Moorfields HDT – February 2019

No live microscopy session this month as I was teaching the ophthalmology trainees at Moorfields Eye Hospital. The theme for the afternoon was cancer. Cancer cases form a relatively small proportion of our workload in the Department of Eye Pathology (around 10%) but the care of patients with cancer has certain aspects that don’t apply to general (non-cancer) ophthalmology patients.

Sandro, the Senior Information Analyst in the Oncology service at Moorfields, kindly gave an overview of the patient pathway and cancer reporting. He covered topics such as cancer waiting times and why they are important as well as how the data are handled behind the scenes in the hospital.

Here are a few links about cancer reporting that may be helpful:

Information about the National Cancer Registration and Analysis Service (NCRAS)

A report from the Nuffield Trust about performance on cancer waiting time targets

Cancer Waiting Times (version 9)

COSD (Cancer Outcomes and Services Dataset)

NHS Standard Contract 2017/18 and 2018/19 Particulars (Full Length)

Here are links to the two books I mentioned during the session:

This is the current TNM classification of malignant tumours (all tumours, not just eye ones)

A useful book for those interested in ocular oncology is the recently (end of 2018) released updated edition of the WHO classification of tumours of the eye.

Not sure where to start with pathology?

I’ve recently been made aware (thanks, Debbie!) of a new educational website about pathology, hosted by the University of Edinburgh. It’s aimed at undergraduates, but if you’re coming up to postgraduate examinations, it might be a useful place to refresh your knowledge.

Pathologia

Most of the cases I presented during the afternoon have already been posted on this blog (do feel free to explore the posts in the archives), but here are some new ones.

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Here are a couple of lymphomas for comparison of “low grade” and “high grade” features.

Case 1

This conjunctival biopsy (epithelium to the left) has a dense, sheet-like infiltrate of monotonous cells with small hyperchromatic (dark) nuclei and little cytoplasm. Immunohistochemistry (not shown) was needed for the specific diagnosis of extranodal marginal zone lymphoma (a B-cell lymphoma).

Case 2

In contrast, another lymphoma within the orbit also has a dense, sheet-like infiltrate of tumour cells. However, the nuclei are larger and more irregular (pleomorphic) with clumped chromatin and nucleoli. There are mitoses. Immunohistochemistry was also needed for this case, which has a diagnosis of diffuse large B-cell lymphoma.

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Case 3

This was a blind painful eye.

Low power of the posterior segment (retina at the top) shows retinal detachment with subretinal fluid. The choroid is massively expanded with necrotic material and some viable tumour.

Higher power view of the choroid shows some necrosis (to the right) with viable tumour on the left. The tumour forms glandular structures, with an appearance consistent with metastatic adenocarcinoma. I believe this patient was known to have a colonic primary.

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Case 4

As a bonus, this is an incidental finding in an enucleated eye. It’s a nice example of a Fuchs’ adenoma – a nodular hyperplasia of the nonpigmented ciliary body epithelium.

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In addition to the Moorfields Half Day Teaching once or twice a year, I run a monthly live microscopy session for trainees, fellows, researchers and other people with an interest in eye pathology. My next session is on Wednesday 13 March. Feel free to get in touch about it. You can use the contact form on this blog, or find me on Twitter.