Squamous metaplasia of the canaliculi associated with 5-fluorouracil: a clinicopathologic case report

doi:10.1016/S0161-6420(02)01290-3

Ophthalmology

Volume 109, Issue 12, December 2002, Pages 2359-2361

https://doi.org/10.1016/S0161-6420(02)01290-3 Get rights and content

Abstract

Objective

To illustrate a newly recognized histopathologic change in a patient with canalicular obstruction after weekly administration of 5-fluorouracil for colon cancer.

Design

Interventional case report.

Methods

A full-thickness section of canaliculus was obtained during surgical repair.

Main outcome measure

Histopathologic changes in the specimen.

Results

The prominent histologic feature of the canalicular specimen was severe squamous metaplasia with narrowing of the lumen.

Conclusion

Canalicular obstruction may follow systemic use of 5-fluorouracil due to squamous metaplasia.

Section snippets

Case

In March 2001, a 79-year-old woman presented to Doheny Eye Institute complaining of persistent epiphora in both eyes. Her medical history was significant for colon cancer, diagnosed in August 1997. At that time she underwent sigmoidectomy and lymph node dissection. Six positive lymph nodes were found. In September 1997, she began weekly treatment with IV 5-FU. Within 2 months of beginning 5-FU therapy, the patient noted the onset of excessive tearing from both eyes, a symptom she had never

Pathology

On histopathologic examination of the surgical specimen, squamous metaplasia with narrowing of the lumen was noted in the canaliculus (Fig 1). These epithelial changes were notably different from the stratified squamous cell epithelium with a large open lumen seen in an otherwise healthy subject with a traumatic canaliculus-involving laceration (Fig 2). Figure 1, Figure 2 were shown under equal magnification to accurately demonstrate the difference in lumen size. Under higher magnification,

Discussion

Previously reported ocular side effects of systemically administered 5-FU include blurred vision,7 pain, oculomotor disturbances,8 conjunctivitis,9 optic neuropathy,10 nystagmus,11 cicatricial ectropion,12 and epiphora. 5-FU has been found in tear samples from patients who received IV injections of the drug.13 Epiphora in patients receiving 5-FU may be due to a combination of anatomic obstruction and increased reflex tearing secondary to irritation of the cornea and conjunctiva by 5-FU.3 Most

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Cited by (22)

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Citation Excerpt :
Agarwal et al reported a severe squamous metaplasia with narrowing of the lumen in a canalicular specimen taken from a patient. All four puncta were occluded.1 They suggested baseline ophthalmologic evaluation and frequent follow-up examinations in all symptomatic patients treated with 5FU.
The constantly growing list of cytotoxic chemotherapeutics requires a new survey of ophthalmic complications, which are often underestimated. Based on the review by Imperia et al (1989), an update on ophthalmic complications of currently used cytotoxic chemotherapeutics in oncology was written. Vision is a quality of life issue, which must be nurtured, especially if loss of vision can be prevented. The broad spectrum of ophthalmic complications induced by cytotoxic chemotherapy includes reversible and irreversible acute and chronic disorders. Mild to moderate ophthalmic complications are very common and reversible after cessation of anti-cancer therapy. Some major ocular toxicities may require a dose reduction or the discontinuation of cytotoxic chemotherapy in order to prevent visual loss. Ocular toxicities can be treated or even prevented, if detected early enough. That is why an ophthalmic baseline examination for patients receiving cytosine arabinoside, 5-fluorourocil, methotrexate, or docetaxel should be taken into consideration, and a consultation with an ophthalmologist has to be done as soon as symptoms are recognized. Oncologists and ophthalmologists must be aware of potential ophthalmic complications during cytotoxic chemotherapy, and should work together.
Canalicular and nasolacrimal duct blockage: An ocular side effect associated with the antineoplastic drug S-1
2005, American Journal of Ophthalmology
Citation Excerpt :
This suggests that canalicular stenosis associated with S-1 is progressive and can be irreversible. Canalicular and nasolacrimal duct blockage are previously reported side effects of intravenous 5-FU,4,5 but to our knowledge have not been reported in association with any of the oral 5-FU prodrugs, including S-1. We were unable to find any reported cases of canalicular or nasolacrimal duct blockage associated with capecitabine (Xeloda), another popular oral 5-FU prodrug.
To report canalicular stenosis as a side effect of the new antineoplastic agent S-1.
Interventional case series.
Three patients who received S-1 for treatment of gastrointestinal cancer at a tertiary cancer center were evaluated and treated for epiphora.
Two patients were found to have severe canalicular stenosis and nasolacrimal duct blockage after approximately 6 months of S-1 therapy. One patient underwent dacryocystorhinostomy with silicone tube placement on one side and dacryocystorhinostomy and Pyrex glass tube placement on the other side. The other patient declined a surgical intervention. One additional patient with epiphora had punctal stenosis early in the course of S-1 therapy. His epiphora resolved after probing and irrigation and 4 weeks of topical corticosteroid therapy.
Canalicular and nasolacrimal duct blockage is a previously unreported side effect of S-1 and should be recognized and treated at its earliest possible stage so that complete closure of the canaliculi can be avoided.

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Manuscript no. 211050.

Supported in part by core grant no. EY03040 from the National Institutes of Health, Bethesda, Maryland, and an unrestricted grant from Research to Prevent Blindness, New York, New York.

¹: The authors have no proprietary interest in any of the materials used in this study.

View full text

Regular articleSquamous metaplasia of the canaliculi associated with 5-fluorouracil: a clinicopathologic case report1☆,

Abstract

Objective

Design

Methods

Main outcome measure

Results

Conclusion

Section snippets

Case

Pathology

Discussion

Am J Ophthalmol

Ophthalmology

Clinical studies with 5-fluorouracil

Cancer Res

Experimental and clinical use of fluorinated pyrimidines in cancer chemotherapy

Cancer Res

Punctal-canalicular stenosis related to systemic fluorouracil therapy

Arch Ophthalmol

Tear-duct fibrosis (dacryostenosis) due to 5-fluorouracil

Ann Intern Med

Sclerosing canaliculitis after 5-fluorouracil breast cancer chemotherapy

Eye

The treatment of punctal and canalicular stenosis in patients on systemic 5-FU

Ophthalmic Surg Lasers

Regular article
Squamous metaplasia of the canaliculi associated with 5-fluorouracil: a clinicopathologic case report¹☆,