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P. R. Odashiro, A. N. Odashiro, P. I. Fernandes, B. F. Fernandes, S. C. Maloney, S. Di Cesare, C. Martins, E. Antecka, C. A. Frota, M. N. Burnier, Jr.; Incidence of Intraepithelial Dysplasia in Pterygium. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2991.
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Pterygium was considered a degenerative disorder. Recent findings published raised the possibility that pterygium is a neoplastic-like disorder. Presence of intraepithelial dysplasia (IED) in pterygium is scantily studied in the literature. The purpose of this study is to report the incidence of IED in a series of pterygium.
From January to July 2009, consecutive excised cases of typical pterygium from a reference eye hospital were analyzed by an ocular pathologist. The criterion for dysplasia was the same adopted for the diagnosis of conjunctival intraepithelial neoplasia. To ensure the diagnosis of IED, the mean of the 10 largest nuclei (MTLN) was measured in units (u) using an ocular microscope ruler. MTLN was measured in all pterygium cases. For comparison, MTLN was measured in 2 normal conjunctiva and 2 cases of conjunctival squamous carcinoma "in situ".
62 cases of pterygium were collected. Patients were 38 (61.3%) female and 24 (38.7%) male. 59 (95.2%) were nasal and 3 (4.8%) temporal. 60 (96.8%) cases were primary and 2 (3.2%) recurrent. 2 (3.2%) cases were clinically grade I, 43 (69.3%) grade II, 11 (17.7%) grade III, and 6 (9.7%) were grade IV. About duration of the lesion, 5 (8.1%) cases had less than 1 year of duration, 17 (27.4%) cases had 1-5 years, 7 (11.3%) cases had 5-10 years and 33 (53.2%) cases more than 10 years. Unfortunately, only 43 cases (69.4%) could be correctly analyzed histopatologically. Most cases unable to be analyzed histopatologically were due to compression artifact. Histopathological analysis showed that 26 (60.5%) cases had no IED, 14 (32.5%) had a mild IED and 3 (7%) had moderate IED. No cases of severe IED/carcinoma "in situ" were seen. The average of the MTLN in all cases without dysplasia was 3.26u, in mild IED was 3.89u, and in moderate IED was 4.53u. The MTLN of the 2 normal conjunctivas taken as control was 3.0u and of the 2 squamous carcinoma "in situ" was 7.0u.
IED was found in almost 40% of all histopathological analyzed pterygium. Importantly, 7% had moderate IED. The high rate of unsuspected IED in cases of classical pterygium suggests that all cases of pterygium should be submitted to histopathological examination.
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