Abstract
Abstract: :
Purpose: Conjunctival squamous cell carcinoma (SCC), the extreme in the spectrum of ocular surface squamous neoplasia (OSSN), is generally a low–grade malignancy. Enucleation or exenteration may uncommonly be required for ocular or orbital invasion; metastasis is rare. To our knowledge, there are only three reports of death due to conjunctival squamous carcinoma in the literature. We report a case of bulbar conjunctival squamous cell carcinoma incompletely resected leading to direct extension to the intracranium and the patient’s death. Methods: Clinicopathologic case report documenting incomplete surgical resections of tumor over a 2–year clinical course with direct intraocular, intraorbital and intracranial extension. Results: A 75–year–old Hispanic man underwent incomplete surgical resection of a large, epibulbar squamous cell carcinoma of the right eye. Intraoperatively, perilimbal scleral necrosis with uveal prolapse was noted. Additionally, it was recognized that there was orbital involvement with neoplastic infiltration of the extraocular muscles left within the orbit. Three weeks later, the globe was enucleated but exenteration was not performed. Histopathology confirmed intraocular invasion. Nine months later, histopathology of an orbital biopsy performed during revision of a contracted anophthalmic socket revealed neoplastic orbital infiltration with prominent perineural invasion. Eight months later, a mass of the right lower lid and further contraction of the orbit finally led to exenteration, which demonstrated incomplete resection of the massively infiltrated orbital soft tissue as well as the optic nerve stump. Six months later, the patient developed facial numbness. A head MRI revealed massive intracranial neoplastic extension. The patient expired with a mass in the frontal lobe of the brain. Conclusions: This is the fourth report of mortality due to OSSN in the American literature. While previous reported cases were as a result of diffuse metastasis, this case is unique in that death occurred as a result of direct neoplastic infiltration of the orbital and intracranial cavity. While most cases of conjunctival SCC are low grade, this case demonstrates aggressive clinical behavior with local neoplastic infiltration resulting in the patient’s death. This case stresses the urgency of early recognition and complete initial surgical incision of OSSN in order to prevent unnecessary mortality.