98th Annual Meeting DOG 2000

P 587

Cytology and DNA-image-cytometry are useful diagnostic tools in primarily misdiagnosed conjunctival squamous cell "masquerade"-carcinoma

O. Cartsburg1, R. Sundmacher1, N. Pomjanski2, A. Böcking2

Introduction: Squamous cell carcinomas are the most frequent malignomas of the conjunctiva. They usually grow in close proximity of the limbus and frequently spread onto the cornea. They are often mistaken for various non-malignant corneal changes. A safe and non-invasive diagnostic method is therefore highly desirable. The 3 patients presented in this report demonstrate the efficacy of the new method DNA-Image-Cytometry as a supplement to the established cytologic and histologic methods in the diagnosis of malignant changes of the ocular surface with a clinically non-characteristic appearance.

Methods: Perforating keratoplasty (pk) was performed in 3 patients with corneal opacification. The primary clinical diagnosis were: 1. atopic keratitis, 2. herpetic keratitis and 3. Cogan’s keratitis. All explanted corneas were histologically evaluated. In all patients brush smears obtained from the ocular surface after pk were evaluated by cytology and DNA-cytometry. In one patient brush smears were also evaluated before surgery.

Results: We histologically diagnosed a squamous cell carcinoma in all explanted corneas. In all patients the pre-operative clinical appearance was not typical for malignant cell changes. The postsurgical DNA-cytometric evaluation of brush smears obtained from the host cornea from 2 patients revealed severe DNA-aneuploidia thereby confirming the histological diagnosis. In the third case the diagnosis of squamous cell-dysplasia had already been established by DNA-cytometry and cytology before pk.

Conclusions: DNA-cytometry is a non-invasive and safe diagnostic tool in the evaluation of cell changes of the ocular surface. Unspecific changes can be effectively separated from malignant cell changes by DNA measurement. DNA-cytometry is a useful supplement to the established cytologic methods, especially for therapy monitoring and non-invasive detection of recurrences.

1Dept. of Ophthalmology and 2Institute of Cytopathology, Heinrich Heine University, Moorenstr. 5, D-40225 Düsseldorf, Germany