|Year : 2014 | Volume
| Issue : 2 | Page : 60-64
A study of the histopathologic pattern of orbito-ocular disease in a tertiary Hospital in Nigeria
Nwafor Chukwuemeka Charles, Ekanem Victor James
Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||13-Jun-2014|
Nwafor Chukwuemeka Charles
Department of Pathology, University of Benin Teaching Hospital, Benin City
Background: Estimates by WHO show show thatthere are about 37 million blind people and 161 million people with visual impairment. About 90% of these people live in developing countries. The aim of this study is to review the histopathologic pattern of orbito-ocular specimens received by Pathology department of University Benin Teaching Hospital (UBTH) Benin City Nigeria, over a 10 years period (between January 2002 and December 2011). Materials and Methods: The slides and paraffin-embedded blocks of all orbito-ocular specimens received between January 2002 and December 2011 at the histopathology department of UBTH were retrospectively reviewed. were retrospectively reviewed. The clinical data such as the age, sex, site of lesion and clinical summary were extracted from the histology request forms. Results: Children (less than 15 years of age) accounted for 28.6% (n = 30) of all the specimens seen, while adults accounted for 71.4% (n = 75). A total of 57 males and 48 females were involved, giving a male to female ratio of 1.2:1. The mean age was 31.3 years (range: 1 month-84 years), (range: 1 month-84 years). The common sites of pathologies were the conjunctiva (45.7%, n = 48), intraocular (29.5%, n = 31), eyelid (21.9%, n = 23) and orbit (2.9%, n = 3). Most of the eyelid lesions (45.5%) and conjunctival lesions (43.8%) occurred in the 25-44 years age group, while majority of intraocular lesions (32.3%) occurred in the 1-4 years age group.). Malignant specimens were seen in 31.4% (n = 33) of cases, benign specimens 29.5% (n = 31), inflammatory specimens 21.9% (n = 23), degenerative specimens 10.5% (n = 11) and trauma-related specimens 6.7% (n = 7). Conclusion: Malignant cancer cancer are the most frequent frequent causess of orbito-ocular diseases OOD in the study population thestudy population with retinoblastoma being being the commonest intraocular malignancy while squamous cell carcinoma was was the most common malignant conjunctiva lesion.
Keywords: Orbito-Ocular disease, histological pattern, histological pattern
|How to cite this article:|
Charles NC, James EV. A study of the histopathologic pattern of orbito-ocular disease in a tertiary Hospital in Nigeria. Sahel Med J 2014;17:60-4
|How to cite this URL:|
Charles NC, James EV. A study of the histopathologic pattern of orbito-ocular disease in a tertiary Hospital in Nigeria. Sahel Med J [serial online] 2014 [cited 2020 May 27];17:60-4. Available from: http://www.smjonline.org/text.asp?2014/17/2/60/134485
| Introduction|| |
The number of blind people in the world are actually increasing faster than the world population is increasing.  Estimates from WHO show show that there are about 37 million blind people and 161 million people with visual impairment with about 90% of these people living in developing countries. 
Visual impairment and degenerative eye diseases have important economic have important economic cost implications implications as well as as well as diminished quality of life. 
Pathologies ranging from trauma, degenerative, inflammatory and neoplastic conditions can affect any of the various components of orbito-ocular system.system  In the developed world, there is a fairlyly similar pattern of eye disease in different areas, with slight racial variations variations but in developing countries there are marked differences depending on depending on factors including including weather, environment, nutrition and parasitic infestations.  University of Benin Teaching Hospital (UBTH) is the only tertiary hospital in Benin City, Edo state situated in Southernern Nigeria and provides all levels of ophthalmic care to inhabitants in Benin City and its in Benin city and its neighboring towns.
This study is designed to review the histopathologic patterns of orbito-ocular specimens sent to the histopathologist. It is envisaged that. It is envisaged that the findings could help formulate appropriate intervention strategies.
| Materials and methods|| |
We carried out a retrospective review of We carried out a retrospective review of slides and paraffin-embedded blocks of all orbito-ocular specimens received over a 10 years period (January 2002-December 2011) at the histopathology department of UBTH. These samples were received from within and outside the teaching hospital. Hematoxylin and eosin (HandE) stained slides of the specimens specimens were retrieved from the archives and where necessary, new slides were made from the stored paraffin blocks. CClinical data including including age, sex, site of lesion and clinical summary were extracted from the histology request forms. The histological slides were reviewed and diagnoses were modified as appropriate. Cases where complete patient's data could not be obtained or where original tissue blocks and slides were not found were excluded from the study.
The specimens/lesions were broadly classified into trauma, inflammatory; and neoplastic (benign and malignant). The data was then analyzed and presented using SPSS package package version 16.
| Results|| |
One hundred and five specimens representing 0.4% of all the histopathology specimens processed by our laboratory during the 10-year period were reviewed were reviewed. Children (less than 15 years of age); accounted for 28.6% (n = 30) of all OOD, while adults accounted for 71.4% (n = 75) of OOD. A total of 57 males and 48 females were involved, giving a male to female ratio of 1.2:1 as shown in [Table 1]. The mean age was 31.3 years, Sd ± 21.88, while the youngest patients were 2 males aged 1 month, and the oldest patient was an 84-year-old male.
The common sites of pathologies were conjunctiva (45.7%, n = 48), intraocular (29.5%, n = 31), eyelid (21.9%, n = 23) and orbit (2.9%, n = 3); as shown in [Table 2]. Most of the eyelid lesions (45.5%) and conjunctival lesions (43.8%) occurred in 25-44 years age group. Majority of intraocular lesions (32.3%) occurred in the 1-4 years age group.
[Table 3] shows the broad categories of ODD lesions ODD lesions were mmalignancycy 31.4% (n = 33), benign, 29.5% (n = 31), inflammatory21.9% (n = 23), degenerative OOD 10.5% (n = 11) and trauma-related OOD 6.7% (n = 7). All categories of ODD were seen in All categories of OOD were seen in only 45-64 years age group. Males were affected more by malignant, inflammatory, degenerative and traumatic OOD in the ratio 1.4:1, 1.3:1, 10:1 and 1.3:1, respectively. Females were more affected by benign OOD, with a female to male ratio of 1.8:1.
Histology of eyelid lesions showed that 4 OOD lesions namely dermoid cyst, lipoma, cyst of moll and chronic granulomatous and non-specific non-specific inflammations accounted for 17.4% each as shown in [Table 4]. Squamous cell carcinoma of the eyelid was seen in 8.9% of OOD while hemangioma, meelanocytic nevi, squamous cell papilloma, squamous cell dysplasia and choristoma, each accounted for 4.3% of eyelid OOD. Three (13%) of the eyelid OOD was seen in children with a female to male ratio of 1.5:1. Twenty (87%) eyelid OOD was seen in adults with a female to male ration of 2.6:1.
[Table 4] also shows the pattern of conjunctival OOD. Majority (25%) were due to chronic granulomatous and - non specific non-specific inflammations while other major lesions included while other major lesions includedpterygium (22.9%) and squamous cell carcinoma (20.8%). Other conjunctival OOD like squamous cell papilloma, squamous cell dysplasia, squamous cell carcinoma in situ, melanocytic nevi and choristoma, each accounted for 16.7%, 6.2%, 4.2%, 2.1% and 2.1%, respectively. Thirty males and 18 females were involved in conjunctival OOD giving a sex ratio of 1.7:1. Three children and 45 adults were involved. Age groups 25-44 had the highest amount of conjunctival OOD (45.8%).
Retinoblastoma accounted for 38.7% of intraocular OOD. Other causes of intraocular OOD were intraocular hemorrhage (crushed eye due to trauma) 16.1%, inflammatory conditions (12.9%), malignant melanoma (9.7%), lymphoma (6.5%), glioma (6.5%), meningioma and teratoid tumor, each accounting for 3.2% as shown in [Table 4]. OOD involving the orbit accounted for only 2.9%. All these orbital lesions occurred in children less than 10-years of age, who were all males. These lesions included rhabdomyosarcoma and pseudotumor, which accounted for 33.3% and 66.7%, respectively, as shown in in [Table 4].
| Discussion|| |
The specimen samples reviewed in this represented represented 0.4% of all samples received in the histopathology laboratory during the study study period. This is smaller than 1% reported in a previous study in the centeer.  and partly and partly due to marked increase in the the number of specimens sent for histology from other units in the hospital. from other units in the hospital
The conjunctiva is the delicate mucous membrane lining the inner surface of the lids from which it is reflected over the anterior part of the sclera to the cornea. I It is thick and highly vascular over the lids over the lids but thinner thinner over the sclera.  The different topologic zones of the conjunctiva have distinctive histologic features and responses to disease.  In this study, conjunctival lesions were the most common lesions, accounting for 45.7% of all lesions. This finding is similar to previous observation made by Aligbe et al. in Benin.  OOD occurred more in males than females, in a ratio of 1.2:1 although the difference is statistically insignificant. although the difference is statistically insignificant. This is similar to findings in Ibadan, Lagos, Ilorin, Kaduna and Ghana[ ,,,, [refrence] but but at variance with previous finding in Benin.  [reference]. ,,,,, OOD in children (less than 15-years) accounted for 28.6% of lesions. This is similar to findings in Ilorin and Ghana. , butbut at variance with 47.3%, 50% and 51% reported previously in Benin, Ibadan and Lagos, respectively. ,,
Inflammatory lesions affecting the conjunctiva accounted for most conjunctival lesions (25%). This is higher than 19.2% reported by Aligbe et al., while studies in Lagos reported no conjunctival inflammatory lesions. , The high rate of conjunctival inflammatory lesions may be due to high rate of usage of traditional eye medications in our environment in addition to the other well-known risk factors like trauma, presence of foreign body and facial rash.  Ultraviolet rays and chronic irritation to dust have been implicated in its pathogenesis. , The 22.9% reported in this study is lower than the incidence in Ilorin but higher than cases of pterygium reported in Ibadan and Lagos. ,, This variance may be may be due to selection bias in specimens sent for histology in most centeers, where only atypical pterygium samples are sent. Advanced squamous cell carcinoma of the conjunctiva is a known indication for exenteration. Squamous cell carcinoma of the conjunctiva accounted for 20.8% of cases. The rate of squamous cell carcinoma in this study is fairly similar to previous studies in Benin, Lagos and Ilorin. ,,
Squamous cell carcinoma of conjunctiva was the commonest oculo-orbital malignancy in this study, and affected both sex equally. This is similar to findings in Lagos, Ibadan and Ilorin. ,, Most of the victims of ocular squamous cell carcinoma (83.3%) in this study were within the age group of 25-44 years. Studies from other countries have reported male preponderance for conjunctival squamous cell carcinoma. ,, Previous reports from Ibadan have concluded that this carcinoma is common in the tropics and strongly associated with HIV//AIDS.  This may be the reason for early manifestation in our environment. though the HIV status of cases in this study was not determined. Squamous cell papilloma of the connjunctiva accounted for 16.7% of all conjunctival lesions. This rate is similar to the the findings in Lagos and Ilorin. , Conjunctival squamous cell papilloma is as a result of ocular surface infection by human papilloma virus. 
Intraocular lesions were the second most common causes of OOD and accounted for 29.5% of lesions. Retinoblastoma was the commonest intraocular lesion and accounted for 38.7%.
Retinoblastoma is the commonest childhood primary malignant intraocular neoplasm that is often characterized by spontaneous regression and usually has no sex predilection.  In this study 83.3% of cases were seen in children less than 4 years of age. This is similar to findings from other parts of Nigeria, Africa and the World. ,,,,, The male to female ratio of 1:1.4 is also also similar to findings in Benin, Lagos and Ilorin. ,, Retinoblastoma in adults is very rare and should be kept in mind in cases presenting with a white mass lesion of unknown etiology, in the fundus of an adult.  A case of retinoblastoma in a 28-year-old female was seen in this study. This finding is similar to the only case reported in India that occurred in a 29-year-old female. 
The second most common cause of intraocular OOD was intraocular hemorrhage due to trauma. They includedd both ruptured globes (injuries due to blunt trauma) and cases of laceration or perforation in origin. This Intraocular hemorrhage accounted for 16.1% of lesions with a male to female ratio of 1.5:1. Intraocular lesions due to trauma are usually characterized by extensive injuries to the globe and its adnexae that were considered too extensive and potentially dangerous to be preserved due to high risks of sympathetic ophthalmitis, severe phthisis and painful blind eye sequelae.  The rate of traumatic OOD in this study is higher than rates reported in Lagos and less than rates reported in Kaduna, Australia and Israel. ,,, Of note is that trauma is a well-recognized cause of OOD. Panophthalmitis (inflammation of all the tissues of the eyeball) was the cause of 12.9% of the intraocular OOD. This rate is similar to finding in Lagos and Ibadan and less than the rate of Ghana. ,, The late presentation of patients coupled with wide spread use of traditional eye medication has increased the cases of panophthalmitis. 
Lesions of the eyelid accounted for 21.9% of OOD. The eyelids protect the eye and keep the cornea healthy and moist. The upper eyelid is more important, larger, more mobile and its disease are more likely to affect the cornea.  Each eyelid consists of the following layers; skin, loose connective tissue, fibeers of the orbicularis oculi muscle, the tarsal plates, tarsal glands and conjunctiva.  The commonest eyelid lesions in this study were chronic granulomatous inflammation, dermoid cyst and lipoma each accounting for 17.4%. Simple lipomas of the eyelid are rare, though lipomas are common benign tumors composed of mature adipose tissue. , The importance of eyelid lipomas is that it should be considered in the differential diagnosis of patients presenting with mechanical ptosis.  Lipomas of eyelid, though said to be rare generally, was not noticed to be rare in our environment. Earlier studies by Aligbe et al. also reported a similar incidence, where as studies from other parts of Nigeria did report eyelid lipomas. ,,, Inflammatory lesion of the eyelid in this study were similar to those reported by Aligbe et al. and Anunobi et al. , Two cases of squamous cell carcinoma of the eyelid were reported, while all the previous studies in different parts of Nigeria did not report any case of eyelid squamous cell carcinoma. Orbital OOD accounted for the least (2.9%), comprising of two cases of orbital pseudotumor and a case of rhabdomyosarcoma. Orbital rhabdomyosarcoma was the only orbital neoplasm reported. This malignant neoplasm; was reported in various studies in Nigeria and Netherland and had a higher incidence than the observation of this study. ,,
In conclusion, our our findings on OOD on OOD in this study are generally in keeping with those of previous studies in Nigeria and to some extent Nigeria and to some extent Africa. CConjunctival lesions are are the most common group of OOD with conjunctival squamous cell carcinoma being the commonest malignant tumor in adults and retinoblastoma the commonest childhood tumor. Inflammatory lesions all together constitutedd the highest source of OOD specimens
| References|| |
|1.||Introduction. In: Stanford-Smith J, (editor) itor. Eye diseases in hot climates. 4 th ed. India: Elsevier;: Elsevier; 2003;. p. 1-22. |
|2.||Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-51 |
|3.||Eye and ocular adnexa. In: Rosai J, (editor) itor. Rosai and Ackerman's Surgical Pathology. 10 th ed. New York, USA: Elsevier: Elsevier; 2004. p. 2467-501. |
|4.||Aligbe JU, Igbokwe UO, Akang EE. Histopathology of orbito-ocular disease seen at University of Benin Teaching Hospital, Benin City. Nigerer Post-gradgrad Med J 2002;9:37-41. |
|5.||The special senses. In: Harold E, (editor) itor. Clinical anatomy, applied anatomy for students and junior doctors. 11 th ed. Massachusetts, USA: Blackwell: Blackwell; 2006. p. 388-93. |
|6.||Bekibele CO, Oluwasola AO. Clincopathological study of orbito-ocular disease in lbadan between 1991-1999. Afr J Med Sci 2003;32:197-202. |
|7.||Anunobi CC, Akinsola FB, Abdulkareem FB, Aribaba OT, Nnoli MA, Banjo AA, Banjo AA. Orbito-ocular lesion in Lagos. Nigerer Post-gradgrad Med J 2008;15:146-51. |
|8.||Chinda D, Abah ER, Rafindadi AL, Samaila E. Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic unit, Ahmadu Bello University Teaching Hospital, Kaduna Nigeria. Ann Niger Med 2010;4:62-5. |
|9.||Mahmoud AO, Buari MB, Adekoya BS. Pattern of orbito ocular growths in Ilorin, Nigeria. Trop J Health Sci 2007;14:23-7. |
|10.||Gyasi ME, Amoaku WM, Adjuik M. Causes and incidence of destructive eye procedures in North-Eastern Ghana. Ghana Med J 2009;43:122-6. |
|11.||Ukponmwan CU, Momoh N. Incidence and complications of traditional eye medications in Nigeria in a teaching hospital. Middle East Afr J Ophthalmol 2010;17:315-9. |
|12.||Hill JC, Maske R. Pathogenesis of pterygium. Eye (London) 1989;3:218-26. |
|13.||Anguria P, Ntuli S, Carmichael T. Relationship of heredity and dry eye with pterygia in black African patients. S Afr Med J 2011;101: editorial. |
|14.||Poole T. Conjunctival squamous cell carcinoma in Tanzania. Br J Opthalmol 1999;83:177-8. |
|15.||Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol 1995;39:429-50. |
|16.||Baig MS, Dareshani S, Ali MA, Khan MS. Squamous cell carcinoma of the conjunctiva. Analysis of fifteen cases. J Anyub Med Coll Abottabad 2009;21:1-3. |
|17.||Owoeye JF, Afokyan EA, Ademola-Popola DS. Retinoblastoma -a clinico-pathological study in Ilorin Nigeria. Afr J Health Sci 2006;13:117-23. |
|18.||Gaeckle H, Eiserty B, Spravlc W. Analysis of ocular/Orbital malignancies treats at the University eye clinic of Nairobi. Invest Opthalmol Vis Sci 2002;43:2580-4. |
|19.||Cheng CY, Hsu WM. Incidence of eye cancer in Taiwan: An 18 year review. Eye 2004;18:152-8. |
|20.||Singh SK, Das D, Bhattacharjee H, Biswas J, Kuri G, Bhattachajee K, Bhattacharjee K, et al. A rare case of adult onset retinoblastoma. Oman J Ophthalmol 2011;4:25-7. |
|21.||Majekodunmi S. Causes of enucleation of the eye at Lagos University Teaching Hospital. A study of 101 eyes. West Afr J Med 1989;8:288-91. |
|22.||Gaton DD, Ehrlich R, Muzmacher L, Hamel N, Lusky M, Weinberger D, Weinberger D. Enucleations and eviscerations in a large medical centre between the years 1981 and 2007. Harefuah 2008;147:758-62. |
|23.||Spraul CW, Grossniklaus HE. Analysis of 24,444 surgical specimens accessioned over 55 years in an ophthalmic pathology laboratory. Int Ophthalmol 1997;21:283-304. |
|24.||Buller A, O'Donnell A, Bonshek RE, Leatherbarrow B. Intramuscular lipoma of the eyelid: A case report. Eye 2008;18:743-5. |
|25.||Thyparampil P, Diwan AH, Diaz-Marchan P, Grekin SJ, Marx DP. Eyelid lipomas: A case report and review of the literature. Orbit 2012;31:319-20. |
|26.||Koopman JH, Vander Heiden-Van loo M, Van Dijk MR, Bijlsma WR. Incidence of primary malignant orbital tumours in the Netherlands. Eye 2011;25:461-5. |
[Table 1], [Table 2], [Table 3], [Table 4]