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Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva as well as the cornea. It is a distinct clinical entity, although it has been known by a variety of different names throughout the literature. Most commonly it arises in the limbal region,...
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Context 1
... limbus between the palpebral fissures (Table 3). Lesions restricted to the conjunctiva or cornea alone are rarer, with the corneal variant potentially a more aggressive form 41 (Fig. 4). Pizzarello and Jako- biec 125 and Erie et a141 have described the macro- scopic appearance as being either gelatinous, velvety or papilliform or leukoplakic (Fig. 5). The gelatinous lesion, with characteristic tufted superficial vessels, is the most common appear- ance (Fig. 4). Two other appearances, nodular and diffuse have also been described. 9 The nodu- lar type is circumscribed, rapidly growing, in- vading adjacent conjunctiva (Fig. 3) and may LEE, HIRST have an increased tendency for ...
Citations
... I n 1995, Lee and Hirst coined the entity, ocular surface squamous neoplasia (OSSN), which histologically comprises diverse spectra of squamous pathologies, ranging from mild dysplasia to invasive carcinoma. [1] It most commonly occurs at the nasal limbus within the interpalpebral fissure, and may or may not involve the cornea. [2] The implicated pathogenetic mechanism lies at the heart of the limbal epithelial crypts that harbor the basal epithelial stem cells which are most abundant in the nasal region where the highest concentration of ultraviolet (UV) radiation is received. ...
The authors present a retrospective analysis of three cases of isolated corneal ocular surface squamous neoplasia (C-OSSN) without limbal or conjunctival involvement and review the clinical and anterior segment optical coherence tomography (AS-OCT) features, along with treatment outcomes. The mean age at presentation was 51 years (range: 32–64 years). The mean tumor diameter was 5 mm (range: 3–6.5 mm). All lesions were placoid with <1 mm thickness. One case had surface keratin. AS-OCT revealed hyperreflective epithelium with abrupt transition in all cases, with mean thickness of 118 μm (range: 60–162 μm). One patient underwent alcohol-assisted keratoepitheliectomy (AKE) and two patients received topical Interferon alpha-2B followed by AKE. Histopathology revealed mild squamous dysplasia in all. No tumor residue or recurrence was noted at a mean follow-up period of 2 years (range: 1–4 years). Isolated C-OSSN is rare. AS-OCT serves as a useful noninvasive tool for supporting the diagnosis of AKE yielding long-term favorable outcomes.
... Since the end of 19 th century, the harmful effects of prolonged exposure of the eye to cumulative radiation of glassblowing have been recognized [3]. These effects include ultraviolet keratitis [4], arc eye or welder's flash [5], ocular surface squamous neoplasia (high exposure of ultraviolet B radiation leads to severe pain and visual loss, arises at limbal region) [6] pterygium, pinguecula, chronic dry eye problems, cataract. Some glass and steel workers developed cataract that is most known ocular occupational disease in recent time also named as glass blowers' cataract [7]. ...
Purpose: The bangle-making industry in Firozabad, India, is a significant source of employment for thousands of workers. However, the occupational hazards associated with this industry, particularly the exposure to glass dust and chemical fumes, calcide powder, etc. have raised concerns regarding the ocular health of bangle makers. This study is aimed to evaluate and describe the status of ocular surface among the bangle makers in Firozabad. Method: This was an OSDI questionnaire based cross sectional descriptive study, consisting a series of 12 questions about symptoms as itching, redness, blurred vision, grittiness, watering etc. Torch light examination of each subject was performed to look for any ocular abnormalities. An unstructured survey regarding the work hours in the factory, working experience in the bangle making industry, ocular complaints, history of hospital visits and prior eye-check-ups was also done. The responses were represented with the help of tables and chart. Results: 74 participants were enrolled in this study, OSDI score ranging from 23-33 that comes in moderate value. Maximum workers reported with normal eye health but there were ocular morbidities and surface abnormalities prevailing in this population, i.e. pterygium (8%), cataract (5.3%), pinguecula (2.7%), itching (6.7%), redness (4%). Conclusion: There is a need to improve occupational safety measures amongst the industry workers, including the provision of proper eye protection and mandatory eye check-ups to minimize the adverse effects on the ocular health of bangle makers, also need to increase awareness to motivate the workers for regular eye check-ups. Keywords: Ocular Surface, Infrared radiation, Occupational hazards, Ocular morbidities, Bangle makers.
... Histopathology is the gold standard for the diagnosis of OSSN (26) . However, only 50% of ophthalmologists perform biopsy to document a pathological diagnosis before starting topical therapy whereas others rely only on the clinical diagnosis possibly due to limited access to pathology services or costs (5,14,27) . ...
Purpose
To describe cellular alterations detected by impression cytology of the ocular surface in patients with xeroderma pigmentosum. The secondary objective was to assess the reliability of impression cytology in diagnosing ocular surface squamous neoplasia.
Methods
Patients with xeroderma pigmentosum underwent a single-day complete ophthalmological examination and impression cytology for ocular surface evaluation using 13 mm diameter mixed cellulose esters membrane filters and combined staining with Periodic Acid Schiff, Hematoxylin and Eosin, and Papanicolaou stains followed by microscopic analysis. The cytological findings were correlated with the clinical diagnosis. The impression cytology findings at baseline and one-year follow-up were correlated with the clinical course (no tumor, treated tumor, residual tumor recurrent tumor, new tumor).
Results
Of the 42 patients examined, impression cytology was performed in 62 eyes of 34 participants (65% females). The mean age of patients was 29.6 ± 17 years (range 7-62). Fifteen eyes had a clinical diagnosis of ocular surface squamous neoplasia. Impression cytology showed goblet cells (47, 75%), inflammatory cells (12, 19%), keratinization (5, 8%), and squamous metaplasia (30, 48%). Impression cytology was positive for atypical cells in 18 patients (12 with and 6 without ocular surface squamous neoplasia). The sensitivity, specificity, positive predictive value, and negative predictive value of impression cytology (at baseline) for diagnosis of ocular surface squamous neoplasia were 80%, 87%, 67%, and 93%, respectively, using clinical diagnosis of ocular surface squamous neoplasia as the reference standard.
Conclusion
Impression cytology has a moderate positive predictive value for the diagnosis of ocular surface squamous neoplasia in patients with xeroderma pigmentosum. However, the lack of detection of atypical cells on impression cytology has a high negative predictive value for ocular surface squamous neoplasia. Integration of impression cytology in the long-term management of high-risk patients, such as patients with xeroderma pigmentosum, can avoid unnecessary diagnostic biopsies.
Keywords:
Xeroderma pigmentosum; Eye neoplasms; Conjunctiva/cytology; Cornea/cytology; Cytological techniques
... Ocular surface squamous cell carcinoma (OSSN) is a general term for a group of conjunctival tumors that includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). 1 OSSN can be classified as mild, moderate, or severe depending on the degree of dysplastic epithelial involvement. Histopathological invasive OSSN or SCC shows foci of infiltrating cells that penetrate the epithelial basement membrane and spread into the conjunctival stroma.OSSN presents with nonspecific symptoms (eye redness and inflammation), but larger lesions can cause visual impairment that obstructs the visual axis and causes astigmatism. ...
... Histopathological invasive OSSN or SCC shows foci of infiltrating cells that penetrate the epithelial basement membrane and spread into the conjunctival stroma.OSSN presents with nonspecific symptoms (eye redness and inflammation), but larger lesions can cause visual impairment that obstructs the visual axis and causes astigmatism. 1,2 Clinically, this disease is suspected in patients who have a conjunctival mass that is elevated, increases in size, and enlarges the feeding vessels. 1 The gold standard for confirming the diagnosis and histological classification is biopsy with histological evaluation. 3 Because these tumors are relatively rare and there is relatively little data regarding these lesions, this study was designed to evaluate the clinico-demographic characteristics and histopathological findings of OSSN. ...
... 1,2 Clinically, this disease is suspected in patients who have a conjunctival mass that is elevated, increases in size, and enlarges the feeding vessels. 1 The gold standard for confirming the diagnosis and histological classification is biopsy with histological evaluation. 3 Because these tumors are relatively rare and there is relatively little data regarding these lesions, this study was designed to evaluate the clinico-demographic characteristics and histopathological findings of OSSN. ...
: Ocular surface squamous cell carcinoma (OSSN) is a general term for various conjunctival tumors, including conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC).
: To evaluate the clinico-demographic characteristics and histopathological findings of ocular surface squamous cell carcinoma.
: eyes of 47 patients aged 21 to 80 years with conjunctival tumors were included in the study and underwent excisional biopsy and subsequent histopathological examination.
: Statistically significant associations were found with age, symptom duration, and lesion size (p<0.05).
Benign and preinvasive lesions are more common than invasive lesions.
... They usually move freely over the sclera with adjacent feeder vessels [2]. OSSN may be misdiagnosed as a pterygium, papilloma, pinguecula, dyskeratosis, or a conjunctival nevus [5]. Confirmation of diagnosis has traditionally been by biopsy, but newer less invasive techniques have been employed in recent years such as anterior-segment optical coherence tomography (AS-OCT) and impression cytology (IC) [3]. ...
... Occasionally confirming the diagnosis by clinical examination alone is difficult. Accuracy of clinical diagnosis has been reported to range between 40 % and 86 % when compared to histopathology results [5,6]. This is a retrospective case series of six conjunctival OSSN lesions with variable clinical appearances and configuration leading to initially confusing clinical diagnoses. ...
Introduction
Ocular surface squamous neoplasia (OSSN) may have atypical or unusual presentations and may attain large sizes especially in cases of delayed presentation resulting in late diagnosis, treatment, and eventual guarded visual prognosis. We are reporting an interesting cases series of OSSN with variable clinical presentations to highlight the importance of the pre-operative clinical judgment and tissue diagnosis.
Presentation of cases
Six patients (4 females and 2 males; mean age 59 years; range 42–79 years) were included with suspicious conjunctival lesions. The maximum dimension of the lesions was 17 mm. The initial suspected pre-operative clinical diagnosis -other than OSSN- included pterygium/pinguecula (n = 2), benign squamous papilloma (n = 1), cyst versus pyogenic granuloma (n = 1), and lymphoma (n = 1). This work has been reported in line with the PROCESS criteria.
Discussion
The final histopathological diagnosis was unexpectedly invasive squamous cell carcinoma (SCC) in 4, one SCC in-situ, and squamous dysplasia in one. The primary treatment included MMC 0.02 % for 2 cycles for chemo-reduction in one of the cases where OSSN was suspected. Excisional biopsy was performed eventually for all lesions with application of one or more of the following modalities: MMC 0.02 %, absolute alcohol 99 %, and cryotherapy to the conjunctival margin. No tumor recurrence was noted in any of the patients after an average period of follow-up of 26 months. Even though the outcome was good, tumor-related morbidity and delay in the referral by general ophthalmologists are to be considered.
Conclusion
Conjunctival OSSN has wide presentation clinically and can be challenging in terms of diagnosis. Histopathological evaluation is essential for a definitive diagnosis and treatment. Accurate clinical diagnosis might affect the management plan with consideration for topical therapeutic modalities, however, these cases are best managed by wide excision using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctiva with consideration of topical chemotherapy.
... Squamous cell carcinoma is the most common ocular and cutaneous neoplasm in XP [4,5]. Lee and Hirst have given the term ocular surface squamous neoplasia (OSSN) [6,7]. It includes the entire spectrum of dysplastic and carcinomatous lesions of the ocular surface. ...
... It includes the entire spectrum of dysplastic and carcinomatous lesions of the ocular surface. Later conjunctival and corneal intraepithelial neoplasms were included [7]. Dysplasia of the ocular surface can be divided into mild, moderate, and severe based on the extent of dysplastic cell invasion in the epithelium. ...
... Risk factors include the location of a person with respect to the equator. The age of onset was younger at latitudes less than 30 degrees from the equator as compared with the age of onset at 45 degrees from the equator [6,7]. The three most important risk factors are ultraviolet B irradiation, human papillomavirus, and human immunodeficiency virus. ...
Xeroderma pigmentosum (XP) is a rare, autosomal recessive disorder characterized by defective DNA repair. Patients with this disorder are at increased risk of developing various oculocutaneous malignancies.
We report a rare case of a child with XP with bilateral ocular surface squamous neoplasia (OSSN) and left eye (OS) medial canthal basal cell carcinoma (BCC). Ultrasound biomicroscopy and contrast-enhanced computed tomography (CECT) of the orbit showed intraocular extension with no orbital involvement. The patient was started on topical interferon therapy in both eyes for OSSN. Topical 5% imiquimod was started for BCC for eight hours a day and then washed off. During follow-up, there was no recurrence of tumors. Since ocular and cutaneous neoplasms tend to occur at an early age in XP with a high rate of recurrence and they tend to be more aggressive, multimodal therapy with long-term follow-up is more advantageous for these patients. Topical 5% imiquimod can be used as a treatment for periocular BCC as an alternative to excision.
... Ocular surface squamous neoplasia (OSSN) describes a spectrum of conjunctival and corneal epithelial neoplasia manifesting as dysplasia, carcinoma-in-situ and squamous cell carcinoma [1]. The two main risk factors are UV-B light and human papilloma virus [2]. ...
We report a rare case of ocular surface squamous neoplasia (OSSN) masquerading as pseudoepitheliomatous hyperplasia in chronic vernal keratoconjunctivitis (VKC). A 24-year-old man presented with a history of bilateral VKC since childhood with a superior limbal mass in the right eye. There was a history of use of intermittent corticosteroids in the past. He underwent impression cytology followed by excision biopsy with wide margins (no touch technique), cryotherapy and amniotic membrane transplantation. Histopathological analysis confirmed the diagnosis of OSSN with mild to moderate dysplasia. This case highlights the importance of strong clinical suspicion and detailed cytological and histopathological examination for early detection and management of OSSN.
... MBH là tiêu chuẩn để chẩn đoán xác định tổn thương và mức độ ác tính của các khối u. Khối u thường xuất hiện nhiều ở vùng rìa, ít hơn ở kết mạc và giác mạc… Hình thái tổn thương đa dạng: dạng nhú, gelatin, bạch sản… Bệnh hay gặp ở người cao tuổi, da trắng, sống gần xích đạo, nam mắc nhiều hơn nữ… Các YTNC của bệnh bao gồm: virus HIV, HPV; tia cực tím; hút thuốc lá, chấn thương mắt, khô da sắc tố, nhiễm trùng BMNC... [3] Tại Việt Nam đã có 1 số NC về đặc điểm lâm sàng và MBH u biểu mô BMNC tuy nhiên chưa có NC nào sâu về các tổn thương tiền ung thư và UTBM tế bào vảy BMNC. Do đó, chúng tôi tiến hành đề tài với mục tiêu mô tả đặc điểm lâm sàng và MBH các tổn thương tiền ung thư và UTBM tế bào vảy BMNC. ...
Mục tiêu: Mô tả đặc điểm lâm sàng và mô bệnh học (MBH) các tổn thương tiền ung thư và ung thư biểu mô (UTBM) tế bào vảy bề mặt nhãn cầu (BMNC). Đối tượng và phương pháp nghiên cứu (NC): NC mô tả hồi cứu trên 69 hồ sơ bệnh án u BMNC là các tổn thương tiền ung thư và UTBM tế bào vảy điều trị tại BV Mắt Trung ương từ tháng 4 năm 2018 đến hết tháng 3 năm 2023. Kết quả: NC được tiến hành trên 69 người bệnh, gồm 50 nam và 19 nữ. Tuổi trung bình là 65.78 ± 15.28 tuổi. Có 69 người bệnh mắc bệnh tại một mắt (100%). Tỷ lệ tổn thương tiền UTBM tế bào vảy BMNC là 43.5%, tổn thương ung thư là 56.5%. Vị trí tổn thương trên BMNC chủ yếu là tại vùng rìa với 87%. Dạng nhú phổ biến hơn với 49.3% và có độ ác tính cao hơn so với hai dạng còn lại.Thời gian bị bệnh tỷ lệ thuận với kích thước (p<0.05) nhưng không có sự liên quan với độ rộng tổn thương (p>0.05). Độ ác tính (p<0.05) tỷ lệ thuận với thời gian bị bệnh, kích thước và độ rộng (p<0.05) nhưng không có sự liên quan với độ xâm lấn giác mạc của tổn thương (p>0.05). Kết luận: Bệnh chủ yếu gặp ở nam giới, người cao tuổi, thường xảy ra ở 1 mắt, vị trí tổn thương phần lớn thuộc vùng rìa kết giác mạc. Dạng nhú phổ biến hơn và ác tính hơn so với 2 dạng còn lại. NC chỉ ra có sự liên quan về lâm sàng như: thời gian bị bệnh tỷ lệ thuận với kích thước tổn thương; liên quan giữa lâm sàng và độ ác tính như: độ ác tính tỷ lệ thuận với thời gian bị bệnh, kích thước và độ rộng tổn thương.
... In the study by Lee and Hirst, it was observed that the typical age at which OSSN appears is around 56 years, with a range from 4 to 96 years. Carcinomas tend to develop 5 to 9 years earlier than intraepithelial neoplasia [3]. In Western regions, OSSN is often found in Caucasian males in their 60s and 70s, especially those living near the equator. ...
... OSSN ranks as the predominant ocular tumor, with occurrence rates between 0.03 and 1.9 for every 100,000 individuals annually. It's ranked as the third most frequent malignant orbital tumor following melanoma and lymphoma [3]. The patients with OSSN commonly report to the outpatient clinic with symptoms such as a fleshy mass or lump in the eye, irritation, discomfort, redness, foreign body sensation, itching, and diminished vision due to astigmatism or loss of visual acuity. ...
Introduction:
Ocular surface squamous neoplasia (OSSN) is the most common ocular malignancy; the pathophysiology is influenced by molecular, genetic, and epigenetic mechanisms. The incidence of OSSN is associated with the anatomy and physiology of the ocular surface, limbal stem cell configuration, limbal vulnerability, cancer stem cells, dysplasia, neoplasia, angiogenesis, invasion, and metastasis. The key etiological factors involved are human papillomavirus (HPV), human immunodeficiency virus (HIV), immunosuppression, p53 tumor suppressor gene, hypovitaminosis A, and failure of Deoxyribonucleic acid (DNA) repair mechanisms.
Areas covered:
This special report is a focussed attempt to understand the molecular mechanism, genetic and epigenetic mechanism, and diagnostic modalities for OSSN.
Expert opinion:
While these mechanisms contribute to genome instability, promoter-specific hypermethylation might facilitate and promote tumor formation by silencing tumor suppressor genes. OSSN understanding has improved with increased literature available on various genetic, molecular, and epigenetic mechanisms, although the exact genetic and epigenetic mechanisms still need to be elucidated. It is important to note that the molecular mechanisms of OSSN can vary among individuals, and further research is required to elucidate the underlying processes fully. Understanding these mechanisms is crucial for the development of targeted therapies and improved management of OSSN.
... 2 Initial stages start at the transition zone between cornea and conjunctiva (limbus) and can involve eyelid and orbit in advanced stages. 2 The term ocular surface squamous neoplasia was first coined by Lee and Hirst. 3 who classified it into three 3 grades -benign dysplasia, pre-invasive OSSN and invasive OSSN. ...
We present a case of recurrent OSSN in HIV positive individual and its successful management. Patient presented to us with slow growing painless greyish mass in temporal area in interpalpebral region. He was diagnosed with HIV 2 years back and was on HAART regimen. He underwent excision for a similar looking mass in same eye 2 years back at the same time he was diagnosed with HIV. On local examination, a greyish white raised nodular gelatinous mass with feeder vessel was seen. It did not involve cornea and took up staining with rose bengal stain. complete excision biopsy using no-touch technique with a margin clearance of 4 mm followed by mitomycin-C and the remaining conjunctival defect closed with amniotic membrane graft was done. Histopathology confirmed OSSN. No recurrence was seen at 2-year follow-up.
HIV shows a strong relation with OSSN and also with recurrent disease. Histopathology should always be done in interpalpebral mass excision in HIV positive patients as the recurrence rate is higher with more aggressive tumour.
