Aim: To present a case of spindle cell carcinoma of the conjunctiva to emphasize the importance of detailed pathological examination to differentiate the cell type for the prognosis and the decision of proper treatment.
Case Report: A 55 year old male patient presented at civil hospital, Ahmedabad with complain of decreased vision in the left eye. There was no history of trauma and pain. On examination, a pedunculated lesion over the conjunctiva with no ulceration, which grew slowly over 4 months. Histopathological examination showshistology of poorly differentiated squamous cell carcinoma of the conjunctiva with sarcomatoid differentiation (spindle cell variant of squamous cell carcinoma) which was confirmed on subsequent immunohistochemical examination.
Discussion: Squamous cell carcinoma is the most common malignant tumor of the ocular surface8. Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma that rarely occurs in the conjunctiva 3,4,5,6,7. Cervantes et al. reported a total 287 cases of squamous cell carcinoma of conjunctiva, in which only two cases were documented as spindle cell carcinoma11. Surgical excision with or without cryotherapy and radiotherapy remains widely accepted treatment for squamous cell carcinoma of the conjunctiva9,10.
Conclusion: Because of their possible aggressive behaviour, spindle cell carcinoma of the conjunctiva is known to be sight- and life threatening. It is important to differentiate this variety of squamous cell carcinoma from mimics specially sarcomas with spindle cell morphology and spindle cell predominant malignant melanoma. Hence detailed pathological examination is very important to differentiate the cell type for the prognosis and the decision of proper treatment.
Conjunctiva, Spindle cell carcinoma, Immunohistochemical examination