| | - Helen A Weiss
- London School of Hygiene and Tropical Medicine, London, England
| | - Matthew J Burton
- London School of Hygiene and Tropical Medicine, London, England10Moorfields Eye Hospital, London, England
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Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wanyonyi L, Wachira J, Munene R, Onyuma T, Sagoo MS, Weiss HA, Burton MJ. Clinical Presentation of Ocular Surface Squamous Neoplasia in Kenya. JAMA Ophthalmol 2016; 133:1305-13. [PMID: 26378395 DOI: 10.1001/jamaophthalmol.2015.3335] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE There is a trend toward treating conjunctival lesions suspected to be ocular surface squamous neoplasia (OSSN) based on the clinical impression. OBJECTIVE To describe the presentation of OSSN and identify clinical features that distinguish it from benign lesions and subsequently evaluate their recognizability. DESIGN, SETTING, AND PARTICIPANTS Prospective multicenter study in Kenya from July 2012 through July 2014 of 496 adults presenting with conjunctival lesions. One histopathologist examined all specimens. Six additional masked ophthalmologists independently examined photographs from 100 participants and assessed clinical features. EXPOSURES Comprehensive history, slitlamp examination, and photography before excision biopsy. MAIN OUTCOMES AND MEASURES Frequency of clinical features in OSSN and benign lesions were recorded. Proportions and means were compared using χ2, Fisher exact test, or t test as appropriate. Interobserver agreement was estimated using the κ statistic. Examiners' assessments were compared with a reference. RESULTS Among 496 participants, OSSN was the most common (38%) histological diagnosis, followed by pterygium (36%) and actinic keratosis (19%). Patients with OSSN were slightly older (mean [SD] age, 41 [11.6] vs 38 [10.9] years; P = .002) and tended to have lower levels of education than patients with benign lesions (P = .001). Females predominated (67% of OSSN vs 64% of benign lesions; P = .65). Human immunodeficiency virus infection was common among patients with OSSN (74%). The most common location was the nasal limbus (61% OSSN vs 78% benign lesions; P < .001). Signs more frequent in OSSN included feeder vessels (odds ratio [OR], 5.8 [95% CI, 3.2-10.5]), moderate inflammation (OR, 3.5 [95% CI, 1.8-6.8]), corneal involvement (OR, 2.7 [95% CI, 1.8-4.0]), leukoplakia (OR, 2.6 [95% CI, 1.7-3.9]), papilliform surface (OR, 2.1 [95% CI, 1.3-3.5]), pigmentation (OR, 1.5 [95% CI, 1.0-2.2]), temporal location (OR, 2.0 [95% CI, 1.2-3.2]), circumlimbal location (6.7% vs 0.3%; P < .001), severe inflammation (6.7% vs 0.3%; P < .001), and larger mean (SD) diameter (6.8 [3.2] vs 4.8 [2.8] mm; P < .001). All OSSN signs were also observed in benign lesions. There was slight to fair interobserver agreement in assessment of most signs and diagnosis (κ, 0.1-0.4). The positive predictive value of clinical appearance in identifying OSSN was 54% (interquartile range, 51%-56%) from photographs in which prevalence was 32%. CONCLUSIONS AND RELEVANCE With overlapping phenotypes and modest interobserver agreement, OSSN and benign conjunctival lesions are not reliably distinguished clinically. Point-of-care diagnostic tools may help.
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Affiliation(s)
- Stephen Gichuhi
- London School of Hygiene and Tropical Medicine, London, England2Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | | | | | - Hilary Rono
- Eye Department, Kitale District Hospital, Kitale, Kenya
| | | | | | - Joseph Wachira
- Ophthalmology Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Rhoda Munene
- Ophthalmology Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Timothy Onyuma
- Department of Pathology, MP Shah Hospital, Nairobi, Kenya
| | - Mandeep S Sagoo
- UCL Institute of Ophthalmology, London, England9Moorfields Eye Hospital, London, England10St Bartholomew's Hospital, London, England
| | - Helen A Weiss
- London School of Hygiene and Tropical Medicine, London, England
| | - Matthew J Burton
- London School of Hygiene and Tropical Medicine, London, England9Moorfields Eye Hospital, London, England
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Cardenas-Cantu E, Valenzuela J, Zavala J, Valdez-Garcýa JE. Basis of Pterygium Development. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/highlights-44-6-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ramberg I, Heegaard S, Prause JU, Sjö NC, Toft PB. Squamous cell dysplasia and carcinoma of the conjunctiva. A nationwide, retrospective, epidemiological study of Danish patients. Acta Ophthalmol 2015; 93:663-6. [PMID: 25903169 DOI: 10.1111/aos.12743] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/18/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the epidemiology of squamous cell dysplasia and carcinoma of the conjunctiva in Denmark. METHODS Review of the histopathological case reports at the Eye Pathology Institute (EPI), University of Copenhagen, and the National Danish Pathology Bank from 1980 to 2011. Information regarding distribution of age and sex, localization, earlier pathology, comorbidity and recurrence of the condition was registered. The Cause of Death Registry at Statens Serum Institut was used to obtain information regarding cause of death. RESULTS A total of 143 cases were identified. Ninety-five (61%) had epithelial dysplasia, 19 (13%) had carcinoma in situ, and 29 (20%) had squamous cell carcinoma. A significantly higher proportion of men were found. The median age at diagnosis was 65 years. The risk of recurrence was 10.0% [95% confidence interval (CI): 5.0-15.0] after 1 year and 17.2% (95% CI: 10.8-23.7) after 5 years. The lesions were most often localized to the corneal limbus. In our records, one patient had a lymph node metastasis and the disease necessitated enucleation in two patients. No patients had died from squamous cell carcinoma of the conjunctiva. CONCLUSION Overall, our data are in agreement with the results of previous studies in Northern, high-latitude countries. There is a low incidence rate; the lesions are predominantly seen in men in their seventh decade and localized to the corneal limbus. The risk of recurrence is high, and the benign lesions have potential to progress to frank carcinoma.
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Affiliation(s)
| | | | - Jan Ulrik Prause
- Eye Pathology Institute; University of Copenhagen; Copenhagen Denmark
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Kabra RC, Khaitan IA. Comparative Analysis of Clinical Factors Associated with Ocular Surface Squamous Neoplasia in HIV Infected and Non HIV Patients. J Clin Diagn Res 2015; 9:NC01-3. [PMID: 26155504 DOI: 10.7860/jcdr/2015/13236.5932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/06/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conjunctival and corneal epithelial disease ranging from dysplasia to invasive carcinoma. HIV infection is an important risk factor postulated for the development of disease. AIM To compare and to find out any statistically significant difference in patient demographics, clinical features and pathological findings in HIV infected and non-HIV infected histologically proven cases of ocular surface squamous neoplasia (OSSN). MATERIALS AND METHODS In the present retrospective case study, data from indoor case records and ocular pathology records of histologically proven cases of OSSN was obtained. The data was then tabulated under various clinicopathological headings in HIV affected and non HIV affected groups. A chi-square test was applied to compare data of two groups and look for any significant difference between two groups. A p-value less than 0.05 was considered significant. RESULTS Amongst the total of 48 patients, 11 were HIV positive and 37 were HIV negative. Age of the patients ranged from 14-66 years in HIV and 22-66 years in non HIV group with a preponderance of younger age patients in HIV positive group. 54.5% patients with lesion having base more than 5mm were observed at the time of presentation in HIV positive population as compared to 21.6% in non HIV cases. Feeder vessels were seen in all HIV patients and a significantly greater degree of fornicial involvement was noted in comparison with non-HIV group. Histopathological analysis showed 63.63% of cases to be of invasive carcinoma amongst the HIV positive group and 54.05% of invasive carcinoma in non HIV group. CONCLUSION Younger age and aggressive looking tumour at presentation should caution ophthalmologist to look for an undiagnosed HIV infection in OSSN patients.
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Affiliation(s)
- Ruchi C Kabra
- Assistant Professor, Department of Ophthalmology, M & J Western Regional Institute of Ophthalmology, BJ Medical College, Civil Hospital , Ahmedabad, Gujrat, India
| | - Isha A Khaitan
- Resident Doctor, Department of Ophthalmology, M & J Western Regional Institute of Ophthalmology, BJ Medical College, Civil Hospital , Ahmedabad, Gujrat, India
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Squamous Cell Neoplasm of the Ocular Surface in a Patient With Psoriasis Treated With Tumor Necrosis Factor-Alpha Inhibitors. Cornea 2015; 34:833-4. [DOI: 10.1097/ico.0000000000000465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hayek S, Mgarrech M, Touhami S, Troumani Y, Bonin L, Rousseau A, Barreau E, Adam C, Labetoulle M. [Invasive conjunctival squamous cell carcinoma after excision of a tumor simulating a pterygium]. J Fr Ophtalmol 2015; 38:e125-7. [PMID: 25976138 DOI: 10.1016/j.jfo.2014.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/02/2014] [Accepted: 05/23/2014] [Indexed: 11/25/2022]
Affiliation(s)
- S Hayek
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - M Mgarrech
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Touhami
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Y Troumani
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - L Bonin
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - A Rousseau
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - E Barreau
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - C Adam
- Service d'anatomopathologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - M Labetoulle
- Service d'ophtalmologie, centre hospitalier universitaire, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Kelishadi M, Kelishadi M, Moradi A, Javid N, Bazouri M, Tabarraei A. human adenoviruses role in ophthalmic pterygium formation. Jundishapur J Microbiol 2015; 8:e16871. [PMID: 26034543 PMCID: PMC4449841 DOI: 10.5812/jjm.16871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 05/31/2014] [Accepted: 06/08/2014] [Indexed: 02/05/2023] Open
Abstract
Background: Ophthalmic pterygium is a common benign lesion of unknown origin and the pathogenesis might be vision-threatening. This problem is often associated with exposure to solar light. Recent evidence suggests that potentially oncogenic viruses such as human papillomavirus and Epstein-Barr virus may be involved in the pathogenesis of pterygia. Expression of specific adenovirus genes such as E1A and E1B, which potentially have many functions, may contribute to their oncogenic activity as well as relevance to cellular immortalization. Objectives: For the first time, we aimed to investigate involvement of adenoviruses in pterygium formation. Patients and Methods: Fifty tissue specimens of pterygium from patients undergoing pterygium surgery (as cases), 50 conjunctival swab samples from the same patients and 10 conjunctival biopsy specimens from individuals without pterygium such as patients undergoing cataract surgery (as controls) were analyzed for evidence of adenovirus infection with polymerase chain reaction using specific primers chosen from the moderately conserved region of the hexon gene. Furthermore, β-globin primers were used to access the quality of extracted DNA. Data was analyzed using SPSS (version 16) software. Results: Of 50 patients, 20 were men and 30 women with mean age of 61.1 ± 16.9 years ranged between 22 and 85 years. All samples of pterygia had positive results for adenoviruses DNA with polymerase chain reaction, but none of the negative control groups displayed adenoviruses. The pterygium group and the control groups were β-globin positive. Direct sequencing of PCR products confirmed Adenovirus infection. Conclusions: Adenoviruses might act as a possible cause of pterygium formation and other factors could play a synergistic role in the development. However, further larger studies are required to confirm this hypothesis.
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Affiliation(s)
- Mishar Kelishadi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | | | - Abdolvahab Moradi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Naeme Javid
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Masoud Bazouri
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Alijan Tabarraei
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding author: Alijan Tabarraei, Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-1714422652, Fax: +98-1714440225, E-mail:
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Yin VT, Merritt HA, Sniegowski M, Esmaeli B. Eyelid and ocular surface carcinoma: Diagnosis and management. Clin Dermatol 2015; 33:159-69. [DOI: 10.1016/j.clindermatol.2014.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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