Pathological uptake and outcomes of ocular surface tumours in an ophthalmic subspecialty hospital in southeast Nigeria

Abstract

Introduction: The ocular surface interacts with the tear film to create a smooth refractive surface for clarity of vision1. Tumours of the ocular surface have the potential for malignant destruction of the globe, loss of vision and potential loss of life. They may be managed medically, using steroids or chemotherapeutic agents2. The gold standard for treatment is surgical excision 3,4 using the Shields no-touch technique5 with advantage of tissue for histopathological diagnosis and cure.

Objective: To assess the uptake and outcomes of histopathology for ocular surface biopsies in a tertiary eyecare centre in Nigeria.

Methods: We retrieved the data of all patients who underwent surgery at a tertiary eyecare centre (The Eye Specialists Hospital (TESH)) in Enugu, from 2011 to 2022. Oculoplastic surgeries were extracted and ocular surface procedures were analysed using Microsoft Excel version 2402.

Results: A total of 3181 surgeries were performed during the 12-year study period. There were 212 Oculoplasty cases with 23 ocular surface
procedures and 20 were tumour excisions. Histopathology was available for only 45 % (9) of biopsies performed. There were 11 males (55%)
with age range from 24 to 85 years and the mean age was 50 years. The clinical diagnoses of 84 tumours and the availability of histopathological reports are displayed in Table 1.The specific histopathologic outcomes of the nine biopsies are presented in Table 2.
Pyogenic granulomas excised by 6 different surgeons, had no histopathological diagnosis. Cystic conjunctival masses, excised by 3 different
surgeons, had no pathology reports. Files could not be traced for 2 biopsy patients. The maximum follow-up period was 6 years with no recurrence reported, while some patients never showed up after surgery.

Discussion: Histopathology was malignant in 55%. Clinical diagnosis of a benign condition appears to be a deterrent to ordering a
histopathological evaluation of the excised sample in this series. However, the possibility of clinical masquerade syndromess should discourage this trend because valuable academic data as a basis for policy-making is lost. Gichuhi et al 6 reported that OSSN couldn’t be distinguished from benign lesions by clinical features alone. There was 100% histopathological uptake with clinical suspicion of a malignancy.

Conclusion: Histopathological uptake was 100% for suspicious masses or malignant tumours but should be mandatory for all human biopsies.