FIT biopsy for conjunctival squamous cell carcinoma with extensive intraocular invasion

Abstract

Dear Editor, Ocular surface squamous neoplasia (OSSN) [conjunctival intraepithelial neoplasia, carcinoma in situ, and invasive squamous cell carcinoma (SCC)] are the most common conjunctival malignancy in the United States, occurring with the incidence of 0.03 cases per 100,000 persons. While OSSN can be locally aggressive, intraocular involvement is infrequent [1, 2]. Histopathologic confirmation of intraocular invasion can be obtained through various diagnostic techniques. Herein, we present a patient with extensive intraocular involvement by SCC, diagnosed with the aid of biopsy with a 25-gauge aspiration-cutter [Finger iridectomy technique (FIT)]. A 73-year-old woman presented with a white, vascular, dome-shaped, nasal limbal lesion, which extended onto adjacent inferonasal right cornea (Fig. 1a). A high-frequency ultrasound biomicroscopy showed no anterior chamber involvement [3]. Excisional biopsy with cryotherapy was performed. Histopathology showed well-differentiated keratinizing SCC (Fig. 1b), with approximately 40% Ki67 proliferation marker labelling index, extending to lateral, but not to deep surgical margins. The patient underwent a course of topical mitomycin-C (0.02%) and was followed closely. Two months after the surgery the epithelial tumour recurred in the region adjacent to the primary site, and the patient had a second course of mitomycin-C. A month later, she presented complaining of pain in her eye. Marked enlargement of conjunctival tumour was noted, associated with increased intraocular pressure, anterior chamber cells, and a mass in the nasal anterior chamber angle (Fig. 2a). The intraocular lesion was biopsied using the FIT. Briefly, A 25-gauge aspiration-cutter (vitrector) was introduced under sodium hyaluronate 1% and through a 1-mm peripheral clear corneal incision. Aspiration (600 mmHg) cutting (300 cpm) was performed to obtain specimens for cytology and histopathology. The detailed methodology of this technique is described in the referenced text [4]. Cytopathologic evaluation of biopsy material revealed dysplastic keratinizing squamous cells and tissue consistent with intraocular invasion by SCC (Fig. 2b). In the course of the next several weeks, the patient developed increasing right eye pain, vitreous debris, and serous retinal detachment. She was advised to undergo orbital exenteration for local tumour control. Histopathologic evaluation of the orbital exenteration specimen revealed well-differentiated SCC. The tumour cells involved the anterior orbit, entered the eye via anterior emissary canals, and infiltrated the anterior chamber angle, Graefes Arch Clin Exp Ophthalmol (2008) 246:467–469 DOI 10.1007/s00417-007-0712-4