Unusual Ocular Surface Squamous Neoplasia (OSSN) – Challenges

Dr. Rama Rajagopal, Dr. Geetha Iyer, Dr. Prema Padmanabhan, Dr. Krishna Kumar, Dr. Veena, Dr. Sumana Chatterjee

Purpose: OSSN is a rare clinical entity which typically presents as a limbal mass. We report 3 patients who presented to a tertiary care centre with unusual findings of OSSN.

Materials & Methods: Case1: A 62 year old female presented with diffuse pigmented lesion resembling a conjunctival melanoma involving tarsus and palpebral conjunctiva medially upto the caruncle. MRI did not show intraocular or orbital involvement. Histopathology revealed squamous dysplasia.

Case 2: A 12 year old girl with Xeroderma pigmentosa who presented with conjunctival OSSN was suspected to have medial rectus infiltration intraoperatively. MRI was suggestive of a single muscle involvement. Patient underwent myectomy with scleral patch graft. Histopathology confirmed squamous carcinoma infiltrating the muscle insertion with free margins at the cut end.

Case 3: A 48 year old HIV positive male presented with large diffuse infiltrating mass involving the conjunctiva and radiological evidence of orbital involvement. Patient underwent a modified lid sparing exenteration and histopathology confirmed squamous cell carcinoma involving orbit.

Conclusion: This series highlights rare clinical variants of OSSN and complementary role of imaging studies and histopathological analysis in managing OSSN effectively. It would be worthwhile considering varied presentation of OSSN in a conjunctival mass lesion.