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Dysplastic changes seen in some pterygium specimens of patients living in low UV index areas
In a geographic area with low ultraviolet light index, the frequency of epithelial neoplasia seen in excised pterygium specimens was higher than expected, according to a Canadian study. The rate was 2.33%.
Of 215 pterygium specimens received at the Henry C. Witelson Ocular Pathology Laboratory, McGill University, Montreal, ocular surface squamous neoplasia was identified in five. Four patients were women and one was a man, and age did not appear to influence the results.
All five lesions were classified according to the Armed Forces Institute of Pathology recommendations. Conjunctival intraepithelial neoplasia I was seen in three cases, and conjunctival intraepithelial neoplasia II and III were seen in one case each.
“Our frequency rates were close to rates reported in Sydney and even higher than in Florida, regions that are known to have higher yearly exposures to UV rays than Montreal,” the authors wrote, postulating that the relatively high rate might be attributed, in part, to light reflection off snow late into spring.
All cases were identified in primary lesions and not in recurrent pterygia, which may be seen in up to 89% of cases after treatment, according to the researchers. The authors suggested that all pterygium samples be sent for pathologic workup because risk factors for pterygium and ocular surface squamous neoplasia are similar. – by Kate Sherrer
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Both conjunctival pterygium and ocular surface squamous neoplasia (OSSN) are believed to be related to chronic sunlight exposure as well as other factors. In this analysis from Montreal, Quebec, a region with low ultraviolet light exposure, the authors studied the shared incidence of both conditions from a pathology laboratory. Of 215 specimens demonstrating pterygium, there were five cases (2%) with additional OSSN, all of which proved to be intraepithelial neoplasia, mostly with mild features. The rate of OSSN is somewhat higher than anticipated, perhaps related to light reflectance off snow or a subset of patients who might frequently travel to sun-laden regions, or even representing immunosuppressed patients. The causes of OSSN are many, including sun exposure, immune suppression, cigarette smoking, eczema and others. Complete history taking could shed light on the true cause. Nevertheless, the authors’ point regarding histopathologic examination of all cases of pterygium is important as they have shown that a small portion could harbor subclinical malignancy.
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Zoroquiain P, et al. Saudi J Ophthalmol. 2016;doi:10.1016/j.sjopt.2016.02.007.