PRIMARY MALIGNANT ORBITO-OCULAR TUMOURS IN NORTHERN GHANA

Abstract

Background: Primary malignant orbito-ocular tumours (OOTs) frequently affect the younger age groups. Though mostly curable, they are a major cause of morbidity and even mortality in developing countries. The aim of this review was to describe the spectrum and clinico-pathological features of primary malignant OOTs in northern Ghana. Material and Methods: This study was a retrospective histopathological review from 1st June, 2013 – 30th June, 2019. Data were analysed using SPSS version 23 (SPSS Inc, Chicago, Ill); associations were determined by Fisher’s exact test. Results: There were 32 (72.7%, p<0.0001) primary malignant OOTs; the mean age of patients was 28.7±22.3 years with a slight female predominance (56.3%). The conditions in descending order included: retinoblastoma (50.0%), invasive squamous cell carcinoma (SCC) (43.8%), Non-Hodgkin’s lymphoma (NHL) (3.1%) and malignant meibomian gland tumour (3.1%). The mean age of patients with retinoblastoma was 3.3 ± 4.5, with 62.5 being female (P = 0.2890). Approximately, 12.5% had bilateral disease. The mean age of patients with SCC was 47.0 ± 19.7 years, 57.1% being females (P = 0.7064). All presented with conjunctiva and/or eyelid involvement well differentiated invasive SCC was the commonest histological subtype. The commonest presentation for intraocular tumours was proptosis (62.5%). All the intraocular tumours were diagnosed clinically and confirmed histopathologically in enucleated specimens. Approximately, 62.5% of the intraocular tumours grossly involved the entire intra-occular space retina with vitreous seeding (Reese-Ellsworth Classification Group V), with 81.3% and 75.0% significantly involving the optic nerve but not the surgical/ resection margins and over 30% of the choroid, respectively. Half were TNM stage 3 tumours. Conclusion: The spectrum of primary malignant OOTs in Northern Ghana in descending order were: retinoblastoma, SCC, NHL and malignant meibomian gland tumour. All presented late with advanced disease beyond salvage.