High frequency of squamous intraepithelial neoplasia in pterygium related to low ultraviolet light exposure

Zoroquiaín, Pablo; Jabbour, Samir; Aldrees, Sultan; Villa, Natalia; Bravo-Filho, Vasco; Dietrich, Helena Luiza Douat; Logan, Patrick; Burnier, Miguel N

doi:10.1016/j.sjopt.2016.02.007

“…A large study reviewing 3,021 histopathological reports of conjunctival lesions found that the frequency of unsuspected OSSN within pterygium is 0.65% [ 11 ]. In a second study performed in Canada, the reported rate of OSSN is 2.33% [ 20 ]. As both these percentages are based on a search through histopathological reports, we suspect this number to be an underrepresentation of the reality as not all excised pterygiums are sent for histopathological review, and, when they are, there is no consensus on reporting of these lesions.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series

Bergeron

¹

,

Ito

²

,

Dossous

³

et al. 2021

Journal of Ophthalmology

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Pterygium is a common lesion consisting of fleshy conjunctival growth extending towards the cornea. There is no documented risk of malignant transformation; however, concomitant disease is not rare, and its link to sunlight exposure indicates a risk of other malignancies. The purpose of our study is to describe histopathological features of resected pterygiums and to recognize patients at risk of other conjunctival diseases. One hundred and forty-nine formalin-fixed and paraffin-embedded pterygium samples were subjected to histopathological analysis. Histological H&E sections were obtained and digitalized using a Zeiss Axio Scan.Z1 slide scanner. Thirteen predefined morphological features were used to record histopathological changes in the epithelium and substantia propria. Neovascularization was observed in 54% of the samples. Sun damage, comprising solar elastosis and stromal plaque, was present in 81% of the samples. Variation in epithelial thickness was the most common change, with acanthosis and atrophy being observed in 62% and 26% of the samples, respectively. In our series, 21% (31/149) of pterygiums showed mild to moderate dysplasia, a finding that may be associated to ocular surface squamous neoplasia (OSSN). Moreover, 32% (47/149) of the cases showed melanocytic hyperplasia, which could represent primary acquired melanosis (PAM). There is a positive correlation between dysplasia and chronic inflammation p = 0.012 and an inverse correlation with epithelial atrophy p = 0.001 and neovascularization p = 0.05 . Similarly, a positive correlation is observed between goblet cell hyperplasia and melanocytic hyperplasia p = 0.02 . Our findings show that pterygiums harbour histological features that may be suggestive of OSSN or PAM in 53% of our patients. Whilst being on the benign side of the spectrum, these two entities are known for their potential progression to malignancy. A recommendation is made for all surgically excised pterygiums to be sent for histopathological diagnosis, and clear guidelines for reporting of these lesions should be established. Associated histopathological findings suggestive of other concomitant diseases should be identified to insure adequate follow-up of these patients.

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“…Likewise, massive amounts of immunoglobulins, such as IgG and IgE, have been found in the basement membrane of primary and recurrent pterygium, suggesting that the pathogenesis of pterygium may be related to type I and type III allergies [19]. However, according to the clinical manifestations of pterygium development, including tissue degeneration, hypertrophy, hyperplasia, and congestion, it is generally believed that the interaction of immunocytes and inflammatory factors leads to fibroblast proliferation and neovascularization and induces the progression and recurrence of pterygium [1, 20]. Thus, elucidating the upstream mechanisms that regulate fibroblast proliferation and neovascularization, and on this basis, to find a way to prevent pterygium recurrence has become an emergent issue.…”

Section: Discussionmentioning

confidence: 99%

“…A pterygium is a fibrovascular and wing-shaped neoplasm that can invade the cornea and cover the pupil area [1]. Pterygia are common causes of induced astigmatism, ocular movement restriction, and visual impairment [2].…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors

Guo

¹

,

Xiao

²

,

Cui

³

et al. 2019

Journal of Ophthalmology

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A pterygium is generally believed to be a chronic inflammatory lesion caused by external stimuli that develops from the conjunctiva and grows onto the cornea. Simple bare sclera excision is the most commonly used method to treat pterygium. However, the high postoperative recurrence rate of pterygium remains a persistent challenge. Mitomycin C (MMC) is an antineoplastic antibiotic that inhibits DNA, RNA, and protein synthesis. In recent years, although MMC has proven useful for the treatment of pterygium, its application has been controversial because of its clear toxicity and the possibility of ocular complications. In the current study, we prospectively recruited patients to receive or not receive a local injection of MMC (0.4 mg/ml). Follow-up was conducted with the patients to determine the postoperative recurrence rate of pterygium and/or to observe any ocular complications. The remarkable results demonstrated that MMC can decrease the postoperative recurrence rate of pterygium without leading to serious eye complications. Further results indicated that MMC can inhibit the activation of the NLRP3 inflammatory signalling pathway and thus downregulate the expression of downstream molecules, including IL-18 and IL-1β. MMC also reduced the expression of inflammatory factors TGF-β1, VEGF, and IL-6. In addition to influencing these factors, MMC suppressed neovascularization and the proliferation of corneal fibroblasts to effectively reduce the recurrence rate of pterygium. Taken together, our results provide a theoretical basis for the development of prevention and treatment strategies for pterygium and suggest that MMC is highly effective as an adjunctive treatment after excision of primary pterygia.

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“…18,19 In Perobatang Village, the proportion of pterygium was 10.7% while the Indonesian Health Survey in 2013 showed the prevalence of pterygium was 8.3% with the highest was in Bali (25.2%) and the lowest was in Banten (3.9%). 4 The prevalence of pterygium was higher in lower latitudes, which has higher sunlight exposure.…”

Section: Discussionmentioning

confidence: 99%

The burden of ocular diseases in an underdeveloped village in Southwest Sumba, Eastern Indonesia, 2016

Sitompul¹,

Lestari²,

Siregar³

et al. 2018

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High frequency of squamous intraepithelial neoplasia in pterygium related to low ultraviolet light exposure

Cited by 17 publications

References 16 publications

Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series

Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series

Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors

The burden of ocular diseases in an underdeveloped village in Southwest Sumba, Eastern Indonesia, 2016

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