TOPICAL MITOMYCIN C IN THE TREATMENT OF CONJUNCTIVAL SQUAMOUS CELL CARCINOMA ABOUT TWO CASES

These are two male patients, aged 56 and 75, respectively, who presented with an unilateral limbal-conjunctival tumor, after a corneoconjunctival excision of the tumor, the histological analysis was performed and established the diagnosis of conjunctival squamous cell carcinoma Purpose: To describe those two cases of conjunctival squamous cell carcinoma that was successfully treated with adjunctive topical Mitomycin C.

Unresectable and chemoresistant conjunctival squamous cell carcinoma on xeroderma pigmentosum treated by salvage radiation therapy: A case report and a review of the literature

Radiotherapy, by its mechanism, has always been suspected to be contra-indicated in patients with xeroderma pigmentosum, depriving them of this very effective modality in the treatment of their cancers. As these suspicions have still not been confirmed, the place of radiotherapy should be reconsidered, while applying precautionary principles.

Gamma Knife Stereotactic Radiosurgery for Conjunctival Squamous Cell Carcinoma Invading the Anterior Orbit: A Case Series

<b><i>Introduction:</i></b> The aim of the study was to report our experience in the use of Gamma Knife Stereotactic Radiosurgery (GKSTRS) for conjunctival squamous cell carcinoma (SCC) invading the orbit, as an alternative to exenteration surgery. <b><i>Patients and Methods:</i></b> Patients who had GKSTRS for conjunctival SCC invading the orbit but sparing the bone (AJCC eighth ed. T4a) with a minimum of 1-year follow-up were included. Treatment failure was defined as no decrease in tumour size 3 months post-treatment, or further growth during the follow-up period. Patients were followed up 3-monthly for 2 years and 6-monthly afterwards with a minimum of yearly MR Imaging of orbit. <b><i>Results:</i></b> Six patients met the inclusion criteria. MR imaging was used to identify the extent of orbital involvement of SCC. Stereotactic radiosurgery utilizing the Leksell Gamma Knife® Perfexion was delivered in a single session in which patients received 18–20 Gy to the 45–50% isodose. The median follow-up was 29 months. Four patients responded to the treatment and had no evidence of recurrence at their most recent follow-up. The treatment failed in 2 patients, in 1 of whom the tumour was larger and extended deeper into the orbit. The other patient developed a recurrence away from the treated area at 9 months, suggesting a multifocal disease. Both patients had poorly differentiated SCC. <b><i>Conclusion:</i></b> GKSTRS is a potential alternative to orbital exenteration surgery for conjunctival SCC extending into the anterior orbit in a selected group of patients refusing orbital exenteration or has a second blind eye. Nevertheless, the disease is more likely to recur than with exenteration surgery, hence lifelong monitoring and low threshold for surgical intervention or retreatment is prudent.

FOXP3/CD8 ratio and CXCR4-positive regulatory T cells as indicators of tumor immunity in the conjunctival squamous cell carcinoma microenvironment

Conjunctival squamous cell carcinoma (SCC) is the most common ocular surface neoplasia. The purpose of this retrospective study was to examine the role of regulatory T cells (Tregs) activity in tumor immunity and investigate the tumor microenvironment as a new treatment focus in conjunctival SCC. A cancer progression gene array analysis and Immunohistochemical analysis of FOXP3 as Treg marker, CD8 as Tumor-infiltrating lymphocyte marker, and CXCR4 expression on activate Treg was also examined in a series of 31 conjunctival SCC cases. To investigate the localization of FOXP3-positive Tregs in detail, the tumor surface, tumor central, and around vessels staining patterns of FOXP3, CD8, and CXCR4 were examined separately. A significant difference in FOXP3, CD8, and CXCR4 staining in tumor-infiltrating lymphocytes and FOXP3/CD8 ratio were in the carcinoma in situ group than advanced stage SCC group(each P < 0.01). In addition, FOXP3/CD8 ratio was correlation with progression-free survival. Double immunostaining of CXCR4/FOXP3 correlate with American Joint Committee on Cancer T-stage, independent of age or Ki67 index(P༜0.01). Our results show that FOXP3, the FOXP3/CD8 ratio, and the CXCR4 axis are important pathologic and prognostic factors of ocular surface neoplasia, including SCC. These tumor microenvironment of conjunctival SCC may be considered in the future development of treatment options.

Treatment of conjunctival squamous cell carcinoma: balancing disease eradication with minimising treatment-induced morbidity

A 41-year-old male presented with a large non-pigmented lesion on the ocular surface involving 8 clock hours of limbus, bulbar conjunctiva, and palpebral conjunctiva. Incisional biopsy confirmed poorly differentiated conjunctival squamous cell carcinoma (SCC). It was staged as a T3, N0, M0 lesion. Treatment was with surgical excision, amniotic membrane transplant, and buccal mucosa graft. Three weekly cycles of 0.04% mitomycin C were administered postoperatively. Six months following excision, although there was no evidence of residual conjunctival SCC, the patient suffered from poor vision, significant pain, and diplopia due to severe dry eye, limbal stem cell deficiency, and symblepharon.This case illustrates the difficult clinical decisions which confront the clinician when treating conjunctival SCC, particularly with balancing the need to eradicate the disease to prevent local invasion and metastatic spread on the one hand and minimising ocular morbidity on the other.

Pattern of Ocular Manifestations among People Living with HIV/AIDS on Highly Active Anti Retroviral Therapy

Aim: To determine the pattern of ocular manifestations in people living with HIV/AIDS on highly active retroviral therapy (HAART). Study Design: A descriptive hospital based cross sectional study. Place and Duration of Study: Presidential Emergency Plan for AIDS Relief (PEPFAR) clinics of the University of Benin Teaching Hospital and Central Hospital, Benin City, Edo State, Nigeria. Between 1st July 2018 and 31st October 2019. Methodology: Four hundred and fifty one (451) patients living with HIV/AIDS on HAART were the subjects of this study. An interviewer administered questionnaire was used. They all had a comprehensive eye examination done. General examination including their height, weight and blood pressure were done. Results: There were 451 patients (104 males and 347 females with a male to female ratio of 0.3:1), the age range was 14 to 75 years with a mean age of 46.55 ± 10.77 years. Most of them, 305 (67.6%) were married. A Majority 210 (46.6%) of them had a CD4 count of 500 cells /microliter and more. Ocular morbidity was present in 385 (85.1%) respondents. The most common ocular morbidity was an uncorrected refractive error in 262 patients with presbyopia being the most common type. Other morbidities seen were cataract followed by allergic conjunctivitis and glaucoma. Ocular manifestations of HIV/AIDS occurred in 32 patients (7.1%). The most common was dry eyes in 15 (46.9%) of these patients followed by posterior uveitis secondary to presumed Toxoplasmosis in 9 (28.1%) patients. Other types of HIV associated ocular morbidities seen were conjunctival squamous cell carcinoma, retinal detachment, optic neuritis and Herpes Zoster ophthalmicus. Conclusion: There is a reduction in the prevalence and a change in the type of ocular manifestations in people living with HIV/AIDS on HAART. They are more prone to developing other ocular morbidities due to their increased lifespan. Eye health care programs should be established for people living with HIV/AIDS.

MACE RNA sequencing analysis of conjunctival squamous cell carcinoma and papilloma using formalin-fixed paraffin-embedded tumor tissue

Recent advances in the field of biomedical research allow for elucidation of the transcriptional signature of rare tumors such as conjunctival squamous cell carcinoma (SCC). In this study we compare its expression profile to conjunctival papilloma (Pap) and healthy conjunctival tissue (Ctrl) and develop a classification tool to differentiate these entities. Seven conjunctival SCC, seven Pap and ten Ctrl were formalin-fixed and paraffin-embedded (FFPE) and analyzed using Massive Analysis of cDNA Ends (MACE) RNA sequencing. Differentially expressed genes (DEG) and gene ontology (GO) clusters were explored and the abundance of involved cell types was quantified by xCell. Finally, a classification model was developed to distinguish SCC from Pap and Ctrl. Among the most prominent DEG in SCC a plethora of keratins were upregulated when compared to Pap and Ctrl. xCell analysis revealed an enrichment of immune cells, including activated dendritic cells and T-helper type 1 cells (Th1), in SCC when compared to Ctrl. The generated classification model could reliably discriminate between the three entities according to the expression pattern of 30 factors. This study provides a transcriptome-wide gene expression profile of rare conjunctival SCC. The analysis identifies distinct keratins, as well as dendritic and Th1 cells as important mediators in SCC. Finally, the provided gene expression classifier may become an aid to the conventional histological classification of conjunctival tumors in uncertain cases.