Márcia Serva Lowen

Long-term results of topical mitomycin C 0.02% for primary and recurrent conjunctival-corneal intraepithelial neoplasia.

Purpose: To evaluate the efficacy, recurrence rate, and long-term complications of topical mitomycin C (MMC) 0.02% for conjunctival-corneal intraepithelial neoplasia (CCIN). Methods: A prospective, nonrandomized, noncontrolled study was conducted of patients with primary or recurrent CCIN treated with topical MMC 0.02%, four times per day, for 28 consecutive days. The main outcome measures were complete resolution of the neoplasia by slit-lamp examination and cytology 1 month after treatment, tumor recurrence, and long-term complications. Results: Between June 1999 and September 2005, 23 patients were included. Eighteen had primary CCIN (group 1) and 5 had recurrent CCIN (group 2). The mean follow-up was 46 months in group 1 and 54 months in group 2. All patients were treated with MMC 0.02% for 28 consecutive days. Complete resolution of the lesion was achieved in all patients after 1 month of treatment. Recurrence occurred in 1 patient (4.3%) after 24 months of treatment. Four patients developed corneal erosion (17.4%), 2 of them with primary CCIN and 2 with recurrent CCIN. Corneal erosion occurred 4 to 24 months after treatment and was treated successfully. The probability for corneal erosions by the log-rank test was equal for both groups (p = 0.1705). Conclusions: The use of topical MMC 0.02% for 28 consecutive days to treat primary or recurrent CCIN was effective and showed a low recurrence rate. Corneal erosion occurred in 17.4% of cases and can occur as late as 24 months after treatment.

Predictive index to differentiate invasive squamous cell carcinoma from preinvasive ocular surface lesions by impression cytology

Background/aims: In the literature, no cytological features have been identified that reliably differentiate invasive squamous cell carcinoma (SCC) from preinvasive lesions in impression cytology (IC) samples. The aim was to identify cytological features related to malignancy and apply them in a quantitative model to determine an index score with the best predictive power to differentiate SCC from preinvasive ocular surface lesions by IC. Methods: 39 patients with ocular surface epithelial lesions were enrolled. IC was obtained from all lesions before surgical excision. Specimens with atypical cells were evaluated regarding 11 cytological parameters based on the 2001 Bethesda system. Results: Histopathological diagnosis was pterygium in one case, actinic keratosis in nine cases, intraepithelial neoplasia in nine cases and SCC in 20 cases. Analysis of the receiver operating characteristic curve revealed that a predictive index score (cut-off point) ⩾4.25 presented the best relationship between sensitivity and specificity in identifying SCC (sensitivity of 95%, specificity of 93%, positive predictive value of 95% and negative predictive value of 93%). Conclusion: The scoring system model presented is suitable for clinical practice in differentiating SCC from preinvasive ocular surface lesions by IC and can be better evaluated with prospective use.

Immunohistochemical profile of lymphoid lesions of the orbit

BACKGROUND Orbital idiopathic inflammation, lymphoid hyperplasia, and lymphoma may all present clinically in the same manner. Histopathology and especially immunohistochemistry play a major role in the differential diagnosis. The purpose of this study was to determine the immunophenotypic features of these lesions. METHODS Fifty-five orbital lymphoid lesions were retrieved from the ophthalmic pathology registries at McGill University, Montreal, Canada, and the Federal University of São Paulo, São Paulo, Brazil. Formalin-fixed, paraffin-embedded, histopathologic sections were stained with hematoxylin and eosin and periodic acid-Schiff. The sections were also immunostained for B-cell (CD20) and T-cell (CD43) markers and for immunoglobulin light chains kappa and lambda. Two pathologists determined the histopathologic and immunohistochemical pattern of each lesion in a masked fashion. RESULTS Of the 55 lesions, 11 (20%) were idiopathic chronic inflammations, 22 (40%) were lymphoid hyperplasias and 22 (40%) were lymphomas. Idiopathic inflammation displayed a predominance of T cells and all lesions expressed polyclonal light chains. Lymphoid hyperplasia displayed a mixture of B cells and T cells, with a slight predominance of the former and all lesions expressed polyclonal light chains. Lymphoma showed a striking predominance of B cells and all lesions expressed monoclonal light chains, usually kappa (63.7%). The differences in the mean percentages of B cells among the orbital lymphoid lesions (inflammation, 35%; hyperplasia, 65.9%; lymphoma, 87.3%) were statistically significant (p < 0.001). INTERPRETATION Orbital lymphoid lesions can be differentiated based on the percentages of B cells and T cells and the monoclonal or polyclonal expression of immunoglobulin light chains.

Use of impression cytology for the detection of unsuspected ocular surface squamous neoplasia cells in pterygia

Purpose: To evaluate the agreement between the methodologies of impression cytology (IC) and histopathology regarding epithelial lesions clinically diagnosed as pterygium and also regarding the detection of unsuspected and associated ocular surface squamous neoplasia (OSSN). Methods: Thirty-two Brazilian patients were included and IC was performed on all pterygia before excision. Histopathogical examination was considered the gold standard and was performed by two experienced ocular pathologists in which consensus existed regarding pterygia diagnosis. IC accuracy was assessed by sensitivity and specificity with a 95% confidence interval. Results: From the 32 primary lesions studied, histopathological examination confirmed the diagnosis of pterygium without atypical cells in 19 cases (60%) and showed unsuspected and associated OSSN cells in 13 cases (40%). IC demonstrated one false-negative and one false-positive result for atypia. Statistical analysis showed an estimated sensitivity of 92%, specificity of 94%, positive predictive value of 92%, and negative predictive value of 94%. Conclusion: IC demonstrated high agreement with histopathological analysis in the detection of atypical epithelial cells in unsuspected OSSN in Brazilian pterygia patients.

Citologia de impressão no diagnóstico de infecção corneana por Acanthamoeba: relato de caso

To describe three cases of corneal infection due to Acanthamoeba sp in which was possible to detect Acanthamoeba sp cysts by the corneal impression cytology technique. Three patients referred to the External Eye Disease Laboratory in 2004 with superficial corneal alterations were submitted to corneal specimen collection by impression cytology filter paper to investigate the presence of Acanthamoeba sp cysts. Two impression cytology samples were obtained from each patient and were stained by PAS, hematoxylin and Papanicolaou. Routine microbiological investigation and culture were also performed using corneal scraping. Positive culture and impression cytology for Acanthamoeba sp was observed in all patients while smears with Giemsa stain were positive in two. Impression cytology Acanthamoeba sp cysts were observed among sheets of corneal epithelial cells and as isolated cells. Cysts were also found in the superficial epithelium in one of these patients after treatment while corneal scraping did not reveal any cyst. Histopathology revealed cysts in the epithelium and stroma in a transplanted cornea in one of these patients. The first description of impression cytology as a diagnostic method for Acanthamoeba keratitis occurred recently. In this study corneal impression cytology detected Acanthamoeba sp cysts successfully in these patients with only superficial involvement. Impression cytology as a non invasive technique can be used to facilitate early recognition of Acanthamoeba infection playing a useful role in the follow-up of the disease.

Massive orbital metastasis of hepatocellular carcinoma

Compared to other organs, the eyes are relatively infrequent sites of metastasis. In a landmark case series, Ferry and Font described 227 cases of carcinoma metastatic to the eyes. Among these cases, only 28 (12%) were orbital metastases, most frequently from tumors of the breast, lung, and genitourinary tract; in this series, the diagnosis of orbital metastasis preceded the diagnosis of the primary tumor in 61% of cases. Metastases represent from 1% to 13% of orbital tumors, the rest being [...]

Achados histopatológicos em retinoblastoma

OBJETIVO: Descrever e analisar os principais achados histopatologicos no retinoblastoma com enfase na invasao de nervo optico e tunicas oculares, correlacionando-os ao tratamento realizado. METODOS: Vinte e oito olhos com diagnostico de retinoblastoma tratados por enucleacao na Universidade Federal de Sao Paulo entre dezembro de 2000 e outubro de 2002 foram submetidos a revisao histopatologica. Os dados clinicos incluiram idade, sexo, raca, lateralidade e tratamento realizado. Na revisao histopatologica foram avaliados neovascularizacao da iris e seio camerular, grau de diferenciacao do tumor e invasao do nervo optico e coroide de acordo com a classificacao de Khelfaoui. RESULTADOS: De 27 pacientes, 13 (48,1%) eram do sexo masculino e 14 (51,9%) eram do sexo feminino, 16 (59,3%) eram da raca branca, 5 (18,5%) eram da raca amarela, 4 (14,8%) eram pardos e 2 (7,4%) eram negros. A media da idade dos pacientes foi de 22,7 meses, sendo 13 casos bilaterais e 14 casos unilaterais. Com relacao ao tratamento utilizado, 13 (46,4%) olhos foram submetidos a enucleacao primaria e 15 (53,6%) tiveram tratamento previo. Na avaliacao histopatologica, 15 (53,6%) tumores eram bem diferenciados. Neovascularizacao da iris e/ou seio camerular foram observados em 60,6% e necrose e calcificacao em 89,2% dos casos. O envolvimento da coroide foi observado em 18 (64,2%) dos casos (grau II e III) e a invasao de nervo optico em 8 (28,5%) (graus II, III e IV). Dos casos submetidos ao tratamento previo 40% tinham algum grau de invasao das tunicas oculares e apenas 6,67% apresentavam simultaneamente invasao do nervo optico e das tunicas oculares. Entretanto nos olhos que foram submetidos a enucleacao primaria 30,7% apresentavam invasao das tunicas oculares e 53,8% apresentavam simultaneamente invasao do nervo optico e das tunicas oculares. CONCLUSAO: Neovascularizacao, necrose e calcificacao foram achados mais comumente observados. A invasao do nervo optico e coroide foram os dois fatores prognosticos mais importantes, encontrados em 28,5% e 64,2% dos casos respectivamente. Os casos tratados com enucleacao primaria apresentavam maior comprometimento ocular.

Impression cytology in the evaluation of ocular surface tumors: review article

Impression cytology (IC) has been widely used as a method for evaluating the ocular surface and superficial cells layers in the diagnosis and follow-up after treatment of several ocular surface tumors of both epithelial and melanocytic origin. Information regarding this can be found in the English-language literature since 1992. Using either cellulose acetate or Biopore membranes for specimen collection, a high correlation has been found between IC and tissue histology. Compared with exfoliative cytology with spatula, IC is less traumatic to the patients eye, provides a precise location of the area being studied, and allows accurate observation of the cells the way they exist in vivo. The additional advantage of IC is the preservation of limbal stem cells responsible for continuous corneal epithelium renewal; these can be affected after incisional or excisional biopsy at the corneoscleral limbus, which is the most frequent site of appearance of tumors in the stratified epithelium. Treatment for ocular surface squamous neoplasia has historically included surgery, but nonsurgical interventions have also been adopted. Hence, in certain cases, ophthalmologists may prefer interventions less invasive than surgical biopsy such as of impression cytology for both initial diagnosis and therapeutic monitoring of treatment for ocular surface lesions. Nevertheless, it should be considered that IC may be less helpful if the results conflict with the clinical picture or if the clinical diagnosis is uncertain and results are negative. In such cases, surgical biopsy is required for accurate diagnosis. The purpose of this review is to examine the published literature on the utilization of IC for the diagnosis and management of ocular surface tumors and to discuss the requirement for further investigation on the subject.

Sebaceous carcinoma of the eyelid - different diagnostic times, different outcomes: case reports

Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6%. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.

Indications for eye removal over a 13-year period at an ophthalmology referral center in São Paulo, Brazil

Purpose: To analyze the indications and types of eye removal at Latin Americas highest-volume ophthalmic reference center in São Paulo, Brazil. Methods: A retrospective analysis was conducted of surgical pathological reports in the electronic database of the Ophthalmology Department of the Universidade Federal de São Paulo Hospital of patients who underwent eye-removal procedures between January 2000 and December 2012. Results: A total of 412 cases met the inclusion criteria for this study. The most common indications for eye removal were ocular melanoma and retinoblastoma, representing 35.4% and 31.1% of the total cases, respectively. Other frequent indications included endophthalmitis (6.3%), nonspecific inflammation (4.1%), squamous cell carcinoma (3.6%), panophthalmitis (3.4%), and phthisis bulbi (1.2%). The remaining indications accounted for 14.8% of all cases, with each accounting for <1% of the total cases. Enucleation was the most common eye-removal procedure seen in our study. Conclusions: The two most common indications for eye removal were ocular melanoma and retinoblastoma. Alternative treatment options are effective in limiting the need for eye removal but are constrained by our public centers so cioeconomic context.