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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Svedberg K. Recurrence of Primary Acquired Melanosis and Conjunctival Intraepithelial Neoplasia. Ocul Oncol Pathol 2023; 8:236-241. [PMID: 36925733 PMCID: PMC10013497 DOI: 10.1159/000526985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate the frequency of recurrences, time to recurrence, and which patients had a recurrence after treatment of conjunctival intraepithelial neoplasia (CIN), carcinoma in situ, and primary acquired melanosis (PAM) with atypia. Methods A retrospective chart review of all patients included in the follow-up program after completion of treatment for CIN or PAM with atypia on October 18, 2021, at the Department of Ophthalmology, Sahlgrenska University Hospital, was conducted. Results There were five recurrences (5/31, 17%) in the group with CIN or carcinoma in situ: two for patients with CIN grade II and three for individuals with carcinoma in situ. Time to diagnosis of recurrence ranged from 6 to 288 months. No recurrence was diagnosed for the 26 patients followed after treatment for PAM with atypia. Conclusion With the strategy of radical treatment for CIN and PAM with atypia, whenever possible, subsequent follow-up can probably be ceased after 10 years if the patient is not immunocompromised. For completely excised PAM with atypia grade I, there is most likely no need for further clinical controls.
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Affiliation(s)
- Karin Svedberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
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3
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Moratal Peiro B, Calvo Garcia R, Soler Sanchis I, Mata Moret L, Cervera Taulet E. Advancing wavelike epitheliopathy after conjunctival intraepithelial neoplasia. Atipical case report. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:337-339. [PMID: 35676026 DOI: 10.1016/j.oftale.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/08/2021] [Indexed: 06/15/2023]
Abstract
An atypical Advancing Wavelike Epitheliopathy case, consecutive to topical treatment for a 360º Conjunctival Intraepithelial Neoplasia, is presented. Mitomycin (0.2 mg/mL) and interferon (1 MUI/mL) drops were used. An atypical presentation, with migrating limbal focus, non clearly delimited in its hourly site through its evolution. Treated with flurometholone drops plus artificial tears, working to complete resolution.
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Affiliation(s)
- B Moratal Peiro
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - R Calvo Garcia
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - I Soler Sanchis
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Mata Moret
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - E Cervera Taulet
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Mirzayev I, Gündüz AK, Gündüz ÖÖ, Özalp Ateş FS, Nalcı Baytaroğlu H. Demographic and clinical features of conjunctival tumours at a tertiary care centre. Clin Exp Optom 2021; 105:708-714. [PMID: 34617502 DOI: 10.1080/08164622.2021.1971048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE This study investigates the demographic and clinical features of conjunctival tumours. BACKGROUND Conjunctival tumours include a large spectrum of conditions ranging from benign lesions to aggressive, life-threatening malignancies. Knowing the distribution of conjunctival tumours by age and gender is important for reducing cancer morbidity. METHODS The clinical records of 375 patients (410 eyes) diagnosed with a conjunctival mass at a tertiary referral centre between February 1999 and November 2020 were retrospectively evaluated. RESULTS Two-hundred-seventeen (57.9%) patients were male and 158 (42.1%) were female. Of 410 conjunctival tumours, 159 (38.8%) were benign, 106 (25.9%) premalignant, and 145 (35.4%) malignant. Overall, the 3 most common diagnoses were squamous cell carcinoma (SCC, 19.5%), conjunctival intraepithelial neoplasia (CIN, 18.3%), and naevus (17.8%). The most common benign, premalignant, and malignant tumours were naevus (n = 73/159, 45.9%), CIN (n = 75/106, 70.8%), and SCC (n = 80/145, 55.2%) respectively. Naevus was the most common tumour in ≤20 years and > 20-40 years old patient groups (56.2% and 25.4% respectively). CIN was the most frequent tumour in patients aged > 40-60 years (25.7%). SCC was the most common tumour in > 60-80 years and > 80 years old patient groups (44.3% and 80.0% respectively). The median patient age was greater in patients with malignant tumours (64.5 years) compared to patients with premalignant (55.5 years, p = 0.011) and benign tumours (22.0 years, p < 0.001). Malignant tumours displayed larger base diameter, greater thickness, and intrinsic vessels compared to premalignant or benign lesions (p < 0.001 for each parameter). Malignant tumours also displayed more amelanotic vs melanotic appearance (p < 0.001) and limbal vs extralimbal bulbar location compared to benign lesions (p < 0.001). CONCLUSION Premalignant and malignant tumours comprised 61.2% of all conjunctival tumours and were usually detected in patients > 40 years of age in this study.
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Affiliation(s)
- Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömür Özlenen Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Jirsova K, Vesela V, Skalicka P, Ruzickova E, Glezgova J, Zima T, Dusinska M, Collins A, Bednar J. The micronucleus cytome assay - A fast tool for DNA damage screening in human conjunctival epithelial cells. Ocul Surf 2021; 20:195-198. [PMID: 33677062 DOI: 10.1016/j.jtos.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess whether the micronucleus cytome assay (MCyt) reliably detects DNA damage occurring in control and pathological superficial epithelial cells from human conjunctiva. METHODS Impression cytology samples from the bulbar conjunctiva of 33 healthy controls, eight patients with conjunctival intraepithelial neoplasia (CIN) and eight with mucous membrane pemphigoid (MMP) were examined using the MCyt modified for the ocular surface. RESULTS The mean number of micronuclei (MNi) in control samples was 0.94 MNi/1000 epithelial cells, with no significant difference between conjunctival quadrants and independent of sex and age. The MCyt assay applied to CIN-affected eyes showed a significantly higher frequency of MNi (18.63/1000 cells), apoptotic cells, nuclear enlargement, multinucleated cells, and keratolysis compared with the corresponding unaffected paired eyes and with the control value. Although the mean MNi frequency in MMP eyes was also higher (1.73 MNi/1000 cells), it did not prove to be statistically different from the control samples. On the other hand, the MMP-affected eyes revealed significantly elevated percentages of cells with snake-like chromatin, multinucleated cells, apoptotic cells, and nuclear buds compared with controls. CONCLUSIONS Micronucleus cytome assay was adapted as a rapid screening test for genomic instability on the ocular surface. We have determined reference levels for MNi and other nuclear alterations on healthy conjunctiva and demonstrated that particularly frequencies of MNi are significantly elevated in conjunctiva affected by CIN. We demonstrate that MNi are more specific than other nuclear abnormalities and thus can be used for screening of ocular surface neoplasia.
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Affiliation(s)
- Katerina Jirsova
- Laboratory of the Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic. https://maps.google.com/?q=Prague,+Czech+Republic+%0D%0A+Albertov+4,+128+00,+Prague,+Czech+Republic&entry=gmail&source=g
| | - Viera Vesela
- Laboratory of the Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Pavlina Skalicka
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Eva Ruzickova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Johana Glezgova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Tomas Zima
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Maria Dusinska
- Health Effects Laboratory, Department of Environmental Chemistry, NILU-Norwegian Institute for Air Research, Kjeller, Norway
| | - Andrew Collins
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Jan Bednar
- Laboratory of the Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Chaidaroon W, Dejkriengkraikul C, Isipradit S, Lertprasertsuke N. Conjunctival Intraepithelial Neoplasia in a Patient Presenting with Pigmented Conjunctival Lesion. Case Rep Ophthalmol 2021; 12:77-82. [PMID: 33613255 PMCID: PMC7879333 DOI: 10.1159/000510570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
We report a case of conjunctival intraepithelial neoplasia (CIN) in a patient presenting with the pigmented conjunctival lesion. This study involved a 56-year-old woman that presented with right eye irritation for 1 month. She noticed brownish pigmentation arising from her right nasal conjunctiva and growing slowly over time. Biomicroscopic examination showed a gelatinous pigmented conjunctival mass with feeder vessels. Conjunctival impression cytology (CIC) was done and reported as CIN. Treatment was started with 0.02% mitomycin-C eye drops. The conjunctival lesion responded well to medication. This report shows that CIN can manifest as a pigmented tumor, resembling melanoma. CIC plays a role in the diagnosis of this condition. This tumor responded well with 0.02% mitomycin-C eye drops.
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Affiliation(s)
- Winai Chaidaroon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sirawit Isipradit
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Vempuluru VS, Kapoor AG, Kaliki S, Jajapuram SD, Mohamed A, Mishra DK. Comparative evaluation of clinical characteristics of biopsy-proven conjunctival intraepithelial neoplasia and invasive squamous cell carcinoma using image processing software programs. Int Ophthalmol 2021; 41:1301-1307. [PMID: 33392945 DOI: 10.1007/s10792-020-01687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify morphological parameters aiding clinical differentiation of conjunctival intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma (iSCC) and to demonstrate the utility of image processing software to objectively assess ocular surface squamous neoplasia (OSSN). METHODS This retrospective case series included all biopsy-proven cases of OSSN presenting as an ocular surface nodule. Based on histopathology, lesions were classified as CIN and iSCC. Clinical image analysis utilized 'Contour' and 'ImageJ' software. The effect of predictors demography, seropositivity, lesion dimensions, keratin, pigmentation, corneal involvement, vascularity and feeder vessels on the final histopathologic grade were assessed. RESULTS A total of 108 OSSN lesions (74 CIN and 33 iSCC) were included. Mean age was 46.1 ± 17.2 years in CIN and 47.2 ± 13.9 years in iSCC. By univariate logistic regression analysis, significant predictors of iSCC were HIV seropositivity (p < 0.0001), maximum diameter (p = 0.003), perpendicular to maximum diameter (p = 0.003), height (p = 0.003), nodular morphology (p = 0.006) and feeder vessels (p = 0.03), whereas gelatinous morphology (p = 0.02) was predictor of CIN. By multiple logistic regression, seropositivity was the predictor of iSCC (p < 0.0001, OR 13.33 ± 8.35, 95% CI 3.90-45.53). CONCLUSION HIV seropositivity is an important predictor of iSCC. Large, thick, nodular lesions with feeder vessels may favor the diagnosis of iSCC, whereas gelatinous, small, flatter lesions without feeder vessels may favor CIN. In a first of its kind study, simple and objective analysis of OSSN with image processing software was demonstrated.
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Affiliation(s)
- Vijitha S Vempuluru
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Vijayawada, Krishna, 521137, India
| | - Anasua Ganguly Kapoor
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Vijayawada, Krishna, 521137, India.
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Sai Divya Jajapuram
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, India
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8
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Palme C, Wanner A, Romano V, Haas G, Kaye S, Steger B. Observation of angiographic dye leakage in ocular surface squamous neoplasia. Am J Ophthalmol Case Rep 2020; 20:100912. [PMID: 32984652 PMCID: PMC7495007 DOI: 10.1016/j.ajoc.2020.100912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose The clinical diagnosis of ocular surface squamous neoplasia is challenging, mostly requiring excisional biopsy. Human tumor angiogenesis is characterized by abnormal vessel architecture and transvascular hyperpermeability. This case report describes features of fluorescein and indocyanine green angiography in a case of conjunctival intraepithelial neoplasia. Observations Color photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed in a patient with suspected conjunctival intraepithelial neoplasia before excisional biopsy and histologic confirmation of clinical diagnosis. Fluorescein dye showed extensive early extravascular dye leakage within the limits of the lesion. Indocyanine green dye displayed corneal terminal vessel bulbs with early leakage after 70 seconds and showed diffuse intralesional dye leakage after 7 minutes. Conclusions Increased fluorescein and early indocyanine green dye leakage can be used to confirm active angiogenesis already in early stages of dysplastic ocular surface squamous neoplasia. Late leakage of indocyanine green dye may be due to chronic transvascular hyperpermeability within intrinsic tumor vessels. The leakage behaviour of intravenous dyes has the potential to serve as a diagnostic indicator of active growth in dysplastic ocular surface neoplastic lesions.
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Affiliation(s)
- Christoph Palme
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Astrid Wanner
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Vito Romano
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
| | - Gertrud Haas
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Stephen Kaye
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
| | - Bernhard Steger
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
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Nuessle S, Soriano D, Boehringer D, Mittelviefhaus H, Lange C, Reinhard T, Atzrodt L, Auw-Haedrich C. HIF-1α, HIF-2α, and ProExC: diagnostic or prognostic relevance in conjunctival intraepithelial neoplasia? Graefes Arch Clin Exp Ophthalmol 2020; 258:2023-2030. [PMID: 32458097 PMCID: PMC7438294 DOI: 10.1007/s00417-020-04734-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The aim of this study was to investigate HIF-1α, HIF-2α, and ProExC expression in conjunctival intraepithelial neoplasia (CIN), to differentiate between metaplasia and dysplasia, and to access their value as diagnostic and prognostic immunohistochemical markers. Recurrence and progression into SCC (squamous cell carcinoma) were defined as endpoints. Methods Forty-three specimens including CIN I (2), CIN II (9), CIN III (29), with and without metaplasia, and metaplasia alone (3), as well as 21 conjunctival control specimens, were stained with antibodies against HIF-1α, HIF-2α, and ProExC. The percentage of positively stained cells were calculated and used for further analysis. Results The mean percentages of HIF-1α and HIF-2α were not increased in CIN. In comparison, the expressions of these markers were even significantly elevated in control specimens (p < 0.001). Upper epithelial cells in CIN were more often ProExC-positive compared with normal conjunctiva or metaplasia (p = 0.06 and p = 0.07). Cox proportional-hazards analysis was performed for characterization of factors influencing the combined endpoint and showed a significant elevated hazard ratio for staining with ProExC (p = 0.04) compared with HIF-1α (p = 0.26) and HIF-2α (p = 0.49). Conclusion Our study shows that HIF-1α and HIF-2α do not serve as diagnostic or prognostic markers in CIN. ProExC seems to be a potential indicator for CIN, but not a reliable diagnostic marker. However, control specimens occasionally also display a high percentage of ProExC-positive cells and staining over the entire epithelial layer.
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Affiliation(s)
- Simone Nuessle
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany.
| | - Daniel Soriano
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Hans Mittelviefhaus
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Clemens Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Lisa Atzrodt
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
| | - Claudia Auw-Haedrich
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany
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Warren N, Mercer RN, Haddad J, Magrath G, Rocha KM. Corneal melt in conjunctival intraepithelial neoplasia. Am J Ophthalmol Case Rep 2020; 19:100689. [PMID: 32426552 PMCID: PMC7225610 DOI: 10.1016/j.ajoc.2020.100689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/31/2019] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Report a case of corneal melt in a patient with conjunctival intraepithelial neoplasia (CIN) treated with topical interferon (IFN) alpha-2B. Observations An 89-year-old man presented with gelatinous paralimbal lesions of the left eye extending onto the cornea with corneal neovascularization extending 5–6 clock hours. Nasally there was mild absence of the terminal vascular loops of the limbal palisades of Vogt and conjunctivalization. Diffuse punctate epithelial erosions were noted. The corneal graft displayed subepithelial and stromal edema. Anterior segment optical coherence tomography detected hyperreflectivity, sectional thickened epithelium, and abrupt transitions from normal to abnormal tissue. The patient was treated with excision of the corneal and conjunctival lesions with cryotherapy to the conjunctival borders. Excisional biopsy revealed CIN Grade 3 and carcinoma in situ of the cornea. Topical IFN alpha-2B four times daily was initiated postoperatively. Two months later, a central epithelial defect developed. The cornea progressively thinned and corneal melt ensued. The patient had several risk factors for corneal melt including neurotrophic cornea, early limbal stem cell deficiency, history of cryotherapy, keratoconjunctivitis sicca, and chronic use of glaucoma medications and steroid medications. Conclusions Interferon alpha-2B is an effective first line treatment for CIN with few side effects. It's side effects include punctate epithelial erosions, conjunctival hyperemia, and follicular conjunctivitis. We report a case of pre-existing keratoconjunctivitis sicca, early limbal stem cell deficiency, neurotrophic cornea, and newly diagnosed CIN Grade 3; it was treated with surgical excision, cryotherapy, and topical IFN alpha-2b with development of corneal melt 2 months later. Caution should be taken when using interferon alpha -2b in patients with pre-existing keratoconjunctivitis sicca, neurotrophic cornea, or limbal stem cell deficiency as it could exacerbate these conditions resulting in corneal melt.
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Affiliation(s)
- Nichelle Warren
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina Charleston, SC, USA
| | - Ryan N Mercer
- Department of Ophthalmology, Mason Eye Institute, University of Missouri Hospital, Columbia, MO, USA
| | - Jorge Haddad
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina Charleston, SC, USA
| | - George Magrath
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina Charleston, SC, USA
| | - Karolinne M Rocha
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina Charleston, SC, USA
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11
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Lozano García I, Romero Caballero MD, Sellés Navarro I. High resolution anterior segment optical coherence tomography for differential diagnosis between corneo- conjunctival intraepithelial neoplasia and pterygium. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:108-113. [PMID: 32007344 DOI: 10.1016/j.oftal.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN). MATERIAL AND METHODS An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis. RESULTS Mean age of patients with pterygium (n=18) was 52.67±15 y.o and 74±12 y.o in subjects with CIN (n=4) (p<0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4±26μm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5±124μm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p<0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141μm as cutoff point of EE. CONCLUSION AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141μm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN.
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Affiliation(s)
- I Lozano García
- Servicio de Oftalmología, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España.
| | - M D Romero Caballero
- Servicio de Oftalmología, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
| | - I Sellés Navarro
- Servicio de Oftalmología, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
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Abstract
Ocular surface squamous neoplasia is the most common tumour of the ocular surface. It is a spectrum of disease from intraepithelial dysplasia to invasive squamous cell carcinoma. Recent years have seen an increase in the use of topical chemotherapeutic agents to treat this condition, often as primary treatment without full-thickness biopsy. This practical approach provides a critical appraisal of the evidence base with the goal being to aid the clinician in the management of these patients.
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Zloto O, Weidenfeld J, Fabian ID. Development of conjunctival intraepithelial neoplasia following phototherapy for mycosis fungoides. Am J Ophthalmol Case Rep 2019; 14:98-100. [PMID: 31011661 DOI: 10.1016/j.ajoc.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 02/06/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
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Patel H, Jeang LJ, Shah A, Espana EM, Margo CE. Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b. Ocul Oncol Pathol 2018; 4:298-303. [PMID: 30320101 DOI: 10.1159/000486339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To emphasize the importance of staging ocular surface squamous neoplasia when contemplating use of topical interferon alpha-2b alone. Cases Two patients with 360 degrees of limbal involvement. Results Two patients with in situ squamous cell carcinoma of the conjunctiva and clinical involvement of the entire limbus were treated with topical interferon alpha-2b. Thorough examination and multiple biopsies excluded invasive disease. The patients had complete response to therapy. Conclusion Widespread intraepithelial squamous neoplasia involving the entire limbus can be successfully treated with topical therapies. Biopsy plays a role in excluding invasive disease. Interferon alpha-2b is a preferable agent to start with because it is well tolerated. Since long-term risks of recurrence are unknown, appropriate monitoring is essential.
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Affiliation(s)
- Hershel Patel
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lauren J Jeang
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Edgar M Espana
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Pagán Carrasco S, Arranz Maestro D. Topical interferon alpha-2B topic as the first therapeutic option in a clinical case of conjunctival intraepithelial neoplasia. Arch Soc Esp Oftalmol 2017; 92:442-446. [PMID: 28292536 DOI: 10.1016/j.oftal.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Conjunctival intraepithelial neoplasia is a pre-malignant lesion of the ocular surface. It can be treated with topical interferon alpha-2b (INF α-2b) as first choice. CLINICAL CASE A 71-year-old man referred for corneal-conjunctival, gelatinous lesion in the left eye (LE) with an area of almost 270°. The clinical diagnosis was compatible with a corneal-conjunctival intraepithelial neoplasia. Topical treatment was started with INF α-2b at a dose of one million international units (IU)/ml, 4 times/day for 4 months, with remission being achieved. CONCLUSION The isolated use of topical INF α-2b is an effective treatment as a first option in the case of corneal-conjunctival intraepithelial neoplasia, positioning itself as a form of effective and safe treatment compared to other therapeutic options. Surgical excision and use of other chemotherapy agents could lead to severe limbic deficits and other side effects.
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Affiliation(s)
- S Pagán Carrasco
- Servicio Extremeño de Salud, Unidad de Córnea y Superficie Anterior, Hospital Nuestra Señora de la Montaña , Cáceres, España.
| | - D Arranz Maestro
- Servicio Extremeño de Salud, Unidad de Córnea y Superficie Anterior, Hospital Nuestra Señora de la Montaña , Cáceres, España
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Joag MG, Gupta A, Galor A, Dubovy SR, Bermudez-Magner JA, Wang J, Karp CL. Conjunctival Intraepithelial Neoplasia with Mucoepidermoid Differentiation: A Case Report of a Subtle Lesion. Ocul Oncol Pathol 2015; 1:278-82. [PMID: 27171853 DOI: 10.1159/000381645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the clinical presentation, diagnostic imaging, and treatment options of conjunctival intraepithelial neoplasia (CIN) with mucoepidermoid differentiation, an in situ stage of mucoepidermoid carcinoma of the conjunctiva (MCC). RESULTS We report the case of an 86-year-old man presenting with a subtle limbal lesion that had only mild erythema and elevation. Based on a few atypical clinical features and an abnormal ultrahigh-resolution optical coherence tomography (UHR OCT), an incisional biopsy was performed revealing CIN with mucoepidermoid differentiation. Treatment involved aggressive surgical excision. No evidence of recurrence was noted in the 5 years of follow-up. CONCLUSION MCC is an aggressive tumor that has a tendency to be invasive and recur after treatment. Therefore, early diagnosis and treatment is critical. CIN with mucoepidermoid differentiation may represent the earliest stage of MCC. It can present subtly, with a clinical resemblance to benign and less aggressive ocular surface lesions. Imaging with UHR OCT may be helpful to detect early neoplasia. A high level of suspicion must be maintained when evaluating potential ocular surface tumors.
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Affiliation(s)
- Madhura G Joag
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Anita Gupta
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Miami Veterans Affairs Medical Center, Miami, Fla., USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Florida Lions Eye Bank, Ocular Pathology Laboratory, Miami, Fla., USA
| | - Jose Antonio Bermudez-Magner
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA; Florida Lions Eye Bank, Ocular Pathology Laboratory, Miami, Fla., USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
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de la Cruz Aguiló RI, Duch-Samper A, Hernández Pérez D, Marí Cotino J. Conjunctival intraepithelial neoplasia. Interferon as a rescue therapy after failure of mitomycin C. Arch Soc Esp Oftalmol 2014; 89:463-5. [PMID: 24377953 DOI: 10.1016/j.oftal.2013.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/21/2022]
Abstract
CLINICAL CASE The case of a 60 year-old male with a conjunctival lesion diagnosed as conjunctival intraepithelial neoplasia (CIN), who was treated with mitomycin-C for 3 weeks with minimal improvement. The therapy was change to interferon 2B. Six month later, and after a complete remission of the lesion, the treatment was suspended, with no signs of relapse. DISCUSSION The treatment of these lesions is currently made with chemotherapy and immunotherapy agents, such as mitomycin-C, 5-fluorouracil, and interferon alfa 2B. The latter, even although is the least used, gives excellent results with fewer secondary effects than mitomycin-C, resulting in an optimal therapy for the non-invasive treatment of CIN lesions.
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