|Year : 1965 | Volume
| Issue : 2 | Page : 68-70
Squamous cell carcinoma of limbus
DL Maria, SP Shukla
Government Medical College, Aurangabad, India
|Date of Web Publication||21-Feb-2008|
D L Maria
Government Medical College, Aurangabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maria D L, Shukla S P. Squamous cell carcinoma of limbus. Indian J Ophthalmol 1965;13:68-70
Squamous Cell Carcinomate of conjunctiva may be so very slow growing that several years may elapse before medical attention is requested. However, Titche (1944) remarked that occasionally these growths demonstrate rapid progression and present themselves as large masses which project into the palpebral fissure. They can have a very insidious onset and certain precancerous changes such as leukoplakia may be seen in the surrounding conjunctiva. These tumours show a tendency to progress indefinitely and at times they exhibit true ulceration.
As regards causation of squamous cell carcinoma, chronic irritation to the conjunctiva has been considered to be a predisposing factor. It tends to occur most frequently at transitional zones of two kinds of epithelia, namely the limbus and the lid margins. However, these can also involve the bulbar conjunctiva away from the limbus.
It may develop from conditions like dyskeratosis, keratoacanthoma, Bowen's disease, leukoplakia and carcinoma in situ. There is much greater tendency for the lesion to become papillomatous and spread along the epithetial surface into the cornea. Lateral extension along the bulbar conjunctiva into the fornices is uncommon. When invasion is observed it is usually restricted to minute foci in the substantia propria, but rarely penetrate the sclera. Intraocular extension and metastasis also occur.-Duke Elder (1938), Green (1962). Parsons (1904) suggested that invasion of the globe took place along the perivascular and perineural lymph spaces at the corneoscleral junction.
It is histologically classified into four grades depending on an anaplastic reaction in the tumour cells. No difficulty occurs in distinguishing grade II, III & IV, but grade I squamous cell carcinoma resembles-Keratoacanthoma.-Walter (1962) and Mortade (1962) have summarised the points of difference.
The apparent rare occurrence of such cases has prompted us to report this case, under our observation.
| Case Report|| |
A female patient, 23 years, was admitted in the Ophthalmic ward of Government Medical College, Aurangabad on 21st March 1964 with a swelling in the temporal part of the right palpebral fissure of two months duration. The complaint started with pain in the right eye lasting for a few days and resulting in a small swelling at the limbus at 9 o'clock position. The swelling started increasing in size in all directions acquiring the present size of 2.5" x 2 w in two months' time. There was no relevant past or family history. A general physical examination revealed no abnormality except enlargement of preauricular lymph glands on the right side, which were firm, mobile but not tender. Investigations like blood pressure, urine, stool, W.R., E.S.R., and blood count did not reveal any abnormal findings.
The left eyeball was normal with visual acuity 6/6.
The right eyeball [Figure - 1] was normal but pulled apart due to the growth. A third of the cornea was covered from the lateral side. The growth was pinkish, firm, pedunculated with a cauliflower like surface and a clear but somewhat irregular edge. There was no ulceration. The growth was freely moveable on the sclera and did not bleed on touch. The eyeball was pushed medially and the motility was restricted on all sides. The fundus could not be seen. Vision was finger counting at two meters on the day of admission which got reduced to counting fingers at one meter within a week's time. The rest of the cornea, anterior chamber and iris were normal. The pupil reaction to light was brisk. X-rays of the orbit and chest were normal.
Biopsy revealed on histopathological examination squamous cell carcinoma grade I showing anaplastic reaction in about 25 per cent of the cells. The tumour was excised under local anaesthesia with a six mm collar of normal conjuctival tissue. The part of the cornea which was covered by the growth was cauterized with carbolic acid. The tumour was again sent for detailed histopathological examination which showed squamous cell carci-
noma. Visual acuity was 6/9. Patient was discharged on 18-4-1964 with good recovery except for a slight internal squint of about 6°.
| Discussion|| |
Birge (1938) reported 59 cases of squamous cell carcinoma, where he observed that lesion of grade I malignancy did not cause death or loss of an affected eye. Invasion of the orbit was not present and surgical excision resulted in an effective cure. He, therefore advised a re-evaluation of many of the "cured" cases of grade I squamous cell carcinoma of conjunctiva; to see if any of these cases of so-called carcinoma were in reality forms of Pseudo-epitheliomatous hyperplasia.
Frank C. Winter and Thomas R. Kleh (1960) studied 25 cases and compared them with 50 cases of the pre- cancerous epithelioma of limbus reported in the literature. They noted 25-40 per cent recurrence.
The histological examination was done twice in the present case to confirm the diagnosis of a malignant tumour.
After the biopsy, growth spread rapidly in all direction -covering the pupillary area, reducing the vision to one meter only in 4 days time. If it was a simple hyperplasia it should not have grown with such a rapidity.
Regarding intraocular extension which is rare there was no sign in this case, The patient has not reported again so far, but still it is too early to expect a recurrence.
| Summary|| |
A case of squamous cell carcinoma of grade I confirmed histopathologically has been reported. Rapidity of growth (2 months duration), pre-auricular enlargement of glands, no history of trauma and no sign of infection suggested the clinical diagnosis.
| References|| |
Aly. Mortada (1962), Brit. J. Ophthal., 46, 248.
Ash and Wilder, H. C. (1942), Trans. Amer. Acad. Ophth. Otolaryng. 46, 215.
Bierge. H. L. (1938), Arch. Ophthal., 20, 254.
Duke-Elder S. (1938), Text Book Ophthal. Vol. 2, Kimpton, London.
Winter F. C. and Kleh T. R. (1960), Arch. Ophthal., 64, 208.
Green, C. H. (1962), Brit. J. Ophthal.. 46, 306.
McGaric. J. S. (1942), Amer. J. Ophthal., 25, 167.
Parsons, J. H. (1904). "Pathology of the eye", Vol. I, Hodder & Stoughton, London.
Titche, L.L. (1944), M. Bull-veterans Administration. 20, 449.
Walter W. L. (1962), Amer. J. Ophthal., 53, 999.
[Figure - 1]