Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, 243 Charles St. Suite 328, Boston, MA, 02114, USA.
Head Neck Pathol. 2024 Oct 14;18(1):94. doi: 10.1007/s12105-024-01701-x.
Radiation therapy is a treatment modality for various ocular and ocular adnexal tumors. The histopathology of chronic radiation dermatitis has been well-described. The authors present two cases demonstrating and characterizing "chronic radiation conjunctivitis" which has not been histopathologically illustrated in detail.
Retrospective case review of two patients who received proton beam irradiation for an anterior uveal melanoma and external beam radiation for conjunctival lymphoma, and developed leukoplakia and/or thickening of the eyelid margin and symblepharon. Hematoxylin and eosin-stained sections of eyelid margin and conjunctival biopsies as well as clinical histories were reviewed.
Conjunctival biopsies in both cases revealed squamous epithelial metaplasia, chronic inflammation and bizarre-appearing stromal cells with hyperchromatic nuclei in a fibrotic/sclerotic stroma, consistent with chronic radiation conjunctivitis. These stromal cells are believed to be the same "radiation fibroblasts" described in chronic radiation dermatitis.
The radiation fibroblast is characteristic for the diagnosis of chronic radiation conjunctivitis, as it is in radiation dermatitis. Features of squamous metaplasia of conjunctival epithelium, keratinization, subepithelial fibrosis/sclerosis and chronic inflammation are frequently found but not specific. A detailed history and other ancillary tests help differentiate cicatrizing conjunctival conditions, and biopsy should be performed in the setting of suspicion for a secondary malignancy.
放射治疗是治疗各种眼部和眼附属器肿瘤的一种方法。慢性放射性皮炎的组织病理学已有详细描述。作者介绍了两例表现和特征为“慢性放射性结膜炎”的病例，该疾病尚未在组织病理学上详细说明。
回顾性分析两名患者的病例，他们因前葡萄膜黑色素瘤接受质子束放射治疗，因结膜淋巴瘤接受外部束放射治疗，随后出现了结膜的白色斑块和/或眼睑边缘增厚和睑球粘连。检查了眼睑边缘和结膜活检的苏木精和伊红染色切片以及临床病史。
这两个病例的结膜活检均显示鳞状上皮化生、慢性炎症和在纤维化/硬化基质中有奇异外观的基质细胞，伴有深染核，符合慢性放射性结膜炎。这些基质细胞被认为与慢性放射性皮炎中的“放射性成纤维细胞”相同。
如同在放射性皮炎中一样，放射性成纤维细胞是诊断慢性放射性结膜炎的特征。结膜上皮的鳞状化生、角化、上皮下纤维化/硬化和慢性炎症等特征很常见，但不具有特异性。详细的病史和其他辅助检查有助于区分瘢痕性结膜炎，并且在怀疑发生继发性恶性肿瘤时应进行活检。
