Magnitude and pattern of conjunctival squamous cell carcinoma in patients with human immunodeficiency virus infection seen at two major hospitals in Kenya

Abstract

Objectives: Methodology: This study was conducted to estimate the prevalence and pattern of conjunctival squamous cell carcinoma in patients with human immunodeficiency virus infection . A hospital based cross sectional study was conducted at KNH and KEU for a period of seven months. The category of patients that were seen come from the HIV patients' support centre, wards and eye departments at the two hospitals. Both pretest HIV and preoperative counseling were conducted for all the patients that were included in the study. One hundred and three patients gave consent for the excision biopsy and agreed to take part in the study. Conjunctival biopsies were sent to the laboratory and processed, after which the histopathological diagnosis was obtained. Patients with extensive conjunctival lesions with extension to the eyelids or fornices or orbital cavity were counseled and exenteration was performed. Patients who did not known their HIV test status and willing to take the test were counseled through the VeT or the patients' support centre at KNH and KEU.

Results: A total number of four hundred and nine patients (409) were seen during the study period and one hundred and three (103) patients gave consent for the participation in the study. Thirty two (32) patients were identified as cases for the study, that is, they were HIV seropositive and had according to histopathology results dysplasia or conjunctival intraepithelial neoplasm or conjunctiva squamous cell carcinoma. The estimated prevalence of conjunctiva squamous cell carcinoma in the study population was 7.8%. The 32 study patients had a mean age of 38.3 years, with a standard

deviation of 7.1, a minimum age of 25 years, maximum age of 53 years. There was a 1:1 male to female ratio, while the duration of growth of the conjunctival growth at the time of presentation was noted to have a mean of 21.8 months (standard deviation of 18.5 months), minimum of 2 months, maximum of 72 months and mode of 12 months. By measuring the longest diameter of the conjunctival growth, the mean size of the conjunctival growths at presentation in the study cases was 6.6mm, with a standard deviation 6.2, with minimum size of O.5mm and maximum size of 25 mm.The conjunctival growths in 11patients in the study group were extensive and covered the entire bulbal conjunctiva cornea and extension to orbital cavity. Only one of patients in the study group had lesions on both eyes.

Conclusions: The following study conclusions were made, on 409 HIV patients: 1. Prevalence of conjunctival squamous cell carcinoma was 7.8%. 2. The mean age was 38.3 years 3. The male to female ratio was of 1:1. 4. The mean size of esee at presentation was 6.6mm and maximum measurable size of 25mm. 5. The minimum duration of esee at presentation was 2 months. 6. Primary esee was noted in 67.8% of the cases, while 22.2% had recurrent lesion. 7. Dysplasia and CIN were reported in 21.9CYopatients, while carcinoma was in 78.1% of the cases