A clinicopathological study of ophthalmic lesions in Indore--A review of 250 cases.
Ophthalmic lesions (OL) more precisely, orbital and ocular tumors or tumor-like lesions require surgical treatment mostly; hence, a correct pre-operative provisional diagnosis followed by series of investigations and clinical examination and confirmation of the same by doing histopathological and cytological examination of the specimen plays an enormous role in treating both benign and malignant ocular and orbital lesions in patient care.  Tumors of the eye and ocular adnexa comprise a small percentage of the total malignancies diagnosed and treated yearly. 
The impartial of the ophthalmic pathology service is to enhance communication between the ophthalmic surgeon and the pathology laboratories and to provide detailed histopathological information that can be correlated with patient history and other clinical data. In this way, continuously histopathological studies have the greatest benefit to ongoing patient care. [3,4] Therefore, objectives of this study were to study the morphological and clinicopathological correlation of OL, to know the pattern of prevalence of OL in hospital, and to compare the data and other investigations for enhance the management of OL.
MATERIALS AND METHODS
This retrospective and prospective study was conducted in the Department of Pathology, MGM Medical College, Indore during period of 2015 and 2016, and the past year cases of 2014 were also be consider to compare the present OL in M. Y. Hospital, Indore. Prior permission form ethical committee of the hospital was taken. Informed consent was taken from all the study patients. In all cases, patient clinical history and other laboratory investigations were recorded in pro forma. The specimens were obtained from 250 patients, which are inflammatory, infective, benign, and malignant. Included all cases for fine-needle aspiration cytology reference and histopathological to correlation with retrospective aspect.
The surgically resected specimens fixed in the 10% formalin were received. Thorough gross examination of each mass for its size, shape, and consistency was done. Several representative areas of tissue were taken from received surgical specimen and subjected to routine paraffin embedding. Four to five sections 2-3 mm thick were taken from different areas of specimen and processed in automatic tissue processor. Blocks were prepared with the help of leuckhart's piece. After trimming of blocks, sections 5-7 um thick were cut with help of rotatory microtome. Sections were floated on water at temperature of 45 degree and were taken on albuminized slides. The sections were stained by hematoxylin and eosin stain in all cases. Patient care and further management were planned accordingly. All positive and relevant findings of study individuals were entered in a specially designed pro forma and analyzed using statistically and Microsoft office Excel; then, the results was interpreted.
Totally 250 cases of OL were observed. It was found that OL were highest (56.4%) in 21-30 year age group and lowest (1.6%) in the age group 0-11. Sexwise, there was not much difference as lesions were found in 46% of females and 54% of males (Table 1). From malignancy point of view, lesions were benign in 51.6% of cases and malignant in 25.2% of cases, and remaining lesions are comes under infective, inflammatory, and others (for those no definitive opinion was possible).
Locationwise, conjunctiva (66.8%) was the most commonly involved site followed by eyelid (20.8%) and lacrimal gland (3.2%) (Table 2). The basal cell carcinoma palisading arrangement of basaloid cell at periphery, squamous cell carcinoma (SCC) intercellular bridging or keratinization, malignant melanoma of large pleomorphic diffuse infiltration of large pleomorphic epithelioid tumor cell with melanin pigment and mucoepidermoid carcinoma sheets of mucous, squamous, and intermediate cells were found in Figure 1.
Among 63 malignant cases shows slightly female predominance whereas among 118 nonmalignant cases predominantly affected population were males. Among 250 cases in 216 cases, we were able to establish management approach whereas in 34 cases, for those, we were not able to make definite diagnosis and not able to establish management approach (Table 3).
The present study showed that maximum number of cases was benign (61.2%) including infective and inflammatory lesions. While 25.2% of cases were malignant, 13.6% of cases come under category in which no definite opinion was possible. Hence, malignant lesions were 25.2% and nonmalignant were 74.8%. Similar findings were also observed in 110 cases, 38.2% of cases were malignant, and 62.8% were nonmalignant,  and in 100 cases, benign lesions were 70% while malignant lesions were 30%. 
In the present study, out of a total, 115 OL found in females, 82 (43.9%) were nonmalignant and 33 (51.6%) were malignant. In the present study, 8 cases were lacrimal gland tumors, out of which 12.5% were benign while 87.5% were malignant. According to the present study, most patients with benign OL were in the third decade of life, and malignant lesions are also more common in the third decade. According to the present study, OL are more common in males (54.0%) than females (46.0%). In the present study, most common eyelid lesion is epidermal inclusion cyst-18 (34.6%) followed by basal cell carcinoma-5 (9.6%) and SCC-5 (9.6%), lipoma-3 (5.7%), dermoid-2, and nevus-2 (3.8%). Among eyelid malignancy, the present study found 41.7% basal cell carcinoma and 38.4% SCC. The study carried out by Bastola et al. found 38.4% sebaceous (meibomian) carcinoma and 33.3% basal cell carcinoma,  and Jahagirdar et al. were observed 37% sebaceous (meibomian) carcinoma and 44% basal cell carcinoma.  Thakur et al.  reported 51.2% of males and 48.8% of females while Sunderraj  observed 56% of males and 44% of females. Frequency among children was 18% in the present study while Anbessa et al.  found it 20% which was almost similar to this study. Frequency of retinoblastoma in our study was 27.5% which were less compared to other study (39%).  Clinical accuracy was decided on the basis where clinical diagnosis matches with histopathological diagnosis. In the study of Obata et al.,  most common benign lesion was intradermal nevus (13%) while in our study, the most common benign lesion were granuloma pyogenicum (22.5%) followed by intradermal nevus (4.5%). In the study of Obata et al.  most common malignant lesion was malignant lymphoma (9%) while in our study, the most common malignant lesion was SCC (22.5%). Among eyelid malignancy, the present study found 41.7% sebaceous (meibomian) carcinoma and 33.3% basal cell carcinoma.  In summary, we can conclude that all OL removed surgically should always be subjected to histopathological examination to establish correct diagnosis for further management.
In summary, we can conclude that all OL detached surgically should always be subjected to histopathological analysis to establish accurate diagnosis for further management.
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We sincerely appreciate the management and all staff in Department of Pathology, MGM Medical College, Indore where we conduct this study.
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Shikha Ghanghoria, Amrita Tripathi, Kulkarni C V, Rakesh Mehar, Sachin Sharma, Pankaj Shinde
Department of Pathology, MGM Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
Correspondence to: Amrita Tripathi, E-mail: email@example.com
Received: May 04, 2017; Accepted: June 29, 2017
Caption: Figure 1: Histopathological finding of different malignant lesion of the eye. (a) Basal cell carcinoma (H and E, high power view), (b) squamous cell carcinoma (H and E, low power view), (c) malignant melanoma (H and E, low power view), (d) Mucoepidermoid carcinoma (H and E, low power view)
Table 1: Age- and sex-wise distribution of cases in the study group Parameters Number of cases (%) Age groups (years) 0-10 04 (1.6) 11-20 33 (13.2) 21-30 141 (56.4) 31-40 36 (14.4) 41-50 12 (4.8) 51-60 13 (5.2) 61-70 06 (2.4) 71-80 05 (2.0) Gender Male 135(54) Female 115(46) Table 2: Distribution of behavior- and location-wise of reported cases of OL Lesions Number of cases (%) Behavior Infective 07 (2.8) Inflammatory 17 (6.8) Benign 129 (51.6) Malignant 63 (25.2) Others 34 (13.6) Location Cornea 07 (2.8) Conjunctiva 167 (66.8) Iris 01 (0.4) Eyelid 52 (20.8) Lacrimal gland 08 (3.2) Lacrimal sac 05 (2.0) Orbit 05 (2.0) Others 05 (2.0) Table 3: Frequency of various ophthalmic lesion of eye and adnexa and their management Lesion Number Diagnoses of cases FNAC Imprint Biopsy Dermoid cyst eyelid 2 2 Epidermal inclusion cyst 18 6 12 Nevus 2 2 Hemangioma 1 Nil Fibroma 1 1 Eccrine spiradenoma 1 1 Trichoepithelioma 1 1 Sebaceous gland carcinoma 1 1 Basal cell carcinoma 5 5 Malignant melanoma 1 1 Chalazion 1 Nil Lipoma 3 3 Verrucous hyperplasia 1 1 Neurofibroma 1 1 Molluscum contagiosum 2 1 SCC eyelid 5 3 2 Poorly different carcinoma 1 1 Inclusion cyst conjunctival 2 Nil Dermoid cyst conjunctival 2 2 Lipoma, conjunctival 2 2 Squamous papilloma 1 1 SCC conjunctiva 3 1 2 Mild dysplasia 26 26 Moderate dysplasia 9 9 Severe dysplasia 5 5 Inflammatory, infective 7 1 3 3 Mucocele lacrimal sac 2 1 1 Inflammatory, lacrimal sac 3 3 Pleomorphic adenoma 1 1 Mucoepidermoid carcinoma 3 1 2 Adenoid cystic carcinoma 2 2 Poorly different 2 2 carcinoma, lacrimal gland Iris cyst 1 1 Spindle cell tumor, orbit 1 1 Schwannoma, orbit 1 1 Orbital dermoid 1 1 Inflammatory orbital lesion 5 2 3 Normal squamous epithelium 84 84 Cornea 7 7 Total 216 24 128 61 Lesion Confirmation Management on histopathology Dermoid cyst eyelid 2 Excision Epidermal inclusion cyst 12 Excision Nevus 2 Laser Hemangioma 1 Topical treatment Fibroma 1 En bloc excision Eccrine spiradenoma Not done Excision Trichoepithelioma Not done Excision Sebaceous gland carcinoma 1 Wide excision, lymph node dissection, and postop radio Basal cell carcinoma 3 Wide excision Malignant melanoma 1 Wide excision Chalazion 1 Excision Lipoma Not done Excision Verrucous hyperplasia 1 Shave excision Neurofibroma 1 Excision Molluscum contagiosum 1 Cryotherapy SCC eyelid 4 Surgical extirpation with radio and cryotherapy Poorly different carcinoma Not done Radio/chemotherapy Inclusion cyst conjunctival 2 Thermal curettage Dermoid cyst conjunctival 2 Excision Lipoma, conjunctival 2 Excision Squamous papilloma 1 Cryotherapy SCC conjunctiva 3 Photo dynamic therapy Mild dysplasia Not done Palliative therapy Moderate dysplasia Not done Palliative therapy Severe dysplasia Not done Photo dynamic therapy Inflammatory, infective 5 Antibiotic, antifungal Mucocele lacrimal sac 2 Microsurgical drainage Inflammatory, lacrimal sac 3 Antibiotic, surgery Pleomorphic adenoma Not done Excision Mucoepidermoid carcinoma 3 Surgical exenteration followed by radical excision Adenoid cystic carcinoma 2 Surgical exenteration with radio, chemotherapy Poorly different Not done Radio/chemotherapy carcinoma, lacrimal gland Iris cyst Not done Drainage Spindle cell tumor, orbit 1 Excision Schwannoma, orbit 1 Excision Orbital dermoid 1 Excision Inflammatory orbital lesion 3 Antibiotics, steroids Normal squamous epithelium Not done Nil Cornea 7 Keratoplasty Total 69 FNAC: Fine-needle aspiration cytology, SCC: Squamous cell carcinoma
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|Title Annotation:||Research Article|
|Author:||Ghanghoria, Shikha; Tripathi, Amrita; Kulkarni, C.V.; Mehar, Rakesh; Sharma, Sachin; Shinde, Pankaj|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Sep 1, 2017|
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