DIAGNOSTIC AND THERAPEUTIC MODALITIES IN THE MANAGEMENT OF A PATIENT WITH OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN)-CASE REPORT AND REVIEW
Abstract
Ocular surface squamous neoplasia (OSSN) is a clinical term that includes epithelial dysplasia of various degrees, carcinoma in situ to invasive squamous cell carcinoma of the conjunctiva. Several procedures are used today to diagnose these lesions: biopsy with pathohistological analysis, cytology, in vivo confocal microscopy, ultrasound biomicroscopy, AS-OCT (Optical Coherence Tomography of the Anterior Segment) and OCT-A (Optical Coherence Tomography-Angiography). Aim: To present the possible diagnostic and therapeutic modalities that are used today in dealing with OSSN, as well as to optimize the management of these lesions in everyday clinical practice, in order for the patient to receive appropriate treatment. Case report, methods and results: In this paper we present the case of a 71-year-old patient, presented for an ophthalmological examination last year at the Clinic for Eye Diseases in Skopje. The patient reported a foreign body sensation and irritation of the right eye due to a tumor formation in the temporal limb that was gradually increasing over the past two years. Biomicroscopic examination and AS-OCT established a clinical diagnosis of OSSN. The lesion was excised and sent to the Institute of Pathology in Skopje, pathohistologically confirmed for in situ carcinoma of the conjunctiva. Conclusion: AS-OCT, surgical excision, and pathohistological examination are the "optimal triad" in the management of these lesions.
Keywords: ocular surface squamous neoplasia, OSSN, carcinoma in situ, pathohistology, Optical Coherence Tomography of the Anterior Segment.
References
1. Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995 May-Jun;39(6):429-50. doi: 10.1016/s0039-6257(05)80054-2. PMID: 7660300.
2. Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology. 2004 Sep;111(9):1747-54. doi: 10.1016/j.ophtha.2004.02.013. PMID: 15350332.
3. Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical Management of Ocular Surface Squamous Neoplasia: A Review of the Current Evidence. Ophthalmol Ther. 2018 Dec;7(2):247-262. doi: 10.1007/s40123-018-0140-z. Epub 2018 Jul 20. PMID: 30030703; PMCID: PMC6258579.
4. Gichuhi S, Sagoo MS, Weiss HA, Burton MJ. Epidemiology of ocular surface squamous neoplasia in Africa. Trop Med Int Health. 2013 Dec;18(12):1424-43. doi: 10.1111/tmi.12203. Epub 2013 Oct 30. PMID: 24237784; PMCID: PMC4440345.
5. Sayed-Ahmed IO, Palioura S, Galor A, Karp CL. Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia. Expert Rev Ophthalmol. 2017;12(1):11-19. doi: 10.1080/17469899.2017.1263567. Epub 2016 Dec 5. PMID: 28184236; PMCID: PMC5293314.
6. Goedert JJ, Coté TR. Conjunctival malignant disease with AIDS in USA. Lancet. 1995 Jul 22;346(8969):257-8. doi: 10.1016/s0140-6736(95)91309-2. PMID: 7616836.
7. Carreira H, Coutinho F, Carrilho C, Lunet N. HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis. Br J Cancer. 2013 Oct 1;109(7):1981-8. doi: 10.1038/bjc.2013.539. Epub 2013 Sep 12. PMID: 24030075; PMCID: PMC3790185.
8. Guech-Ongey M, Engels EA, Goedert JJ, Biggar RJ, Mbulaiteye SM. Elevated risk for squamous cell carcinoma of the conjunctiva among adults with AIDS in the United States. Int J Cancer. 2008 Jun 1;122(11):2590-3. doi: 10.1002/ijc.23384. PMID: 18224690.
9. Scott IU, Karp CL, Nuovo GJ. Human papillomavirus 16 and 18 expression in conjunctival intraepithelial neoplasia. Ophthalmology. 2002 Mar;109(3):542-7. doi: 10.1016/s0161-6420(01)00991-5. PMID: 11874759.
10. Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study. Trop Med Int Health. 2016 Dec;21(12):1522-1530. doi: 10.1111/tmi.12792. Epub 2016 Oct 24. PMID: 27714903; PMCID: PMC5574019.
11. Rundle P, Mudhar HS, Rennie I. Conjunctival intra-epithelial neoplasia occurring in young patients with asthma. Eye (Lond). 2010 Jul;24(7):1182-5. doi: 10.1038/eye.2009.296. Epub 2009 Dec 4. PMID: 19960035.
12. Gichuhi S, Ohnuma S, Sagoo MS, Burton MJ. Pathophysiology of ocular surface squamous neoplasia. Exp Eye Res. 2014 Dec;129:172-82. doi: 10.1016/j.exer.2014.10.015. Epub 2014 Oct 18. PMID: 25447808; PMCID: PMC4726664.
13. Ateenyi-Agaba C, Dai M, Le Calvez F, Katongole-Mbidde E, Smet A, Tommasino M, Franceschi S, Hainaut P, Weiderpass E. TP53 mutations in squamous-cell carcinomas of the conjunctiva: evidence for UV-induced mutagenesis. Mutagenesis. 2004 Sep;19(5):399-401. doi: 10.1093/mutage/geh048. PMID: 15388813.
14. Patel U, Karp CL, Dubovy SR. Update on the Management of Ocular Surface Squamous Neoplasia. Curr Ophthalmol Rep. 2021 Mar;9(1):7-15. doi: 10.1007/s40135-020-00260-y. Epub 2021 Feb 20. PMID: 34804642; PMCID: PMC8597954.
15. Gurnani B, Kaur K. Ocular Surface Squamous Neoplasia. 2021 Dec 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 34424655.
16. Nanji AA, Mercado C, Galor A, Dubovy S, Karp CL. Updates in Ocular Surface Tumor Diagnostics. Int Ophthalmol Clin. 2017 Summer;57(3):47-62. doi: 10.1097/IIO.0000000000000174. PMID: 28590280; PMCID: PMC5484070.
17. Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wanyonyi L, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Toluidine Blue 0.05% Vital Staining for the Diagnosis of Ocular Surface Squamous Neoplasia in Kenya. JAMA Ophthalmol. 2015 Nov;133(11):1314-21. doi: 10.1001/jamaophthalmol.2015.3345. PMID: 26378623; PMCID: PMC5321493.
18. Brierly JD, Gospodarowicz MK, Wittekind C, editors (2017). TNM classification of malignant tumors. 8th ed. Oxford: Wiley Blackwell.
19. Carrilho C, Miu C, Kim Y, Karki S, Balmaceda A, Challa B, Diamond S, Monteiro E, Marole E, Lorenzoni C, Zambujo Y, Liu YT, Schooley RT, Lin JH. p16 Expression Correlates with Invasive Ocular Surface Squamous Neoplasms in HIV-Infected Mozambicans. Ocul Oncol Pathol. 2020 Mar;6(2):123-128. doi: 10.1159/000502096. Epub 2019 Sep 5. PMID: 32258020; PMCID: PMC7109427.
20. Eghtedari M, Beigi V, Maalhagh M, Ashraf H. Expression of interleukin-6 in ocular surface squamous neoplasia. Clin Ophthalmol. 2019 Aug 30;13:1675-1680. doi: 10.2147/OPTH.S221911. PMID: 31564816; PMCID: PMC6722455.
21. Grossniklaus HE, Stulting RD, Gansler T, Aaberg TM Jr. Aspiration cytology of the conjunctival surface. Acta Cytol. 2003 Mar-Apr;47(2):239-46. doi: 10.1159/000326510. PMID: 12685195.
22. Kheirkhah A, Mahbod M, Farzbod F, Zavareh MK, Behrouz MJ, Hashemi H. Repeated applications of impression cytology to increase sensitivity for diagnosis of conjunctival intraepithelial neoplasia. Br J Ophthalmol. 2012 Feb;96(2):229-33. doi: 10.1136/bjo.2010.201103. Epub 2011 Apr 15. PMID: 21498806.
23. Shousha MA, Karp CL, Perez VL, Hoffmann R, Ventura R, Chang V, Dubovy SR, Wang J. Diagnosis and management of conjunctival and corneal intraepithelial neoplasia using ultra high-resolution optical coherence tomography. Ophthalmology. 2011 Aug;118(8):1531-7. doi: 10.1016/j.ophtha.2011.01.005. Epub 2011 Apr 20. PMID: 21507486.
24. Liu Z, Karp CL, Galor A, Al Bayyat GJ, Jiang H, Wang J. Role of optical coherence tomography angiography in the characterization of vascular network patterns of ocular surface squamous neoplasia. Ocul Surf. 2020 Oct;18(4):926-935. doi: 10.1016/j.jtos.2020.03.009. Epub 2020 Apr 25. PMID: 32344147.
25. Tanaka S, Kohanim S. The Role of Confocal Microscopy in Diagnosing Ocular Surface Tumors. Int Ophthalmol Clin. 2017 Winter;57(1):75-85. doi: 10.1097/IIO.0000000000000146. PMID: 27898615.
26. Shields CL, Chien JL, Surakiatchanukul T, Sioufi K, Lally SE, Shields JA. Conjunctival Tumors: Review of Clinical Features, Risks, Biomarkers, and Outcomes--The 2017 J. Donald M. Gass Lecture. Asia Pac J Ophthalmol (Phila). 2017 Mar-Apr;6(2):109-120. doi: 10.22608/APO.201710. PMID: 28399347.
27. Arepalli S, Kaliki S, Shields CL, Emrich J, Komarnicky L, Shields JA. Plaque radiotherapy in the management of scleral-invasive conjunctival squamous cell carcinoma: an analysis of 15 eyes. JAMA Ophthalmol. 2014 Jun;132(6):691-6. doi: 10.1001/jamaophthalmol.2014.86. PMID: 24557333.
28. Ashkenazy N, Karp CL, Wang G, Acosta CM, Galor A. Immunosuppression as a Possible Risk Factor for Interferon Nonresponse in Ocular Surface Squamous Neoplasia. Cornea. 2017 Apr;36(4):506-510. doi: 10.1097/ICO.0000000000001153. PMID: 28129301; PMCID: PMC5334142.
29. Blasi MA, Maceroni M, Sammarco MG, Pagliara MM. Mitomycin C or interferon as adjuvant therapy to surgery for ocular surface squamous neoplasia: comparative study. Eur J Ophthalmol. 2018 Mar;28(2):204-209. doi: 10.5301/ejo.5001035. Epub 2017 Nov 9. PMID: 28967069.
30. Klaassen I, Braakhuis BJ. Anticancer activity and mechanism of action of retinoids in oral and pharyngeal cancer. Oral Oncol. 2002 Sep;38(6):532-42. doi: 10.1016/s1368-8375(01)00118-x. PMID: 12167430.
31. Finger PT, Chin KJ. Refractory squamous cell carcinoma of the conjunctiva treated with subconjunctival ranibizumab (Lucentis): a two-year study. Ophthalmic Plast Reconstr Surg. 2012 Mar-Apr;28(2):85-9. doi: 10.1097/IOP.0b013e3182392f29. PMID: 22186988.
32. Ip MH, Robert George CR, Naing Z, Perlman EM, Rawlinson W, Coroneo MT. Topical Cidofovir for Treatment-Refractory Ocular Surface Squamous Neoplasia. Ophthalmology. 2018 Apr;125(4):617-619. doi: 10.1016/j.ophtha.2017.11.021. Epub 2017 Dec 15. PMID: 29249265.
2. Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology. 2004 Sep;111(9):1747-54. doi: 10.1016/j.ophtha.2004.02.013. PMID: 15350332.
3. Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical Management of Ocular Surface Squamous Neoplasia: A Review of the Current Evidence. Ophthalmol Ther. 2018 Dec;7(2):247-262. doi: 10.1007/s40123-018-0140-z. Epub 2018 Jul 20. PMID: 30030703; PMCID: PMC6258579.
4. Gichuhi S, Sagoo MS, Weiss HA, Burton MJ. Epidemiology of ocular surface squamous neoplasia in Africa. Trop Med Int Health. 2013 Dec;18(12):1424-43. doi: 10.1111/tmi.12203. Epub 2013 Oct 30. PMID: 24237784; PMCID: PMC4440345.
5. Sayed-Ahmed IO, Palioura S, Galor A, Karp CL. Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia. Expert Rev Ophthalmol. 2017;12(1):11-19. doi: 10.1080/17469899.2017.1263567. Epub 2016 Dec 5. PMID: 28184236; PMCID: PMC5293314.
6. Goedert JJ, Coté TR. Conjunctival malignant disease with AIDS in USA. Lancet. 1995 Jul 22;346(8969):257-8. doi: 10.1016/s0140-6736(95)91309-2. PMID: 7616836.
7. Carreira H, Coutinho F, Carrilho C, Lunet N. HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis. Br J Cancer. 2013 Oct 1;109(7):1981-8. doi: 10.1038/bjc.2013.539. Epub 2013 Sep 12. PMID: 24030075; PMCID: PMC3790185.
8. Guech-Ongey M, Engels EA, Goedert JJ, Biggar RJ, Mbulaiteye SM. Elevated risk for squamous cell carcinoma of the conjunctiva among adults with AIDS in the United States. Int J Cancer. 2008 Jun 1;122(11):2590-3. doi: 10.1002/ijc.23384. PMID: 18224690.
9. Scott IU, Karp CL, Nuovo GJ. Human papillomavirus 16 and 18 expression in conjunctival intraepithelial neoplasia. Ophthalmology. 2002 Mar;109(3):542-7. doi: 10.1016/s0161-6420(01)00991-5. PMID: 11874759.
10. Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study. Trop Med Int Health. 2016 Dec;21(12):1522-1530. doi: 10.1111/tmi.12792. Epub 2016 Oct 24. PMID: 27714903; PMCID: PMC5574019.
11. Rundle P, Mudhar HS, Rennie I. Conjunctival intra-epithelial neoplasia occurring in young patients with asthma. Eye (Lond). 2010 Jul;24(7):1182-5. doi: 10.1038/eye.2009.296. Epub 2009 Dec 4. PMID: 19960035.
12. Gichuhi S, Ohnuma S, Sagoo MS, Burton MJ. Pathophysiology of ocular surface squamous neoplasia. Exp Eye Res. 2014 Dec;129:172-82. doi: 10.1016/j.exer.2014.10.015. Epub 2014 Oct 18. PMID: 25447808; PMCID: PMC4726664.
13. Ateenyi-Agaba C, Dai M, Le Calvez F, Katongole-Mbidde E, Smet A, Tommasino M, Franceschi S, Hainaut P, Weiderpass E. TP53 mutations in squamous-cell carcinomas of the conjunctiva: evidence for UV-induced mutagenesis. Mutagenesis. 2004 Sep;19(5):399-401. doi: 10.1093/mutage/geh048. PMID: 15388813.
14. Patel U, Karp CL, Dubovy SR. Update on the Management of Ocular Surface Squamous Neoplasia. Curr Ophthalmol Rep. 2021 Mar;9(1):7-15. doi: 10.1007/s40135-020-00260-y. Epub 2021 Feb 20. PMID: 34804642; PMCID: PMC8597954.
15. Gurnani B, Kaur K. Ocular Surface Squamous Neoplasia. 2021 Dec 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 34424655.
16. Nanji AA, Mercado C, Galor A, Dubovy S, Karp CL. Updates in Ocular Surface Tumor Diagnostics. Int Ophthalmol Clin. 2017 Summer;57(3):47-62. doi: 10.1097/IIO.0000000000000174. PMID: 28590280; PMCID: PMC5484070.
17. Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wanyonyi L, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ. Toluidine Blue 0.05% Vital Staining for the Diagnosis of Ocular Surface Squamous Neoplasia in Kenya. JAMA Ophthalmol. 2015 Nov;133(11):1314-21. doi: 10.1001/jamaophthalmol.2015.3345. PMID: 26378623; PMCID: PMC5321493.
18. Brierly JD, Gospodarowicz MK, Wittekind C, editors (2017). TNM classification of malignant tumors. 8th ed. Oxford: Wiley Blackwell.
19. Carrilho C, Miu C, Kim Y, Karki S, Balmaceda A, Challa B, Diamond S, Monteiro E, Marole E, Lorenzoni C, Zambujo Y, Liu YT, Schooley RT, Lin JH. p16 Expression Correlates with Invasive Ocular Surface Squamous Neoplasms in HIV-Infected Mozambicans. Ocul Oncol Pathol. 2020 Mar;6(2):123-128. doi: 10.1159/000502096. Epub 2019 Sep 5. PMID: 32258020; PMCID: PMC7109427.
20. Eghtedari M, Beigi V, Maalhagh M, Ashraf H. Expression of interleukin-6 in ocular surface squamous neoplasia. Clin Ophthalmol. 2019 Aug 30;13:1675-1680. doi: 10.2147/OPTH.S221911. PMID: 31564816; PMCID: PMC6722455.
21. Grossniklaus HE, Stulting RD, Gansler T, Aaberg TM Jr. Aspiration cytology of the conjunctival surface. Acta Cytol. 2003 Mar-Apr;47(2):239-46. doi: 10.1159/000326510. PMID: 12685195.
22. Kheirkhah A, Mahbod M, Farzbod F, Zavareh MK, Behrouz MJ, Hashemi H. Repeated applications of impression cytology to increase sensitivity for diagnosis of conjunctival intraepithelial neoplasia. Br J Ophthalmol. 2012 Feb;96(2):229-33. doi: 10.1136/bjo.2010.201103. Epub 2011 Apr 15. PMID: 21498806.
23. Shousha MA, Karp CL, Perez VL, Hoffmann R, Ventura R, Chang V, Dubovy SR, Wang J. Diagnosis and management of conjunctival and corneal intraepithelial neoplasia using ultra high-resolution optical coherence tomography. Ophthalmology. 2011 Aug;118(8):1531-7. doi: 10.1016/j.ophtha.2011.01.005. Epub 2011 Apr 20. PMID: 21507486.
24. Liu Z, Karp CL, Galor A, Al Bayyat GJ, Jiang H, Wang J. Role of optical coherence tomography angiography in the characterization of vascular network patterns of ocular surface squamous neoplasia. Ocul Surf. 2020 Oct;18(4):926-935. doi: 10.1016/j.jtos.2020.03.009. Epub 2020 Apr 25. PMID: 32344147.
25. Tanaka S, Kohanim S. The Role of Confocal Microscopy in Diagnosing Ocular Surface Tumors. Int Ophthalmol Clin. 2017 Winter;57(1):75-85. doi: 10.1097/IIO.0000000000000146. PMID: 27898615.
26. Shields CL, Chien JL, Surakiatchanukul T, Sioufi K, Lally SE, Shields JA. Conjunctival Tumors: Review of Clinical Features, Risks, Biomarkers, and Outcomes--The 2017 J. Donald M. Gass Lecture. Asia Pac J Ophthalmol (Phila). 2017 Mar-Apr;6(2):109-120. doi: 10.22608/APO.201710. PMID: 28399347.
27. Arepalli S, Kaliki S, Shields CL, Emrich J, Komarnicky L, Shields JA. Plaque radiotherapy in the management of scleral-invasive conjunctival squamous cell carcinoma: an analysis of 15 eyes. JAMA Ophthalmol. 2014 Jun;132(6):691-6. doi: 10.1001/jamaophthalmol.2014.86. PMID: 24557333.
28. Ashkenazy N, Karp CL, Wang G, Acosta CM, Galor A. Immunosuppression as a Possible Risk Factor for Interferon Nonresponse in Ocular Surface Squamous Neoplasia. Cornea. 2017 Apr;36(4):506-510. doi: 10.1097/ICO.0000000000001153. PMID: 28129301; PMCID: PMC5334142.
29. Blasi MA, Maceroni M, Sammarco MG, Pagliara MM. Mitomycin C or interferon as adjuvant therapy to surgery for ocular surface squamous neoplasia: comparative study. Eur J Ophthalmol. 2018 Mar;28(2):204-209. doi: 10.5301/ejo.5001035. Epub 2017 Nov 9. PMID: 28967069.
30. Klaassen I, Braakhuis BJ. Anticancer activity and mechanism of action of retinoids in oral and pharyngeal cancer. Oral Oncol. 2002 Sep;38(6):532-42. doi: 10.1016/s1368-8375(01)00118-x. PMID: 12167430.
31. Finger PT, Chin KJ. Refractory squamous cell carcinoma of the conjunctiva treated with subconjunctival ranibizumab (Lucentis): a two-year study. Ophthalmic Plast Reconstr Surg. 2012 Mar-Apr;28(2):85-9. doi: 10.1097/IOP.0b013e3182392f29. PMID: 22186988.
32. Ip MH, Robert George CR, Naing Z, Perlman EM, Rawlinson W, Coroneo MT. Topical Cidofovir for Treatment-Refractory Ocular Surface Squamous Neoplasia. Ophthalmology. 2018 Apr;125(4):617-619. doi: 10.1016/j.ophtha.2017.11.021. Epub 2017 Dec 15. PMID: 29249265.
Published
2022-08-31
How to Cite
NIKOLOVSKA, Biljana et al.
DIAGNOSTIC AND THERAPEUTIC MODALITIES IN THE MANAGEMENT OF A PATIENT WITH OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN)-CASE REPORT AND REVIEW.
Journal of Morphological Sciences, [S.l.], v. 5, n. 2, p. 150-161, aug. 2022.
ISSN 2545-4706.
Available at: <http://jms.mk/jms/article/view/vol5no2-21>. Date accessed: 31 mar. 2025.
Issue
Section
Articles
