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Year : 2020  |  Volume : 68  |  Issue : 11  |  Page : 2491-2492

Corneal epithelial hyperplasia masquerading as ocular surface squamous neoplasia

1 Kanupriya Dalmia Ophthalmic Pathology Laboratory, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
2 Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, India

Date of Submission08-Feb-2020
Date of Acceptance06-Jul-2020
Date of Web Publication26-Oct-2020

Correspondence Address:
Dr. Swati Singh
Consultant, L J Eye Institute, Ambala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_264_20

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Keywords: Keratitis, ocular surface squamous neoplasia, OSSN

How to cite this article:
Singh S, Mittal R, Narang P, Mittal V. Corneal epithelial hyperplasia masquerading as ocular surface squamous neoplasia. Indian J Ophthalmol 2020;68:2491-2

How to cite this URL:
Singh S, Mittal R, Narang P, Mittal V. Corneal epithelial hyperplasia masquerading as ocular surface squamous neoplasia. Indian J Ophthalmol [serial online] 2020 [cited 2020 Nov 28];68:2491-2. Available from: https://www.ijo.in/text.asp?2020/68/11/2491/299066

Corneal ocular surface squamous neoplasia (OSSN) commonly present as grayish, avascular superficial corneal opacity with feathery margins and minimal limbal involvement.[1] We describe an unusual presentation of corneal epithelial hyperplasia masquerading clinically as an OSSN. A 45-year-old male presented to ocular oncology services with blurred vision in left eye of 5 months duration. His best-corrected visual acuity (BCVA) was 6/6, right eye and 6/18, left eye. At presentation, slit lamp microscopy showed [Figure 1]a and [Figure 1]b grayish avascular growth involving inferior and central cornea with typical feathery edges. No epithelial discontinuity was noted on fluorescein staining. Anterior segment optical coherence tomography (ASOCT) showed the involved epithelium to have increased reflectivity, and an abrupt transition from the normal uninvolved epithelium [Figure 1]c. The epithelial thickness was increased by 10 microns only, inconclusive of OSSN.[2] He was started on topical IFNa2b 1MIU/ml and minimal change was noted after 3 months of immunotherapy. With clinical diagnoses of pseudo-epitheliomatous hyperplasia (PEH) or OSSN, alcohol keratoepithelectomy was performed. Histopathology revealed squamous metaplastic corneal epithelium with parakeratosis. The epithelium showed reactive changes, mild nuclear enlargement, with patchy presence of peri nuclear halo [Figure 1]e and [Figure 1]f. Occasional superficial cell (arrow marked) showed mild nuclear hyperchromasia, with definite and distinct peri nuclear cytoplasmic clearing. There was no dysplasia. The lesion resolved completely following surgery and showed no recurrence [Figure 1]d. No viral DNA of herpes simplex or human papilloma virus could be detected with polymerase chain reaction.
Figure 1: (a and b), Slit lamp photograph shows grayish avascular lesion involving inferior paracentral cornea with fimbriated borders. (c), ASOCT displays hyper-reflective epithelium with abrupt transition from the uninvolved epithelium. (d), Slit lamp image of clear cornea following keratoepithelectomy. (e and f), Photomicrograph (×20 objective) shows squamous metaplastic epithelium with dispersed cells displaying perinuclear cytoplasmic clearing (asterix marked; ×40 objective) and nuclear hyperchromasia and perinuclear halo (marked with arrow). There was absence of cytological atypia

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  Discussion Top

Corneal epithelial hyperplasia has many etiologies and includes response to toxic irritants applied topically, microbiological infections, nutritional deficiencies, heritable defects, and exophthalmos due to space-occupying orbital masses. These are usually associated with stromal inflammation and neovascularization. The current case had neither vascularization and nor inflammation, which made us think of OSSN as our first differential diagnosis. The exact etiology in the current case remains unknown.

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There are no conflicts of interest.

  References Top

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;6:109-20.  Back to cited text no. 1
Singh S, Mittal R, Ghosh A, Tripathy D, Rath S. High-resolution anterior segment optical coherence tomography in intraepithelial versus invasive ocular surface squamous neoplasia. Cornea 2018;37:1292-8.  Back to cited text no. 2


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