Download
conjunctival squamous cell carcinoma with massive intraocular invasion n.
Skip this Video
Loading SlideShow in 5 Seconds..
Conjunctival Squamous Cell Carcinoma with Massive Intraocular Invasion PowerPoint Presentation
Download Presentation
Conjunctival Squamous Cell Carcinoma with Massive Intraocular Invasion

Conjunctival Squamous Cell Carcinoma with Massive Intraocular Invasion

256 Views Download Presentation
Download Presentation

Conjunctival Squamous Cell Carcinoma with Massive Intraocular Invasion

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Conjunctival Squamous Cell Carcinoma with Massive Intraocular Invasion Fiona Roberts, Glasgow BAOP, Manchester 7-8th April, 2011

  2. Clinical History • 75 year old male • 15 month history of left limbal mass • Biopsied

  3. Clinical History • Invasive poorly differentiated squamous cell carcinoma • Excision was considered best treatment However • Not a good 75 year old and generally frail • Decision to treat with topical mitomycin C • Review in 3 months

  4. 3 Month Review • Condition significantly deteriorated. • Struggling to open the left eye. • Vision had decreased from 6/24 to hand movement. • Mass had increased in size with dystopia • Rubeosis, posterior synechiae and an anterior uveitis. • No fundal view. • Pressure in the left eye was slightly raised

  5. Pathology

  6. CK14

  7. Pathology Summary • Squamous cell carcinoma of the conjunctiva • Extensive intraocular spread • anterior chamber with malignant epithelial downgrowth and invasion of trabecular meshwork • Ciliary body • Choroid with mass forming posteriorly • Secondary effects of raised intraocular pressure

  8. Conjunctival Squamous Cell Carcinoma • Relatively uncommon worldwide • Geographical variation in incidence of 0.02 to 3.5/100,000 • Part of the spectrum of ocular surface squamous neoplasia (OSSN) • Occurs in sun-damaged ocular surface usually at the limbus in elderly males • Also associated with immunosuppression (AIDS, Transplant etc.)

  9. Intraocular Invasion of Conjunctival SCC • Reported to be rare (2 to 13% of cases) • Char et al. BJO, 1992 identified approximately 60 reported cases of intraocular invasion • Since then around a further 18 cases (13 as part of several series and 5 case reports) • Even been reported in a 12 year old Haflinger gelding

  10. Kaps et al. Veterinary Ophthalmology, 2005

  11. Intraocular Invasion - Features • Most commonly in older patients with one or 2 recurrences Shields et al. 1999 • Tumour usually located near corneoscleral limbus • Heralded by onset of low-grade inflammation and secondary glaucoma • A white mass generally was observed in the anterior chamber angle • Most cases reported to date confined to anterior chamber and ciliary body and extension posteriorly is unusual Schlote et al. , Klin Monbl Augenheilkd, 2001

  12. Risk Factors 1 • Neglected primary malignancy • Did failure to excise primary tumour in this case equate with neglect ? • Topical mitomycin C is recognised as an effective treatment of SCC of the conjunctiva • Thin tumours less than 4mm can show complete regression even if extensive • Larger/thicker tumours may show only a partial response • Mitomycin C for chemoreduction prior to surgery Shields et al., Arch Ophthamol, 2005

  13. Risk Factors 2 • Recurrent tumours/Inadequate primary excision • 73 year old male who had conjunctival SCC with intraocular invasion removed by corneoscleral resection with iridocyclectomy • Initial excision showed clear margins • Recurrence one year later in iris and trabecular meshwork well away from primary tumour Glasson et al., Arch Ophthalmol, 1994

  14. Risk Factors 3 • Histological tumour type • Mucoepidermoid carcinomas • Lacour et al. J Fr Ophthalmol, 1991 • Seitz & Henke, Klin Monbl Augenheilkd, 1995 • Gunduz et al. Ophthalmology, 2000 • Spindle cell squamous carcinoma • Shields et al., Cornea, 2007 • Both regarded as more locally aggressive and to have a higher recurrence rate • However, each histological subtype accounts for few than 5% of squamous cell carcinomas of the conjunctiva

  15. Summary • Intraocular invasion from conjunctival squamous cell carcinoma is uncommon • Usually occurs in elderly males with mass at the limbus • Involves anterior chamber with signs of inflammation and raised intraocular pressure • Extension posteriorly is uncommon • Ocular prognosis is poor but survival is good