Mauriello J A, Abdelsalam A, McLean I W
Department of Ophthalmology, UMD-New Jersey Medical School, Newark 07103-2499, USA.
Br J Ophthalmol. 1997 Nov;81(11):1001-5. doi: 10.1136/bjo.81.11.1001.
In order to determine the clinicopathological features and optimum management of a series of patients with adenoid squamous cell carcinoma of the conjunctiva, all cases of squamous cell carcinoma (SCC) of the conjunctiva and cornea on file in the registry of the ophthalmic pathology at the Armed Forces Institute of Pathology were reviewed.
On histopathological examination, a predominant adenoid or pseudoglandular pattern due to islands of neoplastic squamous or epidermoid cells surrounded by acantholytic cells was necessary for inclusion in the study. Histochemical and transmission electron microscopic studies (TEM) were performed. Clinical features of all the patients were extracted from the charts.
The anatomical location of the 14 tumours was corneoscleral limbus (seven patients) and bulbar conjunctiva (seven patients). Eight patients presented with inflammatory signs and irritation (red eye, tearing, foreign body sensation), while six patients developed a slowly growing, painless mass. Histochemical and TEM studies showed extracellular hyaluronic acid and no intracellular mucin. Of the two patients initially treated by enucleation, one was free of disease after 2 years while the second patient had recurrence in the socket and died of brain metastases despite wide orbital excision and radiotherapy. All five patients with recurrent tumours initially had irritated red eyes and two required enucleation. One such patient, after orbital exenteration and radiotherapy, died of unrelated disease.
The study demonstrates that adenoid SCC of the conjunctiva often presents with inflammatory signs. The tumour is locally aggressive and may metastasize and should, therefore, be histopathologically differentiated from the less aggressive conventional squamous cell carcinoma. Optimum treatment includes wide excision with documented histological clear margins of resection on permanent sections and frequent follow up.
为了确定一系列结膜腺样鳞状细胞癌患者的临床病理特征及最佳治疗方法，我们回顾了武装部队病理研究所眼科病理登记处存档的所有结膜和角膜鳞状细胞癌（SCC）病例。
组织病理学检查时，肿瘤性鳞状或表皮样细胞岛被棘层松解细胞围绕，呈现出主要的腺样或假腺样模式，才纳入本研究。进行了组织化学和透射电子显微镜研究（TEM）。所有患者的临床特征均从病历中提取。
14例肿瘤的解剖位置为角巩膜缘（7例患者）和球结膜（7例患者）。8例患者出现炎症体征和刺激症状（眼红、流泪、异物感），而6例患者出现缓慢生长的无痛性肿块。组织化学和TEM研究显示细胞外透明质酸，无细胞内黏液。最初接受眼球摘除术的2例患者中，1例2年后无疾病复发，而另1例患者眼窝复发，尽管进行了广泛的眼眶切除和放疗，仍死于脑转移。所有5例复发肿瘤患者最初均有眼红伴刺激症状，2例需要眼球摘除术。其中1例患者在眼眶内容剜除术和放疗后死于无关疾病。
该研究表明，结膜腺样鳞状细胞癌常表现为炎症体征。该肿瘤具有局部侵袭性，可能发生转移，因此应在组织病理学上与侵袭性较小的传统鳞状细胞癌相鉴别。最佳治疗方法包括广泛切除，在永久切片上有记录的组织学切缘阴性，以及定期随访。
