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Nick Di Girolamo, Jeanie Chui, Minas T. Coroneo, Lien T. Tat, Roger Crouch, Denis Wakefield; Ophthalmic Pterygia: A Stem Cell Disorder With Pre-Malignant Features. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3370.
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Pterygia are common ocular surface lesions thought to originate from UV-altered limbal stem cells. Traditionally regarded as a degenerative condition, pterygia also display tumor-like features including the propensity to invade normal tissue, high recurrence rates following resection, and may co-exist with secondary pre-malignances. This study was initiated to determine the rate of concurrent ocular surface diseases in patients with pterygia recruited from a single surgeon.
One hundred pterygium specimens were histopathologically evaluated and selected cases immunohistochemically assessed to confirm diagnosis.
In addition to the previously documented features including epithelial proliferation, goblet cell hyperplasia, angiogenesis, inflammation, elastosis, stromal plaques, and Bowman’s membrane dissolution, we discovered five cases of ocular surface squamous neoplasia, six cases of primary acquired melanosis, two compound nevi (one suspect invasive melanoma) and one dermoid-like lesion. In 18 specimens, clusters of basal epithelial stem-like cells that co-expressed keratin-15, keratin-19 and p63-alpha were identified at the head of the pterygium which coincided with the clinical observation of Fuchs’ flecks.
Our data shows that significant pre-neoplastic lesions may be associated with pterygium and that all excised pterygia should undergo histological examination. The presence of p63-alpha positive epithelial cell clusters supports the hypothesis that pterygia may develop from limbal epithelial progenitors
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