Purchase this article with an account.
Caroline M Craven, Pia R Mendoza, Matthew Hochuen Ip, Matthew W Wilson, Minas T Coroneo, Hans E Grossniklaus; Invasive corneal squamous cell carcinoma: A case series of five. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2412.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To describe five cases of conjunctival squamous cell carcinoma (SCC) with corneal invasion.
Five cases of corneal invasion of conjunctival squamous cell carcinoma were identified in the L.F. Montgomery laboratory database. Patients were identified and their demographic data, clinical appearance, history, pathologic findings and post-operative course were reviewed.
Five cases of SCC infiltrating the corneal stroma occurred in one female and four male patients between 47 to 83 years of age who had prior resections of presumed pterygia. Patients developed corneal infiltrates six months to four years after initial resection. The degree of corneal involvement dictated the extent of the surgical management. One eye with localized invasion was treated with lamellar keratoplasty and plaque brachytherapy. Another case with involvement of the visual axis was treated with full penetrating keratoplasty. In a third case, widespread invasion of the limbus and entire cornea warranted enucleation. Two cases were treated medically prior to surgical intervention: One eye with localized invasion was treated with combination topical interferon alpha-2b and retinoic acid. This patient's lesion recurred twice, treated first with lamellar keratoplasty, then with enucleation. The fifth case involved the visual axis and was initially treated with doxycycline and fluoromethasone, with cyclosporine for dryness. After some clearing of central corneal haze, the patient developed a raised nodule. This patient then failed topical and intralesional interferon alpha-2b, and the eye was subsequently enucleated. The patients who underwent initial keratoplasty had no recurrence after 6 years of follow up. The patients initially treated with medical therapy had recurrence of lesion at as early as five months, and despite resection of recurrence, they ultimately required enucleation. Histologically, specimens demonstrated SCC, with two tumors of the mucoepidermoid type. Tumors arose from the conjunctival and limbal epithelium and infiltrated deep into the corneal stroma in a linear single-file pattern.
This series demonstrates the importance of maintaining clinical suspicion of conjunctival intraepithelial neoplasia and careful histopathologic evaluation for dysplasia in a presumed pterygium. Undetected conjunctival epithelial dysplasia may give rise to potentially vision- and eye-threatening invasive corneal SCC.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only