|Year : 1966 | Volume
| Issue : 2 | Page : 83-86
Common tumours of the limbus
Eye Infirmary, Medical College Hospitals, Calcutta, India
|Date of Web Publication||12-Jan-2008|
S P Das
Eye Infirmary, Medical College Hospitals, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das S P. Common tumours of the limbus. Indian J Ophthalmol 1966;14:83-6
Limbus is a mm broad area of the conjunctiva between the cornea on one side and the episcleral tissue and sclera on the other. It consists of two structures namely epithelium and stroma, and is characterised by the presence of blood vessels, lymphatics and nerves.
| Materials|| |
During the last twelve years (19501961) 66 cases of tumours of the limbus were examined histopathologically in the Eye Infirmary, Medical College Hospitals, Calcutta. Although [Table - 1] shows several varieties of limbal tumours, the common tumours are confined to the first four of them, which will be briefly discussed in this paper.
From [Table - 2], it can be seen that dermoids and naevus are congenital lesions, so they are seen in the early part of life. papilloma and epithelioma are found mainly in the older age groups. The youngest patient who had a dermoid tumour was two months old and the oldest patient who had limbal epithelioma was 59 years old.
[Table - 3] shows that sex has got no special relation except in case of epithelioma of the limbos. Out of total 18 cases of limbal epithelioma, 17 occured in males and only one occured in female.
| Dermoid|| |
Dermoids are the commonest tumours of the limbus. Although they are congenital, majority of the patients came for medical relief during adolescent period either with the complaint of rapid growth of the tumour mass or due to irritative symptoms from the presence of hair.
Clinically dermoids are yellow or whitish in colour, round or oval in shape and sometimes produce hairs.
All the limbal dermoids in the present observation were of solid varieties. Histologically they are covered by keratinized stratified epithelium. The corium is composed of dense collagenous connective tissue containing hair-follicles, sebaceous glands and blood vessels. Fat, nerves, muscles and sweat glands are occasionally seen.
Removal of dermoids was necessary for cosmetic reasons in the majority of the present series of cases and for irritating symptoms due to protruding hairs in a smaller group of cases.
| Epithelioma|| |
Epithelioma of the limbus starts as a small vascular patch. It is firmly fixed to the underlying tissue. It remains superficial for a long time but unless completely removed, it spreads. In two of the present series of cases spread occured over the whole of the cornea ultimately necessitating enucleation of the eye. In 7 of the present cases, patients noticed the tumour masses after an injury in the affected eyes by the fall of a foreign body. All the present cases were of squamous cell variety.
Histologically, epithelioma of the limbus has the same picture of squamous cell carcinoma as elsewhere in the body. The picture is characterised by down-growth of cells from the surface epithelium and the broken basement membrance. The cells show great hyperplasia with different variations. The peripheral cells are cylindrical, the next row of internal cells are prickle cells and the squamous cells are in the centre. The squamous cells undergo cornification and produce compact laminated masses which stain red with eosin and are called cell nests.
Good results were obtained in the present 16 cases of limbal epithelioma by simple local liberal excision of the tumour masses and in only two cases enucleation of the eye was necessary as the whole cornea was invaded by the spread of the tumour.
| Pappilloma|| |
Papilloma is a benign epithelial tumour and may recur if not completely removed or may rarely turn malignant when it produces the picture of squamous cell carcinoma.
Clinically, they present the appearance of small pedunculated growth and are movable over the sclera.
Histologically, papilloma is composed of papille with greatly thickened squamous epithelium and a central core of fibrous tissue containing blood vessels etc. The thickened epithelium form the main tumour mass and it varies in different tumours. No sign of malignancy was noted in the histological picture in any of the present cases. Treatment adopted in all cases was excision. No recurrence or malignancy was noted in any of the cases.
| Naevus|| |
Naevus is a congenital, mostly pigmented but occasionally non-pigmented benign tumour. Rarely it may undergo a malignant change. Usually such a patient comes during puberty for increased pigmentation and rapid growth of the tumour. The mass is a well localised, elevated pigmented lesion. The size and shape vary in different tumours. The colour of the lesion ranges from brown to black. All the present cases were pigmented.
The histological picture is characterised by naevus cells. The surface epithelium shows many down-dipping prolongations. The naevus cells lie below the epithelium in nest formation. The cells are round or polygonal with irregular, sometimes wedge-shaped nuclei. Often they contain refractile vacuoles. The chromatin is fine and the nucleolus is occasionally present. Pigments have been found in most of the cases but in one case it was absent. They may be seen in both nxvus cells and stromal cells. Nevus are of two types. The junctional type is commonest and originates in the deep layers of the epithelium and affects the adjacent dermis. So the cells are found in the deep part of the epidermis and also below it. The second type is called neuro-nxvus and is characterised by a thin layer of connective tissue between the tumour and the surface epithelium.
All the present 8 cases of naevus were excised taking special care to remove them completely, because of the fact that incomplete removal often leads to a malignant change. No recurrence or malignant transformation occured in the present series of cases.
| Comments|| |
Limbal dermoids are sometimes associated with similar tumours in other parts of the body or any other congenital abnormality. But in the present series of cases there was no such association. These tumours may produce astigmatism. This was true in a few of the present cases.
Epitheliomas of the limbus are comparatively less malignant than carcinoma in other parts of the body. The reasons may be poor lymphatic supply of the area, difficulty of spread due to tough structures like cornea and sclera. So the growth remains superficial for a long time without direct spread and distant metastasis. If the tumour is localised excision is the best treatment. The question of enucleation of the eye is to be considered where there is recurrence or if the cornea is much involved. In Ash and Wilder series of 48 carcinomas of the limbus, a simple excision was sufficient for 23 and in 2 additional excision was essential. Enucleation was performed in 23 patients. In one case only death was presumptively attributed to the tumour. In the present 18 cases, 16 were treated by simple liberal excision and in two only where the cornea was much involved, enucleation of the eye was performed. All the patients are doing well without recurrence. Out of 18 cases of epitheliomas of the limbus, 17 occured in males. This higher incidence in males can be accounted by the predisposing factor of chronic irritation in males. This tumour has a tendency to arise at the site of epithelial transition, so limbus is the favourite site. Basal cell carcinoma is rare at the limbus.
Like epithelioma, papilloma has a tendency to arise at a site of epithelial transition. So limbus is the favourite site like the lid margin. Papillomas occasionally undergo malignant transformation to squamous cell carcinoma. In Ash and Wilder series of 48 epitheliomas of the limbus, 8 were papillary squamous cell type. In the present observation of papillomas of limbus, none recurred after excision or underwent malignant change.
Nevus is usually a pigmented lesion, but occasionally by the side of the pigmented lesion, there remains an unpigmented portion and recurrence usually happens. Nevus is congenital, but it is usually not noticed until puberty because pigmentation occurs between the ages of 4 to 14 years. Sometimes some nevi acquire pigmentation even in infancy. A hormonal influence on melanogenesis can account for increased pigmentation and rapid growth of the tumour during puberty.
| Summary|| |
A series of 66 cases of limbal tumours were examined histopathologically in the pathology department of the Eye Infirmary, Medical College Hospitals, Calcutta over a period of 12 years. The common tumours are briefly discussed in this paper.
| Acknowledgement|| |
I am indebted to Dr. P. K. Sarker, Pathologist for all possible advices.
| References|| |
Ash. 1. E. (1950), Amer. J. Ophthal.33, 1203.
Ash, J. E., and Wilder, H. C. (1942), Amer. J. Ophthal, 25, 926.
Duke-Elder. S. Text Book of Ophthal mology, (1943). Vol. 2, n. 1775, Henry Kimpton, London.
Reese, A. B. (1943), Tumours of the Eye. Hoeber, New York.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2], [Table - 3]