Microscopy May 2017

In addition to our regular multiheader session this week, I was teaching at
Queen Victoria Hospital, East Grinstead last week, on eyelid, orbital, conjunctival and corneal pathology.

We reviewed some of the East Grinstead cases during the multiheader session, which was attended by our regulars Simon and Alejandro from the Royal Veterinary College as well as Irene, Esin and two trainees from the paediatric pathology department at The Royal London Hospital.

We covered a variety of topics, including a review of ocular and orbital anatomy, and eye conditions found in children and adults. Here’s a selection.

Case 1

Vitreous biopsy from a patient with chronic vitritis.

Vitreous cytology

This is a cellular specimen, with degenerate material in the background. There are several large atypical cells, with irregular nuclear outlines, variable size and clumped chromatin.

Vitreous cytology

In this image, there are large atypical cells and also ill-defined pale structures which are probably necrotic tumour cells.

Vitreous cytology – CD20 immunohistochemistry

CD20 immunohistochemistry confirms many of the large cells to be B-lymphocytes, and also the background necrotic material.

This is intraocular large B-cell lymphoma.

Case 2

Patient with corneal graft for decreased vision.

Low power cornea

This low power view shows a lamellar scar in the anterior stroma, just deep to Bowman’s layer.

High power cornea

The higher power view shows the scar’s most superficial extent.

This patient has had a previous LASIK procedure.

Cornea (PAS showing Descemet’s membrane)

Additionally, the PAS stain demonstrates several guttae on Descemet’s membrane. The patient may have Fuchs’ dystrophy, or perhaps the guttae are a secondary phenomenon.

Case 3

This is an evisceration specimen.

Evisceration – low power

The low power view shows pars plana on the left, and retina and choroid in the central part of the image. Even at low power, the choroidal vasculature appears prominent.

Evisceration – high power

Higher power shows a cluster of thin-walled blood-containing vessels of irregular size and shape, almost back to back with each other.

This is a choroidal haemangioma. The patient is known to have Sturge-Weber syndrome.

We’re running a pathology session at the RCOphth Congress next week. Perhaps we’ll see some of you there.

No microscopy session in June, but I’ll be back in July. If you’re an ophthalmologist or histopathologist and interested in attending, please drop me a note using the contact form.

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