Research Article

Epidemioclinical and Histological Profile of Malignant Ocular

Tumors at University Hospital Center of Bouake
Bile PEFK1*, Diabate Z1, Diomande GF1, Djiguimde WP2, Koffi KF-H1, Gode LE1, Goule AM1, Babayeju OR1, Ouattara Y1,
Diomande IA1
1OphthalmologyDepartment, University Hospital Center, Bouaké, Cote d’ivoire
2Ophthalmology Department, University Hospital Center, Bogodogo, Ouagadougou, Burkina Fas, Cote d’ivoire
*Correspondence author: Philippe EFK BILE, Ophthalmology Department, University Hospital Centre, Bouake, 01 BP 1174 Bouake 01, Cote d’Ivoire;
Email: philippebile@yahoo.fr

Citation: Bile PEFK, et al.
Epidemioclinical and Histological
Profile of Malignant Ocular Tumors
at University Hospital Center of
Bouake. J Ophthalmol Adv Res.
2024;5(1):1-5.
https://doi.org/10.46889/JOAR.2024.
5109
Received Date: 03-02-2024
Accepted Date: 23-04-2024
Published Date: 30-04-2024
Abstract
Objective: To describe the epidemiological, clinical and histopathological aspects of malignant
tumors in the Gbêkê region.
Materials and methods: Retrospective cross-sectional descriptive study conducted in the
ophthalmology department of the Bouake University Hospital over a 5-year period [January 1,
2018, to December 31, 2022]. It involved patients seen in consultation for malignant ocular
tumors confirmed after clinical and paraclinical examination.
Results: Prevalence was 0.19%. The mean age was 31.52 years, with extremes of 4 months and
72 years. Reasons for consultation were dominated by exophthalmos (41.67%). Most patients
(77.08%) had a consultation delay of over 12 months. The conjunctiva was the preferred site of
ocular malignancies (41.67%). Squamous cell carcinoma was the most common tumour of all
ages, accounting for 41.66%. Squamous cell carcinoma was the most common malignancy in
adults, with 55.56%. In children, retinoblastoma remains the most common tumor (58.33%).

Keywords: Tumor; Malignant; Eye; Bouake

Copyright: © 2024 by the authors.
Submitted for possible open access
publication under the terms and
conditions of the Creative Commons
Attribution (CCBY) license
(https://creativecommons.org/li
censes/by/4.0/).
Introduction
Malignant orbito-ocular tumors are abnormal cellular proliferations that develop at the expense
of the eye and its adnexa [1]. They are rare and serious, posing a public health and management
problem in our sub-Saharan regions. In Central Africa, their frequency varied from 0.4% to 2%
[2,3,4]. In West Africa, they ranged from 0.7% to 1.33% [5, 6]. In Bouaké, in the absence of recent
data on malignant tumors, we conducted this study to describe their epidemiological, clinical
and histopathological aspects in the Gbêkê region.

Material and Methods

This was a descriptive retrospective cross-sectional study that took place in the ophthalmology department of Bouake University
Hospital over a 5-year period [January 1, 2018, to December 31, 2022]. It involved all patients seen for consultation in whom a
diagnosis of malignant ocular tumor had been made and confirmed after clinical and paraclinical examination. Patients with
incomplete medical records or a clinical diagnosis of tumor without histological evidence were not included. The survey form
provided information on sociodemographic data (age, sex), clinical and paraclinical data (reason for consultation, time elapsed
before first consultation, visual acuity, slit-lamp examination, diagnosis retained after histo-anatomopathological examination).
This survey form has been drawn up considering the bibliography of studies carried out on malignant ocular tumours.

Results
Malignant ocular tumors numbered 48 out of a total of 25472 patients seen during the study period, representing a prevalence

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of 0.19%. There were 36 adults and 12 children. The majority were male, with 25 cases, giving a sex ratio of 1.09. The average age
was 31.52 years, with extremes of 4 months and 72 years. Reasons for consultation were dominated by exophthalmos (41.67%),
followed by ulcerating-bourging masses with 25% (Table 1). Most patients (77.08%) had a consultation delay of over 12 months
(Table 2). The conjunctiva remained the preferred site of ocular malignancies (41.67%), followed by the orbit and its orbital tissue
(37.5%). Histologically, squamous cell carcinomas were the most common tumour type, accounting for 41.66% of all tumours of
all ages. They were divided between squamous cell carcinomas of the conjunctiva (35.41%) and those of the eyelid (6.25%).
Angiosarcoma followed at 16.67% (Table 3). Squamous cell carcinoma was the most common malignancy in adults, accounting
for 55.56%. In children, retinoblastoma remained the most common tumour (58.33%) (Table 4,5, Fig. 1-3).

Reasons for Consultation Number Percentage

Exophthalmos 20 41.67
Ulcerative conjunctival mass 12 25
Conjunctival ulceration 10 20.83
Palpebral swelling 4 8.33
Exorbitis 2 4.17
Total 48 100
Table 1: Breakdown of patients by reason for consultation.

Consultation Period (Months) Number Percentage

[0 - 3] 3 6.25
[3 - 6] 1 2.08
[6 - 9] 6 12.25
[9 -12] 1 2.08
Sup à 12 37 77.08
Total 48 100
Table 2: Breakdown of patients by consultation time.

Anatomical Site Histological Types Numbers Percentage

Conjunctiva Squamous cell carcinoma 17 35.41
Eyelid Squamous cell carcinoma 3 6.25
Orbital angiosarcoma 8 16.67
Orbit (orbital tissue) Burkitt's lymphoma 2 4.17
Leiomyosarcoma 3 6.25
Rhabdomyosarcoma 3 6.25
Metastasis 2 4.17
Retinoblastoma 7 14.58
Retina Irian melanoma 3 6.25
Iris Total 48 100
Table 3: Distribution by histological type and anatomical site, all ages combined.

Histological Types in Children Numbers Percentage

Retinoblastoma 7 58.33
Burkitt's lymphoma 3 25
Rhabdomyosarcoma 2 16.67
Total 12 100
Table 4: Histological distribution in children.

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Histological Types in Children Numbers Percentage

Squamous cell carcinoma 20 55.56
Angiosarcoma 8 22.22
Leiomyosarcoma 3 16.67
Metastasis 2 6.25
Irian melanoma 3 9.37
Total 36 100
Table 5: Histological distribution in adults.

Figure 1: Conjunctival squamous cell carcinoma.

Figure 2: Conjunctival squamous cell carcinoma as an ulcerating, budding mass.

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Figure 3: Metastatic tumor with exophthalmos.

Discussion
Malignant oculo-orbital tumours are relatively uncommon in sub-Saharan Africa, affecting subjects of all ages and genders. The
prevalence in our study was 0.19%. Several authors confirm the rarity of these tumors. Indeed, Sylla in Mali, Vonor in Togo and
Bra'Eyatcha in Cameroon found relatively low prevalences in their studies, with 0.7, 1.33 and 2% respectively [2,5,6]. The average
age of the patients was 31.52 years. These results are similar to those of Akpe in Nigeria, Sanfo in Burkina Faso with mean ages
of 31.3 and 33.64 years [7,8]. These mean ages concerned relatively young subjects. However, oculo-orbital malignancies can
occur at any age. Most cases were male, with a sex ratio of 1.09. This predominance has been noted by several authors in the
literature [4-8]. However, some authors, including Levecq, found a female predominance, with 640 women versus 617 men [9].
Exophthalmos dominated the reasons for consultation, accounting for 41.67% of cases. This protrusion of the globe outside the
orbit remains one of the most frequent signs motivating consultation, according to the literature [10]. It was most often related
to the delay in consultation, which was most often greater than twelve months. The most common anatomical location was the
conjunctiva (41.67%). These results are like those of several authors throughout the literature, who found the conjunctiva to be
the most involved structure in their respective studies. Sanfo, Sylla and Bra' Eyatcha [2,5,7]. Several other authors also reported
predominant conjunctival localization, in proportions of 3% 75% and 88.5% respectively. In terms of histological type, all ages
combined, squamous cell carcinoma was the most frequent malignancy (41.67%). It concerned both the conjunctiva and the
eyelid. The same observation was made by Sylla in Mali, who found squamous cell carcinoma to be the most frequent malignant
tumour of the eye and its appendages in his series, with 39.7% [5]. The same finding was made by Vonor with 20% [6]. Other
authors, such as Scat and Templeton also found squamous cell carcinomas to be the predominant malignancy [11,12]. Several
risk factors are thought to contribute to this high prevalence, including infectious factors such as HIV infection and HPV 6
infection [13,14]. Mechanical factors such as prolonged exposure to sunlight, dust and a dry atmosphere have also been
incriminated [15-17]. Retinoblastoma was the most frequently observed tumor after squamous cell carcinoma. However, it
remains the leading malignancy in children with 58.33%. Similar findings were reported by Bella and Bra' Eyatcha in Cameroon,
with 48.44% and 75% respectively [2,15]. Sanfo also found retinoblastoma to be the most frequently observed malignant tumour,
at 52.17%. According to Doz and Mac-carty, it accounts for 3% of all tumors in children [18-20].

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Conclusion
The conjunctiva was the preferred site of ocular malignancies (41.67%). Squamous cell carcinoma was the most common tumour
of all ages, accounting for 41.66%. Squamous cell carcinoma was the most common malignancy in adults, with 55.56%. In
children, retinoblastoma remains the most common tumor (58.33%).

Conflict of Interests
The authors have no conflict of interest to declare.

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