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  Table of Contents  
Year : 2014  |  Volume : 51  |  Issue : 3  |  Page : 245-246

Solar elastosis in conjunctival squamous cell neoplasm

1 Department of Pathology, College of Allied Health Sciences, Assam Down Town University, Panikhaiti, India
2 Department of Chemistry, Assam Down Town University, Panikhaiti, India

Date of Web Publication10-Dec-2014

Correspondence Address:
A C Deka
Department of Pathology, College of Allied Health Sciences, Assam Down Town University, Panikhaiti
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.146748

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 » Abstract 

Aim: To study the role of solar elastosis in the patient's with Conjunctival Squamous Cell Neoplasia (CSCN). Materials and Methods: Paraffin embedded 30 Conjunctival Squamous Cell Neoplasia tissues were studied for the presence of solar elastosis by Verhoeff's stain. Nineteen Squamous Cell Carcinoma (SCC), 6 Carcinoma In Situ (CIS) and 5 Conjunctival Intraepithelial Neoplasia (CIN) specimens were included in the study. Disease free conjunctiva and pterygium tissues were used as negative and positive control respectively. Results: Solar elastosis was found to be present in 19 of 30 (63.3%) Conjunctival Squamous Cell neoplasia specimens. Conclusion: Our study showed the presence of solar elastosis in conjunctival squamous cell neoplasia. Poor socioeconomic condition is an important factor as most of the elastosis positive patients were farmers.

Keywords: Neoplasms, solar elastosis, squamous cell carcinoma, Verhoeff′s stain

How to cite this article:
Deka A C, Dutta A M, Sarma P C, Baruah K C. Solar elastosis in conjunctival squamous cell neoplasm. Indian J Cancer 2014;51:245-6

How to cite this URL:
Deka A C, Dutta A M, Sarma P C, Baruah K C. Solar elastosis in conjunctival squamous cell neoplasm. Indian J Cancer [serial online] 2014 [cited 2021 Jan 21];51:245-6. Available from:

 » Introduction Top

Conjunctival squamous cell neoplasia is the most common malignant tumor of the ocular surface. [1],[2] The disease is prevalent in tropical areas. The disease severity varies from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma.

Global Burden of Disease of Solar Ultraviolet Radiation estimates that up to 60,000 deaths a year worldwide are caused by too much exposure to ultraviolet radiation (UVR). Squamous cell carcinoma of cornea or conjunctiva is one of the 9 global diseases caused by excessive UVR exposure as assessed by WHO. [3] So, far the cause of the Squamous Cell Neoplasia of the cornea or conjunctiva is not adequately understood. There have been a number of investigations on the relation between the tumor and several factors, including solar exposure [4],[5],[6] and human papilloma virus (HPV). [7],[8] The aim of the present study is to detect solar elastosis in CSCN.

 » Materials and Methods Top

A total of 30 specimens of conjunctival squamous cell neoplasia were randomly selected for the study. Among 30 specimens, there were 19 squamous cell carcinoma, 6 carcinoma in situ and 5 conjunctival intraepithelial neoplasia tissue. Archival paraffin blocks were obtained from histopathology Laboratory of down town laboratory, Guwahati, Assam, India. Four μm sections were cut from each and stained with hematoxylin-eosin and examined for the confirmation of the diagnosis.

Negative Controls were disease free Conjunctiva and Pterygium tissues were used as positive control. All the tissues were fixed in 10% neutral buffered formalin, processed routinely and embedded in paraffin wax. Conjunctival sun exposure has been demonstrated by solar elastosis in the substantia propria [9] by applying the elastic stain (Merck, Germany) using Verhoeff's technique, [10] the abnormal pseudoelastic material in the substantia propria appears as dark brown wavy stripes. Socioeconomic condition of the patients was also studied. Twenty four patients were farmers by occupation and 6 patients were in other services.

 » Results Top

A total of 30 tissue specimens diagnosed as having conjunctival neoplasms in our hospital were studied out of which 20 were males and 10 were females with mean age of 53.7 years ranging from 12 years to 87 years.

Nineteen specimens (63.3%) were found positive out of 30 Conjunctival Squamous Cell Neoplasm specimens. Twelve (40%) squamous cell carcinoma specimens 5 (16.6%) Carcinoma In Situ and 2 (6.6%) conjunctival intraepithelial neoplasia were found to be positive for solar elastosis [Figure 1]. Among 19 SCC, 3 specimens were invasive SCC and all these three specimens were found to be positive for elastic fibers. Positive control, pterygium tissues were found to be positive and disease free conjunctiva was negative for elastic stain. Each set of Verhoeff's stain was done using one positive control and one negative control slide. [Figure 2] shows the positivity of elastic stain from Conjunctival Squamous Cell Neoplasm. Twenty four tissue specimens were from patients who were, professionally farmer, and 6 from Govt. Service holder. Sixteen (66.6%) of the 24 patients of the group of farmers were found to be positive, 3 (50%) of the 6 of other group patients were found to be positive for elastic stain.
Figure 1: Total number of various Conjunctival Squamous Cell Neoplasms with the number of Verhoeff positive specimens. Series 1: Number of various specimens. Series 2: Number positive specimens for elastic fibers

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Figure 2: Positive stain for elastic fiber (black colour fiber against pink and yellowish background

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 » Discussion Top

Conjunctival Squamous Cell Neoplasia is a serious problem with a high impact on public health owing to its relatively high prevalence and the potential to cause severe disability. We conducted a study to find the association of sun exposure and the neoplasm.

In our study, solar elastosis was detected in 63.3% of Conjunctival squamous neoplasm (19/30). Among them 12 (40%) Conjunctival Squamous Cell Carcinoma, 5 (16.6%) Conjunctival intraepithelial neoplasia and 2 (6.6%) were Carcinoma in situ.

Solar exposure has been observed to cause epithelial malignancy. Newton et al. [4] related the prevalence of this malignancy to tropical location of the patient dwellings. Sun et al. [5] found an association between ultraviolet exposure and the prevalence of squamous cell neoplasia of the conjunctiva and the eyelids. Lee et al. [11] found a relation of sun exposure to squamous cell dysplasia in a case-control study. Our results are consistent with those of previous studies. [4],[5],[6],[11] We have observed more solar elastosis in the patients belonging to farmer group. It could be due to excessive exposure to sun light during cultivation and other field work. Various factors have been shown to be associated with Conjunctival Squamous Cell Neoplasm, including actinic exposure, [12] human papilloma virus infection (HPV), [12],[13],[14],[15] cigarette smoking, petroleum product, light hair, European ancestry, and chronic wear of contact lens and sunlight exposure. [16] Sunlight particularly ultra-violate-B (UV-B) radiation causes DNA damage, mutations, and cancerous cells. Individuals who are HIV positive [16] and patients with xeroderma pigmentosa [17] are more likely to develop Squamous Cell Carcinoma of Conjunctiva probably because of their diminish immune response. Thus, it appears that solar elastosis of the conjunctiva alone does not lead to the development of conjunctival epithelial neoplasia and there must be other factors, as discussed earlier, that plays a role. Our study shows the association of solar elastosis in Conjunctival Squamous Cell Neoplasm. Further studies are needed to understand the roles of solar elastosis in developing Conjunctival Carcinomas.

 » Acknowledgment Top

Support from down town Charity Trust.

 » References Top

McLean IW, Burnier MN, Zimmerman LE, F.A. Jacobiec. Tumours of the conjunctiva. In: tumour of the eye and ocular adnexa. Washington DC: Third series. Fascicle 12; 1994. p. 50-2.  Back to cited text no. 1
Grossniklaus HE, Green WR, Luckenbach M, Chann CC. Conjunctival lesion in adults. A clinical and histopathological review. Cornea 1987;6:78-116.  Back to cited text no. 2
Babichan K Chandy. WHO-Facts Sheet. Kuwait Medical Journal 2006; 38:254-8.  Back to cited text no. 3
Newton R, Ferlay J, Reeves G, Beral V, Parkin DM. effect of ambient solar ultraviolet radiation on incidence of squamous cell carcinoma of the eye. Lancet 1996;347:1450-1.  Back to cited text no. 4
Sun EC, Fears TR, Goedert JJ. Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev 1997;6:73-7.  Back to cited text no. 5
Tulvatana W, Bhattarakosol P, Sansopha L, Sipiyarak W, Kowitdamrong E, Paisuntornsug T, et al. Risk factor for Conjunctival squamous cell neoplasia: A matched case control study. Br J Ophthalmol 2003;87:396-8.  Back to cited text no. 6
Nakamura Y, Mashima Y, Kameyama K Mukai M, Oguchi Y. Detection of human papilloma virus infection in squamous tumours of the conjunctiva and lacrimal sac by immunohistochemistry, in situ hybridization and polymerase chain reaction. Br J Opthalmol 1997;81:308-13.  Back to cited text no. 7
Tabrizi SN, McCurrach FE, Drewe RH, Borg AJ, Garland SM, Taylor HR. Human papilloma virus in corneal and conjunctival carcinomas. Aust N Z J Opthalmol 1997;25:211-5.  Back to cited text no. 8
Spencer WH. Conjunctiva degenerations. Ophthalmic Pathology: An atlas and text book. 4 th ed. Philadelphia: Saunders; 1996. p. 101-5.  Back to cited text no. 9
John D Bancroft, Marilyan Gamble. Theory and practice of Histological Techniques. 5 th ed. Churchill Livingstone; 2002. p. 155-6.  Back to cited text no. 10
Lee GA, Williams G, Hirst LW, Green AC. Risk factors in the development of ocular surface epithelial Dysplasia. Ophthalmology 1994;101:360-4.  Back to cited text no. 11
Tuppurainen K, Raninen A, Kosunen O, Kankkunen JP, Kellokoski J, Syrjänen S, et al. squamous cell carcinoma of the conjunctiva: Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction. Acta Ophthalmol (Copenh) 1992:70:148-254.  Back to cited text no. 12
McDonnell JM, Malter JS, Meier JR. DNA of Human Papilloma virus type 16 in dysplastic and malignant lesions of the conjunctiva and cornea. N Engl J Med 1989;320:1442-6.  Back to cited text no. 13
Lauer SA, Malter JS, Meier JR. Human Papilloma Virus type 18 in conjunctival intraepithelial neoplasia. Am J Ophthalmol 1990;110:23-7.  Back to cited text no. 14
Taros SN, McCurrach FE, Drewe RH, Borg AJ, Garland SM, Taylor HR. Human papillomavirus in corneal and conjunctival carcinoma. Aust N Z J Ophthalmol 1997;25:211-5.  Back to cited text no. 15
Newton R, Ziegler J, Beral V, Mbidde E, Carpenter L, Wabinga H, et al. A case-control study of human immunodeficiency virus infection and cancer in adults and children residing in Kampala, Uganda. Int J Cancer 2001;92:622-7.  Back to cited text no. 16
Goyal JL, Rao VA, Srinivasan R, Agarwal K. Oculocutaneous manifestations in xeroderma pigmentosa. Br J Ophthalmol 1994;78:295-7.  Back to cited text no. 17


  [Figure 1], [Figure 2]


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