Updates in Ocular Surface Tumor Diagnostics

Nanji, Afshan; Mercado, Carolina; Dubovy, Sander R.; Karp, Carol L.

doi:10.1097/iio.0000000000000174

Cited by 53 publications

(88 citation statements)

References 66 publications

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“…Conjunctival lymphoma classically presents as a chronic, sessile, pink-colored sub-epithelial conjunctival mass described as a “salmon patch” ( Fig. 1 ) [5, 27, 38]. Another presentation is that of a chronic follicular conjunctivitis ( Fig.…”

Section: Reviewmentioning

confidence: 99%

Classification, diagnosis, and management of conjunctival lymphoma

2019

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Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. Approximately 5–15% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. Ninety-eight percent of conjunctival lymphomas arise from B-lymphocytes. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma (80%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%) and mantle cell lymphoma (3%). Natural killer and T cells (NK/T) are rare causes of lymphoma. While most conjunctival lymphomas are localized to the ocular adnexa at the time of presentation, systemic examination and management are of key importance in the long-term care of the patient. This review outlines the classification, etiology, presentation, diagnosis, and management of conjunctival lymphoma. The novel use of high resolution optical coherence tomography, both as a diagnostic tool and as a means for ongoing evaluation during treatment, is illustrated. Treatment options discussed include external beam radiation, chemotherapy, immunotherapy, antibiotic therapy, and combination regimens. Future investigation of the etiology and pathogenesis of conjunctival lymphoma is expected to reveal opportunities for innovative and individualized therapeutic agents. Collaboration between multiple disciplines is key in the advancement of the field.

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Section: Reviewmentioning

confidence: 99%

Classification, diagnosis, and management of conjunctival lymphoma

2019

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“…The cases reported herein had clinical features highly suspicious for OSSN such as the absence of pigmentation in two patients (cases 1 and 3), mild pigmentation in two patients (cases 2 and 4), (12,13). However, currently, histopathology is superior in reporting tissue architecture at the macroscopic and microscopic level.…”

Section: Discussionmentioning

confidence: 89%

“…AS-OCT is a non-invasive imaging technique used in several fields of ophthalmology (15,16) . For conjunctival tumours, it is useful for directing diagnosis and management, as it provides high quality images of the internal structure and extension (12). Recent studies showed that low-pigmented CM is seen more frequently in eyes with light iris color and is associated with a higher rate of recurrences, distant metastases and death.…”

Section: Discussionmentioning

confidence: 99%

Invasive conjunctival melanoma mimicking ocular surface squamous neoplasia: a case series

et al. 2020

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BackgroundConjunctival melanoma is the second most common conjunctival malignant tumour after squamous cell carcinoma, usually arising from primary acquired melanosis and less commonly from a conjunctival naevus or de novo. We report four cases of conjunctival melanoma masquerading as ocular surface squamous neoplasia.MethodsFour patients (2 females and 2 males; mean age 60.7 years; range 41–72 years) were referred for suspicious conjunctival lesions. In all cases, the lesions had a perilimbal location, were non-pigmented (cases 1 and 3) or mildly pigmented (cases 2 and 4), had a fleshy (cases 1, 2 and 4) or papillomatous (case 3) appearance and involved the corneal surface. In each case, our main clinical differential diagnosis included conjunctival intraepithelial neoplasia and squamous cell carcinoma. All four patients underwent an excisional biopsy with double freeze-thaw cryotherapy and alcohol keratoepitheliectomy.ResultsIn all four cases, the histopathological diagnosis was of invasive conjunctival melanoma with extension to the deep surgical margins. Adjuvant therapy consisting of strontium-90 β radiotherapy (all 4 patients) and topical Mitomicyn C (patient 2) was administered.ConclusionConjunctival melanoma can clinically resemble ocular surface squamous neoplasia. Clinical impressions therefore need to be confirmed histopathologically.

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“…Methylene blue is an acidophilic dye that has a selective affinity for nucleic acids and therefore has increased uptake by malignant cells, thereby causing staining. It has been shown to stain OSSN lesions with a sensitivity of 97% and specificity of 50% [ 44 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa

2020

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Background Ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests. Methods This observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy. Discussion There is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.

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Updates in Ocular Surface Tumor Diagnostics

Cited by 53 publications

References 66 publications

Classification, diagnosis, and management of conjunctival lymphoma

Classification, diagnosis, and management of conjunctival lymphoma

Invasive conjunctival melanoma mimicking ocular surface squamous neoplasia: a case series

Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa

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