Clinico-tomographic-pathological correlation in nodulo-ulcerative ocular surface squamous neoplasia: a study of 16 cases.

OBJECTIVE

To describe the anterior segment optical coherence tomography (ASOCT) features of nodulo-ulcerative ocular surface squamous neoplasia (nuOSSN) and correlate these findings with histopathology.

METHODS

Retrospective study of 16 eyes with nuOSSN with clinical images, ASOCT scans, and histopathology.

RESULTS

The mean age at presentation was 55 years (median, 58 years; range, 25 to 81 years). Systemic predisposing factors included human immunodeficiency virus infection (n = 2, 13%) patients and xeroderma pigmentosum (n = 1, 6%). Bulbar conjunctiva was the most common epicenter (n = 10, 63%), with limbal and corneal extension seen in 16 (100%) and 14 (88%) eyes. In addition to epithelial thickening, typical of OSSN, scleral thinning, limbal thinning, and corneal thinning were seen in 5 (31%), 10 (63%), and 7 (44%) eyes of nuOSSN, respectively. Corneal stromal opacification with normal overlying epithelium was seen in 10 (63%) cases, corresponding to the 'wedge sign' on ASOCT in all 10 cases. This corresponded to stromal invasion of OSSN on histopathology in all eyes. The wedge sign had a sensitivity of 77%, specificity of 100%, positive predictive value of 100%, negative predictive value of 50%, and an accuracy of 81% for stromal invasion compared with the gold standard of histopathological examination.

CONCLUSION

The ASOCT features of nuOSSN differ from classic OSSN. nuOSSN is associated with adjacent areas of scleral/limbal/corneal thinning. Corneal stromal opacification is seen as a wedge sign on ASOCT and corresponds to corneal stromal tumor invasion on histopathology. Areas of scleral/limbal/corneal thinning, along with the 'wedge sign' on ASOCT, confirmed nuOSSN with stromal invasion in 63% of patients in this retrospective study.