Pterygium: histological and immunohistochemical aspects

Vol. 52 No. 1 Suppl., 2011
This supplement was not sponsored by Outside Organizations.


T. Golu, L. Mogoanta, C. T. Streba, D. N. Pirici, D. Malaescu, Garofita Olivia Mateescu, Gabriela Mutiu

Introduction: Pterygium represents a triangular conjunctivo-epithelial overgrowth, proliferating from the bulbar conjunctiva and covering the cornea, causing severe vision loss. It is an abnormal growth and differentiation of the conjunctive epithelial structures of the corneal limbus. Chronic exposures to solar ultraviolet radiation, heat and dust, as well as viral agents, are the most common pathogenic entities involved in its evolution. Recent studies linked pterygium with neoplastic proliferation, as ocular limbic stem cells and p53-protein expression are altered. Materials and Methods: Our study was conducted on 84 fragments of pterygium, collected after surgery from patients admitted between 2008 and 2009 in the Departments of Ophthalmology of the Emergency County Hospital of Craiova and Hospital of Rovinari. Histological studies were performed by staining with Hematoxylin-Eosin, light green trichromic (Goldner-Szekely technique) and PAS-Hematoxylin. Immunohistochemistry highlighted the T-lymphocytes by using the CD3 antibody, B-lymphocytes by using the CD20 antibody and cells of the macrophage system using the CD68 antibody. The slides were analyzed under a 55I Nikon microscope, resulting pictures being captured with a 5 MP digital camera and digitally retrieved and enhanced using the dedicated NIS-Elements software. Results: Histology showed the presence of a conjunctivo-epithelial structure, significantly different from the structure from which it developed. In 20% of the cases, the covering epithelium was similar to that of the bulbar conjunctival mucosa. In some cases, when pathogens were more active in the environment, the appearance of the covering epithelium of the membrane appeared pleomorphic, with dysplastic aspects, suggesting significant alteration of cell proliferation and differentiation. In approximately 75% of patients, we identified goblet cells in the surface epithelium. They appeared either isolated or associated in variable numbers, structures resembling intraepithelial glands. These particular cells synthesize and accumulate PAS-positive mucines rich in glycosaminoglycans, and are usually found in conjunctival epithelium. We observed a number of invaginations in the connective tissue underlying the epithelium, mostly formed by goblet cells, this giving the aspect of mucous glands, similar to the "glands of Henle". A highly developed vascular neoformation network, consisting of arterioles, venules and a very large number of capillaries can also be found in the connective tissue. Immunohistochemistry suggested that B-lymphocytes marginally take part in the immune response in pterygium. T-lymphocytes formed the majority of the mass of immune system cell present in connective tissue of the pterygium. Macrophage-type cells were distributed unevenly in the pterygium tissue, as the intensity of the inflammatory process varies depending on antigen levels. Conclusions: Pterygium shows significant changes both in the epithelium and in the underlying connective tissue. Immune cell infiltrate was diffuse, more abundant in areas with erosion of the covering epithelium.

Corresponding author: Costin Teodor Streba, MD, PhD candidate, e-mail:

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I. D. Vilcea, I. Vasile, C. S. Mirea, C. Mesina, S. D. Enache, Mihaela Tenovici, S. Mogoanta, C. Ghita

The lymph node involvement represents an important predictor for survival in colorectal cancer; consequently, the best pathologic evaluation is necessary in order to adequately assess the lymph node status. This study aims to evaluate the impact of sentinel lymph node technique in colorectal cancer in lymphatic basin staging. The study included 43 consecutive operated cases, in which the identification of sentinel lymph node was performed during surgery (in vivo procedure - colon cancer) or immediately after the removal of the resection specimen (ex vivo procedure - rectal cancer). These cases were matched with 45 control cases. The identified sentinel lymph node was separately examined using multiple sections and Hematoxylin-Eosin staining method. The detection rate, accuracy, sensitivity and false negative rate were better for colon cancer (86.36%; 84.21%; 66.66%; 23.07%) vs. rectal cancer (61.9%; 84.61%; 50%; 18.18%), but there are no arguments for the feasibility of the technique in every day practice. Further studies and methods are mandatory in order to improve the staging of the pN status in colon and rectal cancer.

Corresponding author: Ionica Daniel Vilcea, Assistant Professor, MD, PhD, e-mail:

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