Subject(s)
Tomography, Optical Coherence , Humans , Tomography, Optical Coherence/methods , Biopsy/methods , Anterior Eye Segment/diagnostic imaging , Anterior Eye Segment/pathology , Eye Neoplasms/diagnosis , Eye Neoplasms/pathology , Eye Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathology , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/diagnosisABSTRACT
This study aims to systematically review the reported literature on the use of anterior segment optical coherence tomography (AS-OCT) in ocular surface tumours and simulating lesions. A systematic literature search was done using PubMed, Scopus, and Web of Science databases between January 2002 and December 2021. On AS-OCT, ocular surface squamous neoplasia typically demonstrate epithelial thickening, epithelial hyperreflectivity, and an abrupt transition between normal and abnormal epithelium. Conjunctival nevi usually show mildly hyperreflective epithelium of normal thickness, internal hyperreflectivity, and intralesional cysts which is the hallmark of this tumour. Primary acquired melanosis presents with normal thickness epithelium, basal epithelial hyperreflectivity, and absence of cysts. Conjunctival melanoma demonstrates hyperreflective normal/thickened epithelium, hyperreflective basal epithelium, internal hyperreflectivity, and absence of intralesional cysts. Conjunctival lymphoma shows homogenous, low-medium reflective subepithelial lesions with smooth borders, and dot-like infiltrates. Benign reactive lymphoid hyperplasia findings are similar to lymphoma but the infiltrates are more hyperreflective compared to lymphoma. Pterygium shows thickened conjunctival epithelium, epithelial hyperreflectivity, and subepithelial wedge-shaped hyperreflective tissue separated from the overlying epithelium by a cleavage plane. Pinguecula demonstrates mildly thickened epithelium and similar findings with pterygium but does not extend beyond the corneal limbus. This review shows that AS-OCT, as a noninvasive tool, has potential uses in the differential diagnosis of ocular surface tumours and simulating lesions. Major limitations of AS-OCT include limited visualization of the posterior border of thick, keratinized, and pigmented tumours and lack of assessment of large conjunctival tumours in a single cut.
Subject(s)
Conjunctival Neoplasms , Corneal Diseases , Cysts , Eye Neoplasms , Lymphoma , Pterygium , Humans , Pterygium/pathology , Corneal Diseases/pathology , Tomography, Optical Coherence/methods , Eye Neoplasms/diagnostic imaging , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathologyABSTRACT
PURPOSE: To describe the anterior segment optical coherence tomography (AS-OCT) appearance of conjunctival papilloma and identify differentiating features from papilliform ocular surface squamous neoplasia (OSSN). METHOD: A retrospective chart review of individuals clinically diagnosed with conjunctival papilloma (n = 10) or papilliform OSSN (n = 10) based on slit lamp features. Data on demographics, tumour characteristics, and primary treatment were collected. AS-OCT features were assessed including epithelial thickness and reflectivity, a corrugated epithelial surface, presence of an overhanging edge, presence of intrinsic spaces and posterior shadowing. Histopathology was available in 5 papilloma and 3 OSSN specimens. RESULT: Overall, the majority of individuals in both groups were white males. OSSN lesions were more likely to involve the limbus (80% vs.10%, p = 0.005) and the bulbar conjunctiva (100% vs. 20%, p < 0.001) compared to papillomas. On AS-OCT, maximum epithelial thickness was thicker in papilloma compared to OSSN (936 ± 533 vs. 637 ± 207 µm, p = 0.009). The feature that best differentiated papilloma from OSSN was an overhanging edge (100% vs. 0%, p < 0.001), where the epithelial lesion was seen on top of underlying normal epithelium. Other features more common in papilloma compared to OSSN included a corrugated epithelial surface (70% vs.10%, p = 0.02), the presence of intrinsic spaces (100% vs. 50%, p = 0.03), and posterior shadowing (100% vs. 40%, p = 0.01). CONCLUSION: AS-OCT shows differentiating features between papilloma and OSSN with an overhanging edge as a distinctive AS-OCT feature of papilloma.
Subject(s)
Carcinoma, Squamous Cell , Conjunctival Neoplasms , Eye Neoplasms , Papilloma , Male , Humans , Tomography, Optical Coherence/methods , Retrospective Studies , Carcinoma, Squamous Cell/diagnostic imaging , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathology , Conjunctiva/pathology , Papilloma/diagnostic imagingSubject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Conjunctival Neoplasms/diagnostic imaging , Fluorophotometry/methods , Neoplasm Recurrence, Local/diagnostic imaging , Aged , Antibiotics, Antineoplastic/administration & dosage , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Conjunctival Neoplasms/pathology , Conjunctival Neoplasms/therapy , Cryotherapy , Fluorescein/administration & dosage , Fluorescent Dyes/administration & dosage , Humans , Male , Mitomycin/administration & dosage , Neoplasm Recurrence, Local/pathology , Ophthalmologic Surgical ProceduresABSTRACT
BACKGROUND/OBJECTIVE: Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are two non-invasive imaging techniques used for the measurement of tumour thickness in corneal and bulbar conjunctival tumours. Histopathology (HP), however, remains the gold standard for the measurement of tumour thickness. The aim of this study was to determine whether AS-OCT and UBM are as accurate as HP for measuring tumour thickness. METHODS: Forty-two corneal and bulbar conjunctival tumours were imaged using AS-OCT and UBM. Images were assessed and tumour thickness was measured. Eleven patients subsequently underwent surgical excision. All specimens were measured during histopathological analysis. The correlation of the thickness measurement on HP to AS-OCT and UBM was then statistically analysed. In cases where the tumour was not excised, thickness measurement comparisons between AS-OCT and UBM were analysed. RESULTS: AS-OCT and UBM measurements of tumour thickness were found to be significantly positively correlated (p=<0.001), as were UBM and HP thickness measurements (p=0.031). HP and AS-OCT measurements, however, only showed a mild but non-significant positive correlation. CONCLUSION: Both AS-OCT and UBM are useful techniques to image and measure the thickness of corneal and conjunctival bulbar tumours. While AS-OCT provides better details than UBM, it was more limited in visualising the posterior boundary of the tumour, particularly in malignant tumours. While thickness measurements of both methodologies were correlated, neither should yet be considered as replacements to the gold standard of HP.
Subject(s)
Conjunctival Neoplasms , Microscopy, Acoustic , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/surgery , Cornea/diagnostic imaging , Humans , Microscopy, Acoustic/methods , Reproducibility of Results , Tomography, Optical Coherence/methodsABSTRACT
PURPOSE: The purpose of this study was to describe 2 cases of biopsy-proven conjunctival myxomas and present their optical signs on high-resolution optical coherence tomography (HR-OCT) with clinical and histopathological correlations. METHODS: Two middle-aged female patients with a clinical diagnosis of conjunctival cysts were referred for surgical treatment. Clinical assessment, photographs, ultrasound biomicroscopy, and HR-OCT images were obtained. Excisional biopsies were performed, and specimens were sent for histopathological and immunohistochemical analyses. RESULTS: Clinically, these patients presented with a well-circumscribed, semitranslucent, yellow-pinkish mass. Ultrasound biomicroscopy showed a dome-shaped epibulbar mass with medium-to-high internal reflectivity. No compromise of the underlying sclera was noted. HR-OCT showed a normal conjunctival epithelium, a subepithelial nonhomogeneous mass with hyperreflective and hyporeflective areas lined by a highly hyperreflective band, and mild posterior shadowing. Histopathological findings and immunoreactivity for CD34 and vimentin confirmed the diagnosis of conjunctival myxoma. CONCLUSIONS: The HR-OCT optical signs found in our 2 cases strongly correlated with the microscopic findings. Disclosing the optical signs observed on HR-OCT can help clinicians diagnose and differentiate this lesion, guiding its management. However, more studies with a larger number of patients comparing conjunctival myxoma and other ocular surface tumors are needed to enlighten readers about the unique pattern observed by HR-OCT.
Subject(s)
Conjunctival Neoplasms , Eye Neoplasms , Myxoma , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathology , Eye Neoplasms/diagnosis , Female , Humans , Microscopy, Acoustic , Middle Aged , Myxoma/diagnostic imaging , Tomography, Optical Coherence/methodsABSTRACT
SIGNIFICANCE: Ocular surface squamous neoplasias are superficial tumors of the cornea and conjunctiva that can be sight threatening if neglected. Therefore, accurate noninvasive diagnostic modalities are needed. PURPOSE: The purpose of this case series was to describe the hallmark features of ocular surface squamous neoplasia on high-resolution optical coherence tomography (HR-OCT) imaging and its use in the evaluation and management of superficial ocular tumors. CASE SERIES: Five eyes of four patients with ocular surface squamous neoplasia are described. Whereas two eyes displayed the classic clinical features of ocular surface squamous neoplasia, three of the five eyes had more subtle atypical features. However, all shared features on HR-OCT of epithelial thickening and hyperreflectivity with abrupt transitions between normal and abnormal tissue, classic features of ocular surface squamous neoplasia. All lesions ultimately underwent incisional or excisional biopsy and were confirmed to be ocular surface squamous neoplasia on histopathology. CONCLUSIONS: Ocular surface squamous neoplasia may present as a classic tumor but can also have subtle features or masquerade. Accurate methods to diagnose and manage patients with ocular surface squamous neoplasia are necessary. With recent advancements in technology, HR-OCT has been demonstrated to accurately identify ocular surface squamous neoplasia with the repeatable optical findings of (1) epithelial thickening, (2) epithelial hyperreflectivity, and (3) abrupt transition zone between normal and abnormal tissue. This case series demonstrates how HR-OCT can help provide an optical biopsy to guide appropriate diagnosis and management of this neoplastic lesion.
Subject(s)
Conjunctival Neoplasms/diagnostic imaging , Corneal Diseases/diagnostic imaging , Squamous Intraepithelial Lesions/diagnostic imaging , Tomography, Optical Coherence , Aged , Antibiotics, Antineoplastic/therapeutic use , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents/therapeutic use , Biopsy , Conjunctival Neoplasms/drug therapy , Conjunctival Neoplasms/pathology , Corneal Diseases/drug therapy , Corneal Diseases/pathology , Diagnostic Tests, Routine , Fluorouracil/therapeutic use , Humans , Interferons/therapeutic use , Male , Middle Aged , Mitomycin/therapeutic use , Retrospective Studies , Squamous Intraepithelial Lesions/drug therapy , Squamous Intraepithelial Lesions/pathologyABSTRACT
PURPOSE: To report uveal melanoma (UM) metastasis to the contralateral ocular and periocular structures. DESIGN: Retrospective study. PARTICIPANTS: Thirteen patients with UM metastasis to the contralateral ocular and periocular structures were included. METHODS: Clinical records were reviewed retrospectively. MAIN OUTCOME MEASURES: The development and time to onset of contralateral ocular and periocular metastasis, systemic metastasis, and death. RESULTS: Of the 13 000 treated UM patients, 13 patients were diagnosed with UM metastasis to the contralateral ocular and periocular structures. Mean patient age at primary UM diagnosis was 60 years (median, 60 years; range, 37-87 years). The primary uveal melanoma was in the choroid (n = 11) or ciliary body (n = 2) and was treated with brachytherapy (n = 11), proton beam radiotherapy (n = 1), or enucleation (n = 1). Systemic metastasis developed in 11 patients (85%) at a mean of 66 months (median, 34 months; range, 12-216 months) after diagnosis of the primary UM. All 11 patients (100%) showed liver metastasis and 8 patients (62%) also showed extrahepatic metastasis. The sites of metastasis to the contralateral ocular or periocular structures included the choroid in 4 patients (31%), the orbit in 7 patients (54%), and the eyelid in 2 patients (15%). One patient with eyelid metastasis demonstrated concurrent conjunctival nodule. Mean time to diagnosis of contralateral ocular or periocular metastasis was 94 months (median, 48 months; range, 9-375 months). Contralateral choroidal metastasis was multifocal in 3 of 4 patients (75%). Of 7 patients with orbital metastasis, 5 showed extraocular muscle involvement with restricted ocular motility. Treatment for contralateral choroidal metastasis included brachytherapy (n = 2), transpupillary thermotherapy (n = 1), and observation (n = 1). Treatment for contralateral periocular (orbit or eyelid) metastasis was excision (n = 5), external beam radiotherapy (n = 2), and observation (n = 2). Of 13 patients, death was documented in 11 patients at a mean of 17 months (median, 9 months; range, 3-54 months) as a result of systemic UM metastasis (n = 10) or unrelated cause (n = 1). CONCLUSIONS: Metastasis resulting from UM to the contralateral ocular and periocular structures is rare and generally occurs in patients with disseminated metastasis. Orbital tissue is the most common site of involvement, and these patients have short life expectancy.
Subject(s)
Choroid Neoplasms/secondary , Conjunctival Neoplasms/secondary , Eyelid Neoplasms/secondary , Liver Neoplasms/secondary , Melanoma/secondary , Orbital Neoplasms/secondary , Uveal Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Brachytherapy , Choroid Neoplasms/diagnostic imaging , Choroid Neoplasms/radiotherapy , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/radiotherapy , Eyelid Neoplasms/diagnostic imaging , Eyelid Neoplasms/radiotherapy , Female , Humans , Liver Neoplasms/diet therapy , Liver Neoplasms/radiotherapy , Magnetic Resonance Imaging , Male , Melanoma/diagnostic imaging , Melanoma/radiotherapy , Middle Aged , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/radiotherapy , Retrospective Studies , Uveal Neoplasms/diagnostic imaging , Uveal Neoplasms/radiotherapyABSTRACT
Uveal melanoma (UM) and conjunctival melanoma (CM) are ocular malignancies that give rise to life-threatening metastases. Although local disease can often be treated successfully, it is often associated with significant vision impairment and treatments are often not effective against metastatic disease. Novel treatment modalities that preserve vision may enable elimination of small tumors and may prevent subsequent metastatic spread. Very few mouse models of metastatic CM and UM are available for research and for development of novel therapies. One of the challenges is to follow tumor growth in-vivo and to determine the right size for treatment, mainly of the posterior, choroidal melanoma. Hence, the purpose of this study was to establish a simple, noninvasive imaging tool that will simplify visualization and tumor follow-up in mouse models of CM and UM. Tumors were induced by inoculation of murine B16LS9 cells into the sub-conjunctival or the choroidal space of a C57BL/6 mouse eye under a surgical microscope. Five to ten days following injection, tumor size was assessed by Phoenix MicronIV™ image-guided Optical Coherence Tomography (OCT) imaging, which included a real-time camera view and OCT scan of the conjunctiva and the retina. In addition, tumor size was evaluated by ultrasound and histopathological examination of eye sections. Tumor growth was observed 5-9 days following sub-conjunctival or sub-retinal injection of seven-thousand or seventy-thousand cells, respectively. A clear tumor mass was detected at these regions using the MicronIV™ imaging system camera and OCT scans. Histology of eye sections confirmed the presence of tumor tissue. OCT allowed an accurate measurement of tumor size in the UM model and a qualitative assessment of tumor size in the CM model. Moreover, OCT enabled assessing the success rate of the choroidal tumor induction and importantly, predicted final tumor size already on the day of cell inoculation. In conclusion, by using a simple, non-invasive imaging tool, we were able to follow intraocular tumor growth of both CM and UM, and to define, already at the time of cell inoculation, a grading scale to evaluate tumor size. This tool may be utilized for evaluation of new mouse models for CM and UM, as well as for testing new therapies for these diseases.
Subject(s)
Conjunctival Neoplasms/diagnostic imaging , Disease Models, Animal , Melanoma/diagnostic imaging , Tomography, Optical Coherence , Ultrasonography , Uveal Neoplasms/diagnostic imaging , Animals , Biomarkers, Tumor/metabolism , Cell Line, Tumor , Conjunctival Neoplasms/metabolism , Conjunctival Neoplasms/pathology , Immunohistochemistry , MART-1 Antigen/metabolism , Melanoma/metabolism , Melanoma/pathology , Melanoma-Specific Antigens/metabolism , Mice , Mice, Inbred C57BL , Monophenol Monooxygenase/metabolism , Neoplasm Proteins/metabolism , Uveal Neoplasms/metabolism , Uveal Neoplasms/pathologyABSTRACT
BACKGROUND/AIM: This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic infiltrations of the conjunctiva with various degrees of malignancy. PATIENTS AND METHODS: A total of 160 conjunctival pigmented lesions were studied. Each lesion was scored using dermatoscopic patterns and the characteristics of malignancy described by Kittler. Also, the Authors' own clues were added to the evaluation. RESULTS: In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions - primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. CONCLUSION: The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma and pigmented naevus and melanosis and also between PAM.
Subject(s)
Conjunctival Neoplasms/diagnostic imaging , Melanoma/diagnostic imaging , Nevus, Pigmented/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Child , Conjunctival Neoplasms/pathology , Dermoscopy , Female , Humans , Male , Melanoma/pathology , Middle Aged , Nevus, Pigmented/pathology , Skin Neoplasms/pathology , Young AdultSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Carcinoma, Squamous Cell/therapy , Conjunctival Neoplasms/therapy , Immunotherapy , Orbital Neoplasms/therapy , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/secondary , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/secondary , Tomography, X-Ray ComputedABSTRACT
Ocular melanoma is classified under the category of noncutaneous melanomas. Noncutaneous melanomas are relatively rare. Ocular melanoma commonly arises from choroid. Conjunctival melanoma is a rare but potentially lethal form of ocular melanoma. It can invade locally. Systemic spread is seen in up to 25% of cases, often associated with lymph node involvement. Metastatic sites include the lungs, liver, gastrointestinal tract, and the central nervous system. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET-CT) scanning is indicated for staging cutaneous melanoma patients. However, few studies have evaluated its role in the management of conjunctival melanoma. This case highlights the use of F-18 FDG PET/CT for imaging, preoperative staging, and evaluation for metastasis in conjunctival melanoma.
Subject(s)
Conjunctival Neoplasms/pathology , Fluorodeoxyglucose F18/metabolism , Melanoma/pathology , Neoplasm Recurrence, Local/pathology , Positron Emission Tomography Computed Tomography/methods , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/metabolism , Humans , Male , Melanoma/diagnostic imaging , Melanoma/metabolism , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/metabolism , Prognosis , Radiopharmaceuticals/metabolismABSTRACT
No disponible
Subject(s)
Humans , Male , Conjunctival Neoplasms/diagnostic imaging , Lipoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Choristoma/diagnostic imaging , Choristoma/pathology , Conjunctival Neoplasms/pathology , Lipoma/pathology , Skin Neoplasms/pathology , Magnetic Resonance ImagingABSTRACT
INTRODUCTION: Ocular benign fibrous histiocytoma can involve corneoscleral limbus and adjacent cornea and usually has a good prognosis after surgical removal. Despite the low recurrence rate, we reported a rare case of ocular benign fibrous histiocytoma with twice recurrences after excision. PATIENT CONCERNS: A 12-year-old Chinese girl presented with two painless progressively enlarging masses in the right eye for 6 years. She once had the lesions excised 1 year ago. However, the primary lesions relapsed again. DIAGNOSIS: Histopathologic and immunohistochemical examinations of the excised samples supported the diagnosis of benign fibrous histiocytomas of the corneoscleral limbus. INTERVENTIONS: The patient underwent mass resection with limbal stem cell transplantation and amniotic membrane transplantation at first. As for the tumors' second recurrence, we performed extended excision combined with lamellar keratoplasty and amniotic membrane implantation. OUTCOMES: The corneal graft remained clear with no sign of tumor recurrence 3 years after the second surgery. CONCLUSION: Complete surgical resection with tumor-free margins is critical to reduce the recurrence of benign fibrous histiocytoma and appropriate ocular surface reconstruction is necessary to remedy tissue defect and maintain epithelial integrity.
Subject(s)
Eye Neoplasms/surgery , Histiocytoma, Benign Fibrous/surgery , Neoplasm Recurrence, Local/surgery , Child , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/pathology , Conjunctival Neoplasms/surgery , Cornea/diagnostic imaging , Cornea/pathology , Eye Neoplasms/diagnostic imaging , Eye Neoplasms/pathology , Female , Histiocytoma, Benign Fibrous/diagnostic imaging , Histiocytoma, Benign Fibrous/pathology , Humans , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/pathology , Tomography, Optical CoherenceSubject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Eye Neoplasms , Pandemics , Pneumonia, Viral/epidemiology , Adult , COVID-19 , Child , Choroid Neoplasms/secondary , Conjunctival Neoplasms/diagnostic imaging , Conjunctival Neoplasms/therapy , Eye Neoplasms/diagnosis , Eye Neoplasms/therapy , Humans , Melanoma/therapy , Nevus/diagnostic imaging , Retinoblastoma/diagnosis , Retinoblastoma/therapy , SARS-CoV-2ABSTRACT
OBJETIVO: Valorar si la tomografía de coherencia óptica de segmento anterior (OCT-SA) es un método de diagnóstico no invasivo adecuado para diferenciar lesiones córneo-conjuntivales benignas (pterygium) de las premalignas (neoplasia intraepitelial córneo-conjuntival [CIN]). MATERIAL Y MÉTODOS: Estudio observacional, analítico y transversal de 22 ojos con diagnóstico de sospecha de pterygium y CIN durante 2 años. Con la OCT-SA se estudiaron las características morfológicas y se compararon espesores epiteliales (EE) y grado de extensión sobre la superficie corneal (GIC). Posteriormente se confirmó el diagnóstico con el estudio histopatológico tras exéresis quirúrgica. RESULTADOS: La edad media de los pacientes con pterygium (n = 18) fue de 52,67 ± 15 años y 74 ± 12 años en los sujetos con CIN (n = 4) (p < 0,021). En los pterygium, la OCT-SA mostró EE normal, adelgazado o levemente aumentado (77,4 ± 26 μm), además de aumento del tejido subepitelial en forma de cuña. Los CIN presentaron un aumento del EE (262,5 ± 124 μm), que era fuertemente hiperreflectivo, con transición abrupta entre epitelio sano y patológico. El análisis de los EE en OCT-SA entre pterygium y CIN reveló diferencias estadísticamente significativas (p < 0,002). La curva ROC reveló una sensibilidad y especificidad del 100% de la OCT-SA en la diferenciación entre CIN y pterygium, utilizando EE de 141μm como punto de corte. CONCLUSIÓN: La OCT-SA es una herramienta útil para la diferenciación entre pterygium y CIN, ya que proporciona características morfológicas típicas. Un aumento del espesor del EE córneo-conjuntival mayor de 141 μm en OCT-SA sugiere una sensibilidad y especificidad del 100% para diagnosticar CIN
OBJECTIVE: To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN). MATERIAL AND METHODS: An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis. RESULTS: Mean age of patients with pterygium (n = 18) was 52.67 ± 15 y.o and 74 ± 12 y.o in subjects with CIN (n = 4) (p < 0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4 ± 26 μm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5 ± 124μm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p < 0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141μm as cutoff point of EE. CONCLUSION: AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141 μm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma in Situ/diagnostic imaging , Conjunctival Neoplasms/diagnostic imaging , Corneal Diseases/diagnostic imaging , Pterygium/diagnostic imaging , Tomography, Optical Coherence/methods , Cross-Sectional Studies , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN). MATERIAL AND METHODS: An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis. RESULTS: Mean age of patients with pterygium (n=18) was 52.67±15 y.o and 74±12 y.o in subjects with CIN (n=4) (p<0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4±26µm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5±124µm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p<0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141µm as cutoff point of EE. CONCLUSION: AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141µm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN.
Subject(s)
Carcinoma in Situ/diagnostic imaging , Conjunctival Neoplasms/diagnostic imaging , Corneal Diseases/diagnostic imaging , Pterygium/diagnostic imaging , Tomography, Optical Coherence , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Tomography, Optical Coherence/methodsABSTRACT
Solitary or isolated neurofibroma is uncommonly observed in the orbit. Neurofibromas typically involve peripheral nerves and occasionally the cranial nerves. A 29-year-old man presented with recent onset left eye proptosis and exotropia. Physical examination was positive for hyperpigmented lesions of the ipsilateral ocular surface and hard palate. Imaging revealed an infiltrative orbital mass with extension through superior orbital fissure into the brain. There was also bone defect of greater sphenoid wing. Medial orbitotomy was performed to obtain biopsies of the orbital mass and the pigmented ocular surface lesions. Histopathologic diagnosis of neurofibroma was confirmed for the former and melanocytoma for the latter. His symptoms and examinations remained stable during the follow up. This case is unique due to several features, including extensive intracerebral spread of orbital neurofibroma in a patient without definite diagnosis of neurofibromatosis type 1 and association with ipsilateral ocular surface melanocytoma and palatal pigmented lesions. ABBREVIATIONS: CT: computed tomography; GFAP: glial fibrillary acid protein; MRI: magnetic resonance imaging; NF-1: neurofibromatosis type 1.