Clinicopathological Characteristics of Ocular Surface Squamous Neoplasia: A 10-Year Review form a Referral Tertiary Centre in Nigeria

Background: Ocular surface squamous neoplasia is a heterogenous group of proliferative squamous lesions on the ocular surface with varying biologic behaviours. This study aims to report the clinical profile and pathologic characteristics of cases of OSSN seen at a tertiary referral centre in North West NigeriaMethods: A retrospective review of all cases of OSSN diagnosed over a 10-year period was doneResults: OSSN accounted for 68 out of 91 ocular surface lesions affecting twice as many males as females and a peak incidence in the 30-39 years age group. They frequently presented as higher grade and higher stage lesions with invasive squamous cell carcinoma being the most frequently diagnosed OSSN. They also frequently show association with HIV infection and a relatively long duration of symptoms before presentationConclusion: OSSN occur in a relatively young age group in our environment. Certain clinical and epidemiological features appear to [predict the occurrence of higher grade lesions and this may help in the clinical prediction of likely pathologic grade and/or biologic behaviour of these lesions.

Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy

Background/aimTo evaluate the safety and efficacy of ruthenium-106 (Ru-106) plaque brachytherapy in managing invasive ocular surface squamous neoplasia (OSSN).MethodsThis is a retrospective, non-comparative, interventional case series of 42 eyes with OSSN with histopathologically-proven corneal stromal and/or scleral invasion that underwent Ru-106 plaque brachytherapy. Main outcome measures were tumour regression, eye salvage, final visual acuity, treatment complications and metastasis.ResultsAt presentation, the mean tumour basal diameter was 9.3 mm (range 5–26 mm) and thickness 3.1 mm (range 1.5–11 mm). Prior treatment included excision biopsy in two patients (5%), incision biopsy and topical interferon in one each (2%). Following excision with 4 mm clinically clear margins, corneal stromal and/or scleral invasion of OSSN was confirmed in all 42 cases, with the excised base showing invasive squamous cell carcinoma. A total dose of 5000 cGy over a mean duration of 19.7 hours (range 7–41 hours) was provided to an axial depth of 2 mm using Ru-106 surface plaque. Over a mean follow-up of 36.9 months (range 22.3–72 months), complete tumour regression was achieved in all eyes (100%). Two eyes (5%) showed conjunctival tumour growth remote from the site of prior treatment. Visual acuity was maintained at ≥20/200 in 35 eyes (83%), with a loss of >2 Snellen lines in 1 eye (2%). There was no evidence of regional lymph node or systemic metastasis.ConclusionHistopathology-guided use of Ru-106 surface plaque brachytherapy is a safe and an effective adjuvant therapy in the management of corneal stromal and/or scleral invasion of OSSN.

3D printed customised external cranial plate in a patient with syndrome of trephined: ‘a case report’

Background Syndrome of the trephined is a well-recognised phenomenon that occurs in patients following a craniectomy. It is associated with several symptoms, including headaches, motor impairments, cognitive disorders and reduced consciousness. Treatment for the syndrome usually involves replacing the skull defect. Case Study A 71-year-old male underwent a left-sided craniectomy after being diagnosed with biopsy-confirmed invasive squamous cell carcinoma with associated skull erosion. Subsequently, he developed a severe case of syndrome of the trephined (SoT,) resulting in having to lie flat to prevent the motor component of the Glasgow Coma Score (GCS) falling from M5/6 (E3/4 Vt M5/6) to M1 (E3/4 Vt M1) on sitting to 30 degrees. Unfortunately, due to ongoing chest sepsis and physical frailty, he was unable to undergo a cranioplasty. Therefore, to aid in clinical stabilisation, the treating physicians and clinical engineering teams designed and manufactured a prosthesis on-site, allowing rapid patient treatment. The prosthesis led to the patient being able to sit up to 30 degrees without the motor component of the GCS falling from M6 to M1 (E4 VT M6). Conclusion Clinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. Furthermore, we have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework.

Attitudes Among Dermatologists Regarding Actinic Keratosis Treatment Options

Actinic keratosis (AK) is a carcinoma in situ that may progress into an invasive squamous cell carcinoma and, previously, it has been considered as a pre-cancerous lesion. Its prevalence is increasing, and it has been estimated worldwide to range between 1% and 44% of the adult population. The main risk factors for AK are advanced age, fair skin phototype and cumulative sun exposure. Treatment of AK consists of lesion-directed treatment to target single lesions (i.e., cryotherapy, curettage, electrocoagulation, and laser therapy) or field therapy to treat multiple AKs (i.e., photodynamic therapy (PDT), 5- Fluorouracil (5-FU), diclofenac sodium (DIC), imiquimod (IMQ), ingenol mebutate (Ing Meb)). The choice of therapy depends on the number and localization of AKs, patient’s condition, and the patient's tolerability and compliance. In this survey we provided data from one hundred and ten Italian dermatologists regarding knowledge and attitude towards different therapeutic approaches specific for AK. In our study, we observed that the most frequent treatments for AK are cryotherapy and PDT while surgery and laser therapy are the less frequently utilized. The most frequent topical therapies utilized are DIC and IMQ 3.75% cream compared to IMQ 5% cream, Ing Meb, and 5-FU. Choice the correct treatment for AK can be challenging but the adherence to therapy plays a key role to obtain good results. Considering the high and progressive increase in incidence of AK, it is crucial to improve the knowledge of different therapeutic approaches among dermatologists.

Dermatoscopy of Facial Non-Pigmented Actinic Keratosis and Intraepidermal Carcinoma

Dermatoscopy improves the diagnostic accuracy of non-pigmented facial lesions, including actinic keratosis (AK) and intraepidermal carcinoma (IEC) and helps to differentiate them from common invasive malignancies such as basal cell carcinoma and invasive squamous cell carcinoma. The most common dermatoscopic features characterizing AK are background erythema/erythematous pseudonetwork, white follicular openings/targetoid hair follicles, surface scales, rosettes, fine, linear, wavy vessels, microerosions and sun-damaged surrounding skin. In comparison, the most common dermatoscopic features of IEC are background erythema, red starburst pattern, surface scale, dotted/glomerular vessels, hairpin vessels, microerosions/ulcerations and targetoid hair follicles. The practice of recognizing these features in dermatoscopic images is a useful tool in the armamentarium of a clinician examining skin lesions.

Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System

For every 100,000 women in the United States, eight new cervical cancer cases and two deaths are reported as per the most recent (2017) Center of Disease Control and Prevention statistics. Of all the gynecologic cancers (ovary, uterus, cervix, vagina, and vulva), only cervical cancer has a screening test. Cervical Pap test (or Pap smear) is the best screening method for cervical precancerous lesions and is best reported using a unified and a well-established reporting system like The Bethesda System. In this system, “Epithelial cell abnormality: Squamous” includes squamous intraepithelial lesion (SIL) category which encompasses a spectrum of squamous cell lesions starting from the precancerous lesions of low-grade SIL (LSIL) to high-grade SIL (HSIL), and ultimately invasive squamous cell carcinoma. However, depending on the qualitative and quantitative limitations with the specimen, some equivocal morphological features suggestive of squamous cell abnormality may fall under equivocal category: “Atypical Squamous Cells” (ASCs), which are subdivided into two categories; “Atypical Squamous Cells of Undetermined Significance” (ASC-US) or “Atypical Squamous Cells, HSIL cannot be excluded” (ASC-H), based on the suspected underlying lesion LSIL versus HSIL, respectively. This review provides the key cytologic features that distinguish Bethesda squamous categories from other important entities, using algorithmic approach and illustrations of common cytomorphologic patterns for clear identification of those entities in practice. The important mimickers which may be considered during the differential interpretation of SIL are discussed and presented here in a brief cytomorphologic review.

“A HISTOPATHOLOGICAL STUDY OF TUMORS OF ORAL CAVITY”

Background: The incidence of oral cavity neoplasms in the population has increased manifold over the years. Oral cancer is one of the common cancers in the world, common in India, and also in Bangladesh, Srilanka and Pakistan. Oral cancer is one of the few cancers, whose cause were known and hence it is possible to prevent. The real challenge in oral cancer lies in its prevention and early diagnosis. Objectives: 1.To study the morphological spectrum of neoplasms in oral cavity. 2.To study the age and gender incidence of various neoplasms. 3.To study the commonest sites of various neoplasms. 4.To evaluate or analyse the associated risk factors. Materials and methods: This is a prospective study of the cases attended to Government General Hospital, Vijayawada or Government Dental College Hospital Vijayawada, of oral cavity neoplasms. The biopsy of the tissues was carried out at the Department of Pathology, Siddhartha Medical College, Vijayawada. The study period was from June 2011 to August 2013 over a period of two years and three months. Results: The Study comprises a total of 74 surgical biopsies from oral cavity neoplasms received in the Department of Pathology, 52 of these were malignant lesions and 20 were benign tumour and 2 were premalignant conditions. The invasive squamous cell carcinoma was the most frequent histological type of oral cavity neoplasms. Among the oral cancers, peak age th th incidence was the 5 and 6 decade of life. There was signicant male preponderance. Tongue was the most common site involved. Smokeless tobacco consumption was the commonest associated habit which leads to malignancy. Conclusion:In thisa study we observed that among the oral cavity neoplasms, high incidence of carcinomas are seen, among these squamous cell carcinomas are predominant.