|Year : 1991 | Volume
| Issue : 1 | Page : 6-8
Malignant tumours of the eye and adnexa
Regional Institute of Ophthalmology, Madras-600 008, India
Regional Institute of Ophthalmology, Madras-600 008
Source of Support: None, Conflict of Interest: None
We analysed 262 consecutive histopathologically proved cases of malignant tumours of the eye and its adnexa seen over a nine year period. Two peaks were observed in the age distribution one in the first decade due to retinoblastoma and another between forty one to sixty years due to malignant lid tumours especially meibomian carcinoma. Males (56%) were affected more often. Intraocular tumours (34%) formed the commonest group of malignant orbito-ocular tumours; lacrimal gland tumours (3%) occurred least frequently. Of the individual tumours, retinoblastoma (32%) was seen most often followed by squamous cell carcinoma (25%). The frequency of meibomian gland carcinoma in Madras was significantly more than in North India. Extra-ocular malignant melanomas out-numbered intraocular (uveal) malignant melanomas. The significance of these observations is discussed.
|How to cite this article:|
Sunderraj P. Malignant tumours of the eye and adnexa. Indian J Ophthalmol 1991;39:6-8
| Introduction|| |
Malignant orbito-ocular tumours are rare and there are few composite studies of these tumours ,,,. Many of the reports of ocular tumours have dealt mainly with individual tumours like retinoblastoma , and those arising from the lacrimal gland sub , meibomian gland , conjunctiva+ ,  and orbit . Hence, we undertook the present study to determine the frequency of various malignant tumours of the eye and its adnexa in Tamil Nadu.
| Material and methods|| |
Patients presenting to our eye hospital with ocular neoplasms are operated upon, where appropriate. These specimens are then subjected to histopathologic examination at the affiliated Medical College after routine fixation and staining. Special procedures are carried out, if necessary, for definitive diagnosis. Histopathologically proved cases of malignant ocular tumour seen in our hospital in the last nine years formed the material for this study. The present report is an analysis of the above data based on the W.H.O. Classification (1980) .
| Observations and discussion|| |
Age and sex distribution of patients with malignant eye tumours [Table - 1] showed two obvious peaks - one less than ten years of age and the other between 41 and 60 years. Retinoblastoma was responsible for the former peak while the latter was due to eyelid malignancies, especially meibomian carcinoma. Males (56%) were affected more often than females. These observations are in agreement with those of previous authors ,.
Intra-ocular tumours (34%) were the commonest malignant orbito-ocular tumours in our study [Table - 2] followed by eyelid tumours. However, malignant lid tumours were more frequent in all the past reports , [Table - 3]. Malignant tumours of the lacrimal gland occurred least frequently as in other studies ,
| Retinoblastoma|| |
Retinoblastoma was the most frequent (96%) intraocular tumour in our series and also the single commonest (32%) malignant tumour arising from the eye and adnexal structures.
Gogi et all and Reddy et a1  reported similar findings. According to Reddy et al , retinoblastoma was the commonest intraocular tumour, but as a whole was less than squamous cell carcinoma arising from various parts of the eye and adnexa.
The average age of retinoblastoma patients in our study was 33 months compared to 36 months  and 42 months  in previous studies. Abiose et al  from Nigeria reported 30.4 months, while the average age in Western countries is 18 months . This earlier age of presentation in developed countries is probably due to the better diagnostic facilities, and increased awareness among the public unlike our patients who come to the hospital only in the advanced stages.
We did not observe any significant male (53%) predominance similar to that observed by Yanoff and Fine . Some authors have, however, reported that retinoblastoma has a predilection for males ,
| Malignant melanoma|| |
These tumours are generally rare in the pigmented races . We observed three cases of malignant melanoma of the choroid forming 3% of the malignant intraocular tumours. This is less than the 10.5% and 15%  already reported. Other ocular malignant melanomas observed included two from the eyelids and seven from the conjunctiva. They were found significantly more in females, similar to Ratnakar et al . However, unlike previous studies , malignant melanomas from external ocular structures out numbered those from the uvea. Miller et a1  reported a similar finding in the black race. It is probably that the deeply pigmented skin of blacks and coloured races prevents, in an yet unknown way, the origin of intraocular malignant melanomas. On the other hand, the non pigmented conjunctiva is directly exposed to sunlight and ultra-violet rays. This may account for the predominance of conjunctival malignant melanomas in our .study and in the pigmented races in general.
| Eyelid tumours|| |
This was the most frequent (29%) group of tumours in our study next to intraocular tumours. They occurred mainly between the fifth and seventh decades of life and showed no sex preference. Squamous cell carcinoma was the predominant individual tumour in this group (34% of the malignant lid tumours) similar to Reddy et a1 sub and Ratnakar et al  sub whereas basal cell carcinoma was more common according to Gogi sub and Greer1 .
We noticed a significant number of meibomian gland carcinomas (33% of all malignant lid tumours) compared to 12.5%[ 1], 32% , and 16.5%  in previous studies. As pointed out by Ratnakar et al , the incidence of this carcinoma seems to be more in the coastal areas of South India , compared to North India ,. Kakinada , Pondicherry  and Madras (present study) are all located on the South Indian coast and have similar climatic conditions. The high degree of humidity and sweating in coastal South India relative to the dry heat of North India may account for this variation in the reported frequency of meibomian gland carcinoma 17 . Sex incidence is controversial - females were more in our series unlike in a previous study 
| Tumours of the conjunctiva and cornea|| |
These malignant tumours were significantly more in our study (26%) compared to previous studies ,,.This is partially because we observed more limbal tumours than other authors . The commonest tumour in this group was squamous cell carcinoma (55.1 %) followed by carcinoma-in-situ. Squamous cell carcinomas occurred more often in males and those arising from the limbus out-numbered squamous cell carcinomas arising from elsewhere. This is because the limbus is the junction of two epithelia and so the favourite site for these tumours  These findings are consistent with past reports ,,
Limbal carcinomas were distributed in all the age groups while the epitheliomas from other sites tended to occur between 31 to 50 years. Three female patients with limbal squamous cell carcinoma ages 16, 18 and 55 years had associated xeroderma pigmentosa.
Carcinomas-in-situ also affected the males more commonly and were usually seen in a relatively younger age group, that is, in the third and fourth decades.
| Orbital tumours|| |
This group accounted for 8% of the malignant orbitoocular tumours. Lymphoma was the commonest malignant orbital tumour (32%) as in previous reports ,.Five of the seven cases belonged to the diffuse lymphocytic lymphoma type. The majority (6 patients) were between 31 and 50 year similar to other authors ,
Other frequent malignant orbital tumours were three cases of undifferentiated carcinoma and three cases of secondaries including two of neuroblastoma.
| Lacrimal gland tumours|| |
Malignant lacrimal gland tumours were rare and occurred least frequently consistent with past experience ,,. It was more common in males and between the ages of 31 to 50 years as reported by Agarwal et a1 . It is said that adenoid cystic carcinoma is the commonest malignant tumour of the lacrimal gland . However, pleomorphic adenocarcinoma occurred equally frequently in our series and was more common in a previous study .
| References|| |
Gogi R, Nath K, Ahuja L, Shukla M. Indian J. Ophthalmol. 27 : 25 (1979)
Reddy S C. Rao C R, Rao V V R, Banerjea S. Indian J. Ophthalmol. 30 475 (1982)
Ratnakar C. Krishnan M M, Veliath A J. Paper presented at the Annual Conference of the Madras State Ophthalmol Assoc. (1986)
Dhir S P, Jain I S. Dar G R, Guptha H D. Indian. J. Ophthalmol. 28 : 97 (1980)
Agarwal P K. Ram R, Kumar D. Agarwal J. Indian. J. Ophthalmol.30 : 509 (1982)
Shukla I M. Mukherjee P K. Das D K. Indian. J. Ophthalmol.31 : 327 (1983)
Zaidi N. Nath K, Gogi R.Indian. J. Ophthalmol.28 : 171 (1981)
Sunderraj P P, Pungalenthi N. Afro-Asian J. Ophthalmol. 6 : 16 (1987)
Kulshrestha 0 P, Arora I, Shukla Y, Mathur M. Indian. J. Ophthalmol. 31 : 313 (1983)
World Health Organisation. Histological Typing of Tumours of the Eye and its Adnexa. W.H.O.. Geneva, 1980.
Abiose A.Eng 0, Adido J,Agarwal S C.Cancer 55.:.2889 (1985)
Reese A B. Tumours of the Eye 3rd Edition. Harper and Row.. Hagerstown, Maryland 1976, p.37
Yanoff M, Fine B S, Ocular Pathology. Harper and Row. Hagerstown, Maryland 1975, p.656
Greer C H. Ocular Pathology 3rd Edition. Blackwell Scientific Co., Oxford. London 1979, p. 70, p. 205
Miller B, Abrahams C, Cole G C, Proctor N S F. Br. J. Ophthalmol. 65: 720 (1981)
Reddy M K, Veliath A J. Nagarajan S. Aurora A L. Indian J. Med. Res. 75 :882 (1982)
[Table - 1], [Table - 2], [Table - 3]
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