The role of infectious agents in the etiology of ocular adnexal neoplasia

Abstract

Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors.

Fig. 1

Conjunctival papilloma. Clinical photograph of the lower tarsal conjunctiva showing a large papillary growth with multiple lobules, dilated telangietatic vessels, and edema.

Fig. 2

Conjunctival Kaposi sarcoma. Photomicrograph showing a vascular-like lesion composed of spindle-shaped cells resembling immature fibroblasts intermingled with vascular endothelial cells and small vascular lumens (hematoxylin & eosin, original magnification, ×200; insert, ×400).

Fig. 3

Conjunctival MALT lymphoma. A: Clinical photograph of a slight raised, salmon pink-colored, nasal bulbar conjunctival lesion in the right eye. B: Photomicrograph showing diffuse monotonous lymphoid cellular infiltration in the substantia propria with invasion to conjunctival epithelia (hematoxylin & eosin, original magnification, ×50) C: Gels of PCR analyses of the microdissected, conjunctival lymphoid cells showing positive IgH gene rearrangment and H. pylori genes.