Search tips
Search criteria 


Logo of brjopthalBritish Journal of OphthalmologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Br J Ophthalmol. 1997 November; 81(11): 1001–1005.
PMCID: PMC1722040

Adenoid squamous carcinoma of the conjunctiva—a clinicopathological study of 14 cases


AIMS—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.
METHODS—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.
RESULTS—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.
CONCLUSION—The study demonstrates that adenoid SCC of the conjunctiva often presents with inflammatory signs. The tumour is locally aggressive and may metastasise 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.

Figure 1
Clinical photograph of the eye of a 62-year-old man with irritated superior bulbar conjunctival mass (case 8).
Figure 2
Note pseudoglandular pattern due to acantholysis of the neoplastic squamous cells.
Figure 3
Island of tumour cells show extracellular Alcian blue positive substance that was digested by pretreatment with hyaluronidase (not shown) and consistent with hyaluronic acid.
Figure 4
Electron micrograph of tumour cells from Figure 1 shows surface epithelial cells with microvillous processes.
Figure 5
Electron micrograph of tumour cells from Figure 1 shows intracytoplasmic short collagen fibrils and desmosomal connections are present. There are no intracytoplasmic vacuoles.

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group