Presentation By Dr. Vaishya. Maulik. P., Prof. Dr. Shubhangi. Nigwekar., Prof. Dr. S.V. Bangal. Prof.Dr.Sanjay. Shelke.

1. INTRAORBITAL EXTENTION
OF MODERATELY
DIFFERENTIATED
SQUAMOUS CELL
CARCINOMA OF
CONJUNCTIVA
PRESENTATION BY
DR. VAISHYA. MAULIK. P.

2. INTRODUCTION
•Squamous cell carcinoma of the conjunctiva is a rare malignancy;
however, it is reported to be the most common malignant tumour
of ocular surface.(1)
•In SCC the abnormal cells extend through the basement
membrane into the conjunctival stroma & has the potential to
penetrate the corneoscleral lamella into the anterior chamber of
the eye or can breach the orbital septum to invade the soft tissues
of the orbit, sinuses, and the brain. (2,3)
•These tumours may metastasize via lymphatics or blood during
the course of disease & owing to their possible aggressive
behaviour, conjunctival SCCs are therefore known to be sight and
life threatening.(3,4)
•Cytogenetic studies of conjunctival SCC have not revealed any
consistent chromosomal abnormalities or gene mutations in tumor
cells.(5)

3. CASE REPORT
•In nov-2015, a seventy year old female came to ophthalmology
opd.
•Patient gives h/o left eye cataract sx 11 yrs back at nagar and got
good vison.
•But since last 6-7 yrs pt c/o pain, redness, watering, itching and
sticky discharge with gradual,painful diminution of vision.
•Patient was prescribed various eye drops but there was no relief.

4. EXAMINATION
•On examination hard,tender, irregular mass was present
involving all intraocular contents which was adherent to eyelids.
•There was mucopurulent discharge present in left eye with
matting of eyelashes & lid edema.
•Dilated and tortuous feeder vessels was present on temporal side
of mass.
•Visual acuity was 6/18 in right eye (pseudophakic) while there
was no perception of light in left eye.
•There was severe ciliary tenderness present.
•Ocular movements were restricted and painfull in all directions of
gazes.
•On posterior segment examination no red glow was seen.

5. MANAGEMENT
•Biopsy under local anesthesia confirmed the diagnosis of
moderately differentiated squamous cell carcinoma.
•Patient underwent exentration surgery with wide excision of both
eyelids.
•Skin grafting was done over the orbital cavity.
•Post operatively pt was started on systemic antibiotics, analgesic
and antiinflammatory.
•Daily betadine dressing was done.

6. Ct scan showing intraorbital extention of squamous cell
carcinoma of conjunctiva

7. HISTOPATHOLOGY
•Report showed lining of Stratified
Squamous Epithelium(SSE), tumor
arising from it and infiltrating the stroma.
•Tumor cells are arranged in cords
and nest and scatterd singly.
•Individual tumor cells are large,
pleomorphic with hyperchromatic nuclei
with prominent nucleoli,clumped chromatin
irregular nuclear membrane and scanty
cytoplasm giving rise to high N:C ratio.
•The stroma is fibrocollagenous and show
infiltration by chronic inflammatory cells

8. DISCUSSION
•Squamous cell carcinoma of the conjunctiva is usually a slowly
progressive neoplasm that rarely invades the eye or orbit.(6,7)
•Immunosuppressed patients are at increased risk to develop
conjunctival squamous cell carcinoma.(5)
• Tumors in immunosuppressed patients can behave
aggressively.(5)
•Metastasis of conjunctival squamous cell carcinoma occurs in
less than 1% of patients, usually to the regional lymph nodes.(8)
• Rarely, intraocular invasion(6) or distant metastases to the lung
and bone have occurred.(8)
•Recurrence of conjunctival squamous cell carcinoma is generally
greater in patients with higher grade undifferentiated tumors and
in those with incomplete initial excision.(9)

9. CONCLUSION
•Advanced-stage SCC can be treated surgically.
•An extensive surgical approach is sometimes inevitable.
•Patients with surgical excision of advanced-stage disease should
be reviewed closely as recurrences may occur and even after
more than 5 years.
•However, on early detection, most of these recurrences can be
handled by local excision.

12. REFERENCES
(1) Sun EC, Fears TR, Goedert JJ. Epidemiology of squamous cell conjunctival
cancer. Cancer Epidemiol Biomarkers Prev 1997; 6(2): 73–
77. | PubMeds | CAS |
(2) Iliff WJ, Marback R, Green WR. Invasive squamous cell carcinoma of the
conjunctiva. Arch Ophthalmol 1975; 93(2): 119–122. | Article | PubMed |
(3) Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Surv
Ophthalmol 2004; 49(1): 3–24. | Article | PubMed|
(4) Walsh-Conway N, Conway RM. Plaque brachytherapy for the management of
ocular surface malignancies with corneoscleral invasion. Clin Exp Ophthalmol
2009; 37(6): 577–583. | Article |
(5) Yanoff and Duker, Ophthalmology, 4th Edition, Page 196.
(6) Shields JAShields CL Premalignant and malignant tumors of the conjunctiva
epithelium. In:Shields JAShields CLeds.Atlas of Eyelid and Conjunctiva
Tumors Philadelphia, Pa Lippincott Williams &Wilkins1999;226- 241
(7) Shields JAShields CLGunduz KEagle RC Intraocular invasion of conjunctiva
squamous cell carcinoma in five patients: the 1998 Pan American
Lecture. Ophthalmic Plast Reconstr Surg 1999;15153- 160
(8) Tabbara KFKersten RDaouk NBlodi FC Metastatic squamous cell
carcinoma of the conjunctiva. Ophthalmology. 1988;95318- 321