2020 posts

Here are all the posts so far from this year

  • Eye pathology case 16 - I recently received a query as to whether I’ve come across corneal copper deposition, as we might see in the Kayser-Fleischer ring of Wilson disease. Not sure who Kayser, Fleischer or Wilson were? Here’s a little information. There’s a nice picture of the clinical appearance and an overview of Wilson disease here. On checking our… Continue reading Eye pathology case 16
  • Eye pathology case 15 - Cornea from a young adult with gradually worsening vision This low power image shows a full thickness cornea with a little artefactual creasing. Remember, the 5 layers are: epithelium, Bowman’s layer, stroma, Descemet’s membrane and endothelium. The stroma is perhaps a little thinned towards the right of centre, and there is subtle scarring in the… Continue reading Eye pathology case 15
  • Eye pathology case 14 - Enucleation specimen The patient is an elderly male. The reason for surgery is a choroidal melanoma, but I’m not going to show that in this post: there’s something else of note. This low power image shows the anterior segment (cornea, iris, ciliary body and lens). The feature of interest is that instead of having a… Continue reading Eye pathology case 14
  • Eye pathology case 13 - Incidental finding in an enucleation specimen I took a little break from pathology last week and shared a fiction reading post from my other website. Back to some interesting (I hope!) cases now. This low power image is centred on the ciliary body and adjacent sclera. It also shows the limbus (on the right) with… Continue reading Eye pathology case 13
  • Eye pathology case 12 - Conjunctival mapping biopsies from an elderly patient This conjunctival specimen is folded, which is why we have epithelium on the top and bottom of the image. The epithelium is disorganised and has lost its normal maturation pattern. That is, for much of the specimen we don’t have a neat basal row of small cells with… Continue reading Eye pathology case 12
  • Eye pathology case 11 - Middle-aged patient with worsening vision many years after a previous procedure This low power view shows a full thickness corneal button. We’ve sliced it in two and embedded both halves on our cut surface. It is not obviously inflamed or vascularised (something I specifically mention in my reports as a negative finding). However, there is… Continue reading Eye pathology case 11
  • Eye pathology case 10 - Orbital mass in a young adult This is a low power image. The tumour is solid (as opposed to eg cystic or nested). There are prominent vascular spaces with an irregular “staghorn” profile. In the annotated image, I’ve outlined a few of the irregular vessels in green. In this higher power field, we see the… Continue reading Eye pathology case 10
  • Eye pathology case 9 - Evisceration of a blind eye with multiple previous operations Evisceration specimens usually include the cornea (with a scleral rim) as well as the intraocular content. In contrast to enucleations, the tissue is disrupted by the surgery. This can make it difficult to recognise anatomic structures, especially as there is often scarring and disorganisation due to… Continue reading Eye pathology case 9
  • Eye pathology case 8 - Cornea from an elderly female with gradually deteriorating vision Corneas make up a significant proportion of our workload. Most of our corneal specimens fall into four categories: endothelial failure, dystrophies, infections or interference with vision (eg scarring or ectasia). This specimen is full thickness cornea, with the epithelium on the right and endothelium on the… Continue reading Eye pathology case 8
  • Eye pathology case 7 - Enucleation specimen. Intractable raised intraocular pressure due to an iris mass. This is a low power view of the anterior segment (cornea, anterior chamber, iris, ciliary body and a piece of lens). The section is off-centre, and so the iris is continuous rather than having a central gap where the pupil is. The iris is… Continue reading Eye pathology case 7
  • Eye pathology case 6 - Biopsy from a young adult with an orbital mass and pain For those of you sitting exams (whether ophthalmologists or histopathologists), this is a classic pattern to recognise. It shows cribriform (“sieve-like”) architecture, sometimes compared to Swiss cheese for obvious reasons. There are nests of basaloid tumour cells containing punched-out cystic spaces filled with mucin.… Continue reading Eye pathology case 6
  • Eye pathology case 5 - Persistent eyelid lump First, some background orientation. Here’s a normal full-thickness eyelid. Epithelium forms a continuous cover of the surfaces, with epidermis at the top and conjunctiva at the bottom. Beneath the epidermis lies skeletal muscle (orbicularis). Deep to that lies the tarsal plate. The tarsal plate consists of dense fibroconnective tissue and the meibomian… Continue reading Eye pathology case 5
  • Eye pathology case 4 - Temporal artery biopsies Temporal artery biopsies are submitted when there is a clinical concern about temporal arteritis (also known as giant cell arteritis—GCA—or cranial arteritis). Patients may initially present to the ophthalmologist with sudden and catastrophic visual loss (anterior ischaemic optic neuropathy). They may also have headache or more generalised symptoms such as joint pain… Continue reading Eye pathology case 4
  • Eye pathology case 3 - This is a classic exam-type case for the FRCOphth and similar examinations. The patient is a young adult undergoing a corneal graft. (Click on the images to see them full-sized) This is a low power view. Non-keratinising stratified squamous epithelium covers the convex surface. Beneath it lies Bowman’s layer (not readily visible at this power)… Continue reading Eye pathology case 3
  • Eye pathology case 2 - Here’s a case that I came across recently. I know I said in my last post I’d concentrate on common or exam-type diagnoses, but this one is a useful clinical pitfall to know about. Young adult with a subconjunctival pigmented area ?melanoma This medium power image shows fibroconnective tissue with no identifiable epithelium. Centrally, there… Continue reading Eye pathology case 2
  • Eye pathology case 1 - Now that I’m not doing face-to-face teaching sessions, I plan to post educational eye pathology cases online. These are likely to be exam-type cases (for ophthalmology and pathology trainees) and/or common cases that a pathology laboratory might receive for reporting. Those of you following my teaching blog might notice some repeats from previous posts, but… Continue reading Eye pathology case 1
  • A brief update - I’ve been rather quiet on this blog, but 2020 got off to a rough start. First there were personal matters to deal with, and now the coronavirus pandemic is occupying pretty much everyone’s attention. Our department is working from home as much as we can. Unfortunately, this means my monthly microscopy sessions are on hold… Continue reading A brief update
  • Microscopy January 2020 - In yesterday’s session, we covered a lot of topics including eyelid anatomy, differential diagnosis of lymphomas using immunohistochemistry, various tumours with myxoid stroma and a few benign skin tumours. Here are a few of the case we discussed. Case 1 Enucleation for an intraocular tumour The tumour was anteriorly located, and there was iris rubeosis… Continue reading Microscopy January 2020