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Abstract：
BACKGROUND: Ocular surface squamous neoplasia (OSSN) may have atypical or unusual presentations and may attain large sizes especially in cases of delayed presentation resulting in late diagnosis, treatment, and eventual guarded visual prognosis. We are reporting an interesting cases series of OSSN with variable clinical presentations to highlight the importance of the pre-operative clinical judgment and tissue diagnosis.
METHODS: Six patients (4 females and 2 males; mean age 59 years; range 42-79 years) were included with suspicious conjunctival lesions. The maximum dimension of the lesions was 17 mm. The initial suspected pre-operative clinical diagnosis -other than OSSN- included pterygium/pinguecula (n = 2), benign squamous papilloma (n = 1), cyst versus pyogenic granuloma (n = 1), and lymphoma (n = 1). This work has been reported in line with the PROCESS criteria.
CONCLUSIONS: The final histopathological diagnosis was unexpectedly invasive squamous cell carcinoma (SCC) in 4, one SCC in-situ, and squamous dysplasia in one. The primary treatment included MMC 0.02 % for 2 cycles for chemo-reduction in one of the cases where OSSN was suspected. Excisional biopsy was performed eventually for all lesions with application of one or more of the following modalities: MMC 0.02 %, absolute alcohol 99 %, and cryotherapy to the conjunctival margin. No tumor recurrence was noted in any of the patients after an average period of follow-up of 26 months. Even though the outcome was good, tumor-related morbidity and delay in the referral by general ophthalmologists are to be considered.
CONCLUSIONS: Conjunctival OSSN has wide presentation clinically and can be challenging in terms of diagnosis. Histopathological evaluation is essential for a definitive diagnosis and treatment. Accurate clinical diagnosis might affect the management plan with consideration for topical therapeutic modalities, however, these cases are best managed by wide excision using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctiva with consideration of topical chemotherapy.
METHODS: Six patients (4 females and 2 males; mean age 59 years; range 42-79 years) were included with suspicious conjunctival lesions. The maximum dimension of the lesions was 17 mm. The initial suspected pre-operative clinical diagnosis -other than OSSN- included pterygium/pinguecula (n = 2), benign squamous papilloma (n = 1), cyst versus pyogenic granuloma (n = 1), and lymphoma (n = 1). This work has been reported in line with the PROCESS criteria.
CONCLUSIONS: The final histopathological diagnosis was unexpectedly invasive squamous cell carcinoma (SCC) in 4, one SCC in-situ, and squamous dysplasia in one. The primary treatment included MMC 0.02 % for 2 cycles for chemo-reduction in one of the cases where OSSN was suspected. Excisional biopsy was performed eventually for all lesions with application of one or more of the following modalities: MMC 0.02 %, absolute alcohol 99 %, and cryotherapy to the conjunctival margin. No tumor recurrence was noted in any of the patients after an average period of follow-up of 26 months. Even though the outcome was good, tumor-related morbidity and delay in the referral by general ophthalmologists are to be considered.
CONCLUSIONS: Conjunctival OSSN has wide presentation clinically and can be challenging in terms of diagnosis. Histopathological evaluation is essential for a definitive diagnosis and treatment. Accurate clinical diagnosis might affect the management plan with consideration for topical therapeutic modalities, however, these cases are best managed by wide excision using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctiva with consideration of topical chemotherapy.
摘要：
背景：眼表鳞状细胞瘤（OSSN）可能具有不典型或不寻常的表现，并且可能会出现大尺寸，尤其是在延迟表现导致晚期诊断的情况下，治疗,和最终保护的视觉预后。我们正在报告一系列有趣的OSSN病例，其临床表现各不相同，以突出术前临床判断和组织诊断的重要性。
方法：6名患者（4名女性和2名男性；平均年龄59岁；范围42-79岁）被纳入可疑结膜病变。病变的最大尺寸为17mm。除OSSN-外，最初的可疑术前临床诊断包括翼状胬肉/翼状胬肉（n=2），良性鳞状乳头状瘤（n=1），囊肿与化脓性肉芽肿（n=1），淋巴瘤（n=1）。据报道，这项工作符合工艺标准。
结论：最终的组织病理学诊断是4个预料不到的浸润性鳞状细胞癌（SCC），一个原位SCC，和鳞状发育不良。主要治疗包括MMC0.02％，用于2个周期的化学减少，其中一例怀疑有OSSN。最终对所有病变进行切除活检，并应用以下一种或多种方式：MMC0.02％，纯酒精99%,对结膜边缘进行冷冻治疗。平均随访26个月后，所有患者均未发现肿瘤复发。即使结果很好，应考虑肿瘤相关的发病率和普通眼科医生的转诊延迟.
结论：结膜OSSN具有广泛的临床表现，在诊断方面具有挑战性。组织病理学评估对于明确的诊断和治疗至关重要。在考虑局部治疗方式的情况下，准确的临床诊断可能会影响管理计划。然而,这些病例最好通过使用无接触技术和双冻融冷冻疗法对结膜进行广泛切除，并考虑局部化疗。
方法：6名患者（4名女性和2名男性；平均年龄59岁；范围42-79岁）被纳入可疑结膜病变。病变的最大尺寸为17mm。除OSSN-外，最初的可疑术前临床诊断包括翼状胬肉/翼状胬肉（n=2），良性鳞状乳头状瘤（n=1），囊肿与化脓性肉芽肿（n=1），淋巴瘤（n=1）。据报道，这项工作符合工艺标准。
结论：最终的组织病理学诊断是4个预料不到的浸润性鳞状细胞癌（SCC），一个原位SCC，和鳞状发育不良。主要治疗包括MMC0.02％，用于2个周期的化学减少，其中一例怀疑有OSSN。最终对所有病变进行切除活检，并应用以下一种或多种方式：MMC0.02％，纯酒精99%,对结膜边缘进行冷冻治疗。平均随访26个月后，所有患者均未发现肿瘤复发。即使结果很好，应考虑肿瘤相关的发病率和普通眼科医生的转诊延迟.
结论：结膜OSSN具有广泛的临床表现，在诊断方面具有挑战性。组织病理学评估对于明确的诊断和治疗至关重要。在考虑局部治疗方式的情况下，准确的临床诊断可能会影响管理计划。然而,这些病例最好通过使用无接触技术和双冻融冷冻疗法对结膜进行广泛切除，并考虑局部化疗。
