Abstract
Aim: Ocular surface squamous neoplasia (OSSN) is a term that encompasses a wide and varied spectrum of very rare dysplastic disease of cornea and conjunctiva, ranging from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma (SCC) of conjunctiva and/or cornea. Case report: In our case report, we present squamous cell carcinoma of the conjunctiva and cornea in a 78-year old man. Our diagnostic algorithm included: slit lamp and fundus examination, gonioscopy, impression cytology (IC) andmagnetic resonance imaging (MRI). The patient underwentsurgical excisional biopsy of the lesion and intraoperativecryotherapy of the cut conjunctival edges and sclera-conjuctiva base region. Following surgical therapy, we started topical 0.02 % (0.2 mg/ml) Mitomycin C (MMC) application daily for 14 days. Control excisional biopsy of conjunctival edge and abrasion of involved cornea were performed following the last day of topical chemotherapy. Our controlexcisional biopsyrevealed tumor positive corneal tissue and the second cycle of topical 0.04 % (0.4 mg/ml) MMCchemotherapy wasstarted for next 3 weeks. The patient has been followed-up for 20 months through monthly–based visits, with no recurrence of the disease. Conclusions: OSSN is a surgical challenge requiring a specialized â€no-touch’ (NT) technique. In our case, the combination of surgical excision with intraoperative cryotherapy and topical chemotherapy with 0.02 % MMC application for 14 days, completed with second cycle of topical 0.04 % MMC drops for the next 21 days given the positive control biopsy, proved to be a good choice for eradication of OSSN with accurate further monitoring of the patient.
Highlights
Ocular surface squamous neoplasia (OSSN) is a term that encompasses a wideand varied spectrum of very rare dysplastic diseases of the cornea and conjunctiva with a figure ranging from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma(SCC) of conjunctiva and/or cornea.In 1995, Lee and Hirst first proposed the term OSSN and definedit as intraepithelial and invasive squamous cell carcinoma of the conjunctiva and cornea[1]
The lesions are difficult to differentiate since OSSN includes benign ocular surface changes such as squamous papillomas, precancer as actinic keratosis and conjunctival intraepithelial neoplasia (CIN), carcinoma-in-situ (CIS) and squamous cell carcinoma (SCC)[2]
Ocular surface squamous neoplasia(OSSN) is a very rare tumor which occurs in sun damaged ocular surface, usually at the limbus in elderly men[11].The most common method of treatment for conjunctival neoplasms has been wide local excision with supplemental cryotherapy to the surgical margins and primary or adjuvant chemotherapy.Topical chemotherapies can be used as nonsurgical method for treating the entire conjunctival surfacein case of multicentric or ill-defined lesions, with minimal side effects and possibility of repeating the therapy cycles depending on clinical response[11]
Summary
Ocular surface squamous neoplasia (OSSN) is a term that encompasses a wideand varied spectrum of very rare dysplastic diseases of the cornea and conjunctiva with a figure ranging from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma(SCC) of conjunctiva and/or cornea.In 1995, Lee and Hirst first proposed the term OSSN and definedit as intraepithelial and invasive squamous cell carcinoma of the conjunctiva and cornea[1]. OSSN isusually a slowly growing tumor and rarely spreads to corneal stroma, sclera, deeper intraocular or orbital structures[2]. It rarelymetastasizes to the preauricular, submandibular and upper deep cervical lymphnodes[2], but systemic metastases are rare.Intraocular invasion has been reported in 2 %-15 %8and orbital invasion in 12-16 %9. The lesions are difficult to differentiate since OSSN includes benign ocular surface changes such as squamous papillomas, precancer as actinic keratosis and conjunctival intraepithelial neoplasia (CIN), carcinoma-in-situ (CIS) and squamous cell carcinoma (SCC)[2]. Diagnostic procedure of OSSN includesbiomicroscopy, gonioscopy (for the assessment of intraocular angle involvement), ultrasound biomicroscopy (for the assessment of scleral and intraocular involvement), impression cytology (IC) and tissue histology, computerised tomography (CT) scans and magnetic resonance (MR) scans to to determine intraocular, intraorbital or intracranial expansion
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