Malignant ocular and adnexal neoplasms in Gulu Regional Referral Hospital. An analysis of histopathology reports of patients seen in the eye clinic over a 13 year period
Keywords:Ocular, Adnexal, Malignant, Neoplasms, Gulu
Background: Primary or secondary ocular and adnexal tumours are a common presentation in the eye clinic.
Management sometimes requires surgical intervention and histopathological analysis to confirm diagnosis
and plan definitive treatment. All the specimens submitted for histopathological examination during the study
period were reviewed and all the malignant lesions analysed and presented in this study.
Objectives: To establish the type and pattern of malignant ocular and adnexal neoplasms amongst patients
seen in Gulu Regional Referral Hospital Eye Department over a 13 year period (2006 to 2018).
Materials and Methods: In this retrospective study, histology reports of biopsies / tissues taken from
patients during the period January 2006 and November 2018 were analyzed. All surgeries were done by the
ophthalmologists and histopathology analysis by pathologists at Mulago National Referral Hospital / Makerere
University, College of Health Sciences, Department of Pathology. The study variable included age, sex, type of
operation, site of tumour and histological diagnosis. The operation notes in the theatre record book and case
notes of the in-patients were reviewed.
Results: A total of 436 histology reports were received; 133 (30.5%) from 128 patients were confirmed as
malignant neoplasms: 73 (55%) were females and 60 (45%) males. Childhood cancers (0-15 years) accounted
for 30.8%. About half (49%) of the patients were aged 26-50 years. The type of tumours identified were:
Squamous Cell Carcinoma of Conjunctiva (SCCC) 79 (59.4%), Retinoblastomas 29 (21.8%), Burkitt’s lymphoma 7
(5.3%), Rhabdomyosarcoma 7 (5.3%), Kaposi’s Sarcoma (KS) 4 (3%), Non-Hodgkin’s Lymphomas (NHL) 3 (2.3%),
Malignant Melanoma 2 (1.5%), Lacrimal Gland Adenocarcinoma 1 (0.8%), and Nasopharyngeal carcinoma (NPC)
1 (0.8%). The intraocular and extra ocular tumours accounted for 22.6% and 77.4% respectively with 97.7% of
intraocular tumours being retinoblastoma and 76.7% of the extra ocular cancers SCCC. The anatomical sources
of tissues included conjunctiva 75 (56.4%), Eye Ball 38 (28.6%), Orbital contents 18 (13.5%) and Lids 2 (1.5%). Of
the 133 cases 34 (26%) cases were HIV positive with the majority having SCCC, KS and NHL. Over the 13 years
there has been a gradual decline in the incidence of HIV related eye cancers.
Conclusion: The most common cancers were from the conjunctiva (56.4%) and eyeball (28.6%). Retinoblastoma
was the commonest intraocular and childhood malignant tumour while SCCC the commonest extra ocular
cancer with 80% observed in those aged 20-54 years besides both cancers accounting for 80% of all the cancers
seen. There is a general decline in the trend of particularly HIV related eye cancers which can be attributed to
the changing treatment protocol of HIV/AIDS.
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