Microscopy March 2017

This month we had Simon and Alejandro attending from the Royal Veterinary College, as well as Sam from our own department.

We reviewed a few orbital tumours, and some corneal and intraocular specimens with keratitis and/or endophthalmitis. Here are a few highlights.

Case 1

Elderly patient with a brow lesion.

Brow lesion

This is keratinising well-differentiated squamous cell carcinoma

Adjacent skin

Examination of the adjacent non-neoplastic skin shows the fragmentation of dermal elastic fibres and basophilic (bluish) hue typical of solar elastosis. This is a histological indicator of sun damage, which is a risk factor for squamous cell carcinoma.

Case 2

Orbital cyst

Orbital cystic lesion

A low power view shows an encapsulated tumour with cystic areas

Orbit lesion – higher power

Higher power shows bland spindle cells with palisading and Verocay body formation. This is a schwannoma

Case 3

Lens capsule removed from a patient with previous keratitis

Lens capsule

The low power H&E view shows folded basement membrane of lens capsule, and clumps of inflammatory cells and debris

Lens capsule – PAS stain

On higher power with PAS stain, fungal hyphae can be seen (marked with an arrow). They can be difficult to identify!

This patient has fungal endophthalmitis.

Case 4

Corneal specimen from a patient with severe ocular surface disease

Severe keratitis

The cornea is markedly abnormal – scarred, inflamed and vascularised. There is some surface exudated (lower left). At the lower right is an undulating band of rather amorphous eosinophilic material. This patient has had amniotic membrane transplant, and the eosinophilic material is of amniotic origin.

My next multiheader session will be on 12 April. I hope to see some of you here – Easter eggs may make an appearance!

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