ESCRS - FP14.07 - Ocular Surface Squamous Neoplasia (Ossn) Masquerades In Clinically Diagnosed Pterygium! Importance Of Histopathology In Routinely Excised Pterygium Samples.

Ocular Surface Squamous Neoplasia (Ossn) Masquerades In Clinically Diagnosed Pterygium! Importance Of Histopathology In Routinely Excised Pterygium Samples.

Published 2023 - 41st Congress of the ESCRS

Reference: FP14.07 | Type: Free paper | DOI: 10.82333/2bxv-p327

Authors: Durgalaxmi Dhananjay Modak* 1 , Shruthi MK 2 , Harsha Nagaraja 1 , Rohit Shetty 1

1Cornea & Refractive services,Narayana Nethralaya,Bengaluru,India, 2Ocular Pathology,Narayana Nethralaya,Bengaluru,India

Purpose

The aim of this study was to evaluate the incidence and prevalence of histopathologically identified Ocular Surface Squamous Neoplasia (OSSN) in patients with presumed clinical diagnosis of Pterygium, undergoing routine pterygium excision surgery with conjunctival autograft. Evaluation of recurrence in same patients post-operatively was also done.

Setting

Narayana Nethralaya, Bengaluru, India

Methods

A prospective review was done for patients with clinically suspected excised pterygium (n=1000) which were routinely submitted for histopathological examination. The tissue was processed into paraffin blocks and slides made from blocks were stained with routine Haemotoxylin and Eosin (H&E) and studied under light microscopy by an ophthalmic pathologist. Grades of intraepithelial dysplasia were noted in all the samples along with presence of elastotic degeneration and presence of goblet cells. Subsequently, the demographic, surgical, clinical outcomes and pathological information were recorded and analysed. We also analysed antibodies against HPV-DNA using Immunohistochemistry. Prevalence of OSSN was noted.

Results

A total of 1000 consecutive specimens were evaluated out of which 8 cases (0.8%) showed dysplastic change. Age, gender and outcomes of surgery were not significantly different between patients with histologically normal and dysplastic specimens. All these cases of incidentally detected OSSN had coexisting pterygium changes in the form of  elastotic degeneration. Out of the 8 case, 2 showed mild dysplasia (25%), 3 showed moderate (37.5%) and 3 severe (37.5%). Antibodies directed against HPV-DNA were analysed using Immunohistochemistry which were negative. Following the diagnosis, all the patients are under close follow up and were given adjuvant therapy for OSSN as required.

Conclusions

Pterygium is a common ocular surface mass in the out-patient department, which can also rarely have a more sinister differential diagnosis. Most common cause of a pterygium is ultraviolet radiation and is common in our terrain, due to higher exposure to ultraviolet radiation, which may also be a predisposing factor to OSSN. There may be overlap of certain clinical features of pterygium and OSSN, a suspicion of subclinical OSSN should always be kept in mind and clinical evaluation along with Rose Bengal staining, and histopathological study of surgically excised pterygium to rule out OSSN can be included in the routine evaluation of pterygium patients.