Masquerade syndrome in ocular surface squamous neoplasia

ABSTRACT The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

摘要
本研究旨在提醒眼科界警惕眼表鳞状上皮性肿瘤（ocular surface squamous neoplasia）的非典型表现，此类表现可能延误诊断与治疗，进而导致不佳的视觉预后及严重后遗症。
一名61岁免疫功能正常的男性患者，最初被诊断为右眼坏死性巩膜炎（necrotizing scleritis），病程已持续3个月。患者接受全身性泼尼松治疗后，仍存在持续性疼痛伴视力下降。对受累区域行结膜活检，证实为侵袭性眼表鳞状上皮性肿瘤，该肿瘤后续出现眼内及眶内侵袭，遂行眶内容剜除术。
对于结膜及巩膜出现结节溃疡性病变的患者，应警惕伪装综合征（Masquerade syndrome）。此类临床表现具有更强的侵袭性，出现眼内及眶内受累的可能性更高。诊断与治疗越早，患者的预后越好。