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Immunohisto-chemical Results in 29 Patients with Ocular Surface Squamous Neoplasia (OSSN) of the Conjunctiva
1Guthoff R., 1Lieb W., 2Marx A., 2Ströbel P.,
1Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)
2Pathologisches Institut, Julius-Maximilians-Universität Würzburg (Würzburg)
Purpose: Ocular surface squamous neoplasia (OSSN) comprise of dysplasia, carcinoma in situ and invasive squamous carcinoma. Though intraorbital and intraocular spread are rare, the recurrence rate of OSSN is 20-39%. We investigated the prognostic value of immunohistochemical markers in correlation with clinical and histopathological findings.
Patients and methods: The clinical data and histopathological findings of all patients with OSSN who underwent surgical excision of OSSN of Würzburg University eye department from 1995 until 2001 were analyzed retrospectively. Moreover immunohistochemical staining followed.
Results: Twenty-nine patients were evaluated. Of these, 90% were male. The average follow-up period was 15 months. The mean age was 67 years (range, 42-90). In 79% we found corneal involvement. Lid infiltration was seen in 2 patients. Of these, 1 showed a beginning orbital invasion. There were no metastasis or lymph node involvement. Fifteen patients were treated with local tumor resection. Of these, in 6 additional cryotherapy was administered. In 7 patient lamellar keratoskleroconjunctivectomy was performed, in 6 of these in combination with cryotherapy. Two patients underwent orbital exenteration. In 4 patients radiotherapy or topical application of Mitomycin C was necessary. The recurrence rate was 10.4%. Dysplasia was were seen in 9 patients, carcinoma in situ in 5 patients and invasive carcinoma in 13 patients. in 2 patients with progressive disease a mutation in the p53-gene was seen immunohistochemically.
Conclusions: Early histological diagnosis with complete removal of OSSN-suspicious lesions is required. Otherwise in progressive stages of disease conversion to a more aggressive behaviour of tumour growth may occur. There might be a correlation between defective apoptosis because of inactivating p53 mutations and the dimension of invasive growth.