Dr. Nikhil Balakrishnan (Pg Student), Dr. Kishor Badhe (Professor), Dr. Surekha V Bangal (Professor)

1. E-POSTER
Dr Nikhil Balakrishnan (PG Student)
Dr Kishor Badhe (Professor)
Dr Surekha V Bangal (Professor)
PAPPILOMATOUS SQUAMOUS
CELL CARCINOMA AT THE
LIMBUS

2. INTRODUCTION
• The average annual incidence of Squamous cell carcinoma is approximately 1 case per 700–
850 persons.
• Generally, the tumors occur in older adults.
• They affect all racial groups and both sexes.
• Risk factors include a history of repeated intense sunlight exposure, male sex, outdoor
occupations, advanced age, cigarette smoking, a history of squamous cell carcinoma of the
skin of the head and neck, blonde hair, light complexion, xeroderma pigmentosum, AIDS, and
conjunctival infection by human papilloma virus 16 and 18.
• People with AIDS tend to develop tumors of the conjunctival and corneal SSE at a younger
age. Their tumors tend to be substantially more aggressive than the typical conjunctival SCC.
• The pathogenesis of tumors appears to be disordered epithelial maturation induced by various
irritants. Cytogenetic studies of conjunctival SCC have not revealed any consistent
chromosomal abnormalities or gene mutations in tumor cells.
• Tumors of the conjunctival and corneal Stratified Squamous Epithelium appear most
frequently as focal epibulbar lesions at the corneoscleral limbus temporally or nasally.
• When the disordered epithelial maturation involves the corneal epithelium, it frequently
appears as a zone of translucent corneal epithelial clouding visible by slit-lamp biomicroscopy.

3. • Three morphologic patterns of Squamous Cell Carcinoma are most common.
• Other features indicative of probable malignant histology include prominent epibulbar
vasculature of the lesion, corneoscleral or intraocular invasion, anterior orbital invasion,
and spontaneous bleeding.
• Such tumors are regarded as malignant when they exhibit anaplasia, invasion of the
substantia propria of the conjunctiva, underlying sclera or cornea, or both.

4. CASE REPORT
• 40 year old male gives history of mass encroaching upon the cornea
of right eye temporally since one and a half year.
• Mass was gradually increasing in size and painless.
• Associated with redness and watering.
• History of allergy to dust.
• Patient was diagnosed to be HIV positive 1 year back and is on
regular ART treatment (Zidovudine-Lamivudine-Nevirapine).
• Not associated with ocular trauma.

5. CLINICAL FEATURES
• A 8x6 mm reddish brown
mass encroaching from the
temporal conjunctiva onto
the cornea of the right
eye.(2mm on the cornea).
• Multiple dilated and
tortuous feeder vessels
present.

6. TREATMENT
• Right eye temporal limbal mass was
excised under local anesthesia.
• Deep Keratectomy was performed
and a deep conjunctival excision was
done leaving a bare sclera.
• Cryotherapy to the bulbar
conjunctiva adjacent to the incision
around the lesion and to the sclera
underlying the site of the excised
limbal lesion was performed to
reduce the likelihood of recurrence.
• Topical chemotherapy using
mitomycin C (0.02%) drops were
administered four times daily for 1 to
2 weeks after the corneal epithelium
had healed.

7. HISTOPATHOLOGY
• Report showed lining of Stratified
Squamous Epithelium(SSE) and a
tumor arising from it and infiltrating
the underlying stroma.
• Tumor Cells were arranged in a nest
and scattered singly
• Individual tumor cells were
enlarged, pleomorphic at places,
spindle shaped with
hyperchromatic, pleomorphic
nuclei, irregular nuclear
membrane and scanty cytoplasm.
• Abnormal mitotic figures were
seen .
• Areas of hemorrhages, necrosis
and infiltration by
polymorphonuclear lymphoctes
were seen.

8. POST OPERATIVE RESULTS
• No symblepharon, restricted ocular
motility, or scleral melting was seen
following Cryotherapy.
• Patient was followed up regularly.
• No recurrent intraepithelial neoplasia
following prior excision was
observed even upto 9 months
following the excision.
• Preauricular lymph nodes were
palpated on follow up to check for
presence of metastasis.

9. CONCLUSION
• Squamous Cell Carcinoma in patients with concurrent AIDS are
particularly likely to exhibit rapidly progressive malignant
conjunctival and corneal neoplasms of the SSE and metastasis of
those neoplasms.
• Patients whose conjunctival and corneal SSE tumors are excised
completely by histopathological criteria are usually cured.
• Supplementation of excision with Cryotherapy and administration of
Mitomycin C and 5- Fluorouracil prevents the likelihood of
recurrence.

10. REFERENCES
1. Albert and Jakobiec, Principles and Practice of Ophthalmology, 3rd
Edition, Vol-3, Page 3584-3586.
2. Yanoff and Duker, Ophthalmology, 4th Edition, Page 196-198.
3. American Academy of Ophthalmology 2015 Edition, Page 2001.
4. www.ncbi.nlm.nih.gov>PMC1770993.
5. British Journal of Ophthalmology 2000:84: Page 268-272.