| Abstract|| |
Ocular metastasis is considered a rare phenomenon. Metastatic spread of tumors in the eyeball is usually discovered only when it affects the visual acuity. In women, breast tumors are to known metastasize in and around the eyeball. Cervical carcinomas are rarely known to metastasize in the eyeball. We present here a rare case of ocular metastasis, diagnosed on fine-needle aspiration cytology, in a known case of squamous cell carcinoma of the cervix.
Keywords: Cervix, ocular metastasis, squamous cell carcinoma
|How to cite this article:|
Vedant D, Kaushal V, Gulati A. Cytological diagnosis of ocular metastasis of squamous cell carcinoma cervix. J Cytol 2021;38:171-3
| Introduction|| |
Tumor metastasis to the eye is a rare complication of carcinoma cervix. The anterior chamber is an extremely rare site for metastasis. There are only isolated case reports of ocular metastasis from squamous cell carcinoma (SCC) cervix. We describe here a patient of SCC cervix who presented with pain and impaired vision in the left eye and was found to have ocular metastasis in cytological smears 2 years after her primary disease was diagnosed. These findings were confirmed on histopathological examination.
| Case Report|| |
A 56-year-old female attended the ophthalmology outdoor department with complaints of impairment of vision in the left eye for the past 3 months. It was painful and gradually progressive. Two years back the patient had a hysterectomy for SCC cervix. She had received six cycles of chemotherapy followed by adjuvant radiotherapy. Her ocular examination showed a visual acuity of no light perception in the left eye. Slit-lamp examination showed multiple yellowish-white deposits over the iris and in the anterior chamber giving rise to acute narrow-angle glaucoma. The right eye had a visual acuity of 6/9 with normal color vision. Anterior chamber and vitreous paracentesis of the left eye was performed. Aqueous fluid was less than 1 mL in quantity, and it was a white gel-like substance on physical examination. Microscopic examination showed cellular smears consisting of scattered, isolated, and few small aggregates of pleomorphic tumor cells having hyperchromatic angulated nuclei, coarse chromatin, inconspicuous nucleoli, and basophilic cytoplasm. The background showed numerous degenerate and intact neutrophils along with debris [Figure 1].
|Figure 1: FNAC (fine-needle aspiration cytology) smear showing isolated neoplastic squamous cells in the background of neutrophils and debris. Giemsa 40×. Inset: A cluster of neoplastic squamous cells. Giemsa 10×|
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Vitreous tap was 0.2 mL hemorrhagic fluid. Microscopically, it showed paucicellular smears with tumor cells having similar morphology as that found in the aqueous fluid. Keeping in view the clinical details of the patient, possibility of metastatic squamous cell carcinoma was suggested.
Due to acute narrow-angle glaucoma and the patient developing endophthalmitis, the painful blind eye was enucleated.
Gross examination of the specimen of the eye showed yellowish-white opacity behind the cornea. On bisecting the eye, there was a gray-white nodular growth of size 3 mm in the anterior chamber of the eye, extending laterally to the ciliary body [Figure 2]. The aqueous and vitreous fluid were obtained from the specimen, which on microscopy showed neoplastic squamous cells and inflammatory cells. The sections from the eyeball showed nests and sheets of neoplastic squamous cells, lying anterior to the lens and separated by thin fibrocollagenous septa with interspersed melanin pigment. However, there was no pigment in the tumor cells. There was a cystic space lined by neoplastic squamous cells in the growth with acantholytic cells in the lumen. The growth was extending laterally to both the sides behind the ciliary body [Figure 3]. The wall of the eyeball showed acute inflammatory cells. The diagnosis of metastatic SCC was confirmed.
|Figure 2: Cut section of eyeball showing gray-white growth in the anterior chamber|
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|Figure 3: Photomicrograph showing nests of neoplastic squamous cells in the anterior chamber extending behind the ciliary body. Hematoxylin and Eosin 40×. Inset: Whole mount view of section from eyeball. H.E|
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| Discussion|| |
The first case of metastatic carcinoma in the eye was described by Perl in 1872. Since then various studies have been undertaken to estimate the incidence of ocular involvement by the tumors. Clinical and autopsy studies have shown that metastatic cancer is the most common intraocular neoplasms., In women, breast carcinoma is the most common malignancy giving rise to ocular metastasis., All other primary sites are relatively uncommon as sources of intraocluar metastasis.
Shields et al. in 1993 demonstrated the safety and reliability of transocular fine-needle aspiration cytology (FNAC) in the diagnosis of intraocular tumors in 159 cases. In his study, adequate cytological material was obtained in 88% of the cases with 100% sensitivity rate and 98% specificity rate.
Cervical carcinoma as the primary lesion has been reported in only one case, as uveal metastasis in one series of 227 patients of autopsy-proven carcinoma, and none in two other similar series.,
In the literature, there are only isolated case reports available regarding the orbital metastasis of carcinoma cervix.,, Das and McLellan have reported a case of metastatic squamous carcinoma to the anterior uvea. In our case, metastatic deposits were seen in the anterior chamber of the eye and extending in the posterior chamber.
Obtaining the material through fine-needle aspiration (FNA) is easy in the hands of a trained pathologist. Cytological material can be obtained from the eyeball by FNA without compromising the eyeball. Core biopsy from eyeball cannot be done without sacrificing the visual acuity. Here the usefulness of FNA greatly increases. This helps the surgeon in quickly deciding on the radial procedures such as enucleation.
| Conclusion|| |
Ocular metastasis should be considered as a possibility in SCC cervix patients presenting with ocular symptoms. This case illustrates the importance of FNAC in the diagnosis of ocular metastasis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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Das BN, McLellan DR. Metastatic squamous carcinoma to the anterior uvea: Clinicopathological report. J R Coll Surg Edinb 1990;35:312-4.
Dr. Deepak Vedant
Department of Pathology, I.G. Medical College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]