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Ophthalmic Pathology
Sunday, March 18, 2012, 7:30 PM
Convention Centre 215
Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Pathology of the Cornea
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Moderator:
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THOMAS J. CUMMINGS
Duke Univ Med Ctr
Durham, NC
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose.
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Panelists:
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Michele M. Bloomer, UCSF , San Francisco, CA
Patricia Chevez-Barrios, The Methodist Hospital, Houston, TX
Gordon K. Klintworth, Duke Univ Medical Center, Durham, NC
Lynn Schoenfield, Cleveland Clinic, Cleveland, OH
Nora V. Laver, Tufts Medical Centr, Boston, MA
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Clinical histories are displayed below.
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for Text and References
Submitted by: Michele M. Bloomer -
UCSF , San Francisco, CA
Case #1 A 31 year old female with a history of congenital cataracts and microphthalmos underwent cataract surgery and was left aphakic. Over the next few years the patient’s vision deteriorated and she developed pain. The patient also has a history of glaucoma controlled by topical drops. Best corrected visual acuity at presentation was 20/200. Her cornea was opaque with a central corneal thickness of 904µm. She had several corneal epithelial defects. A penetrating keratoplasty was performed and the cornea button was sent to pathology.
Case #2 A 19 year old female patient with Down Syndrome had progressively decreasing vision. Her best corrected visual acuity is Count Fingers at 4 ft. A penetrating keratoplasty is performed and the corneal button is submitted to pathology.
Case #3 A 73 year old female patient with progressive, painless loss of vision bilaterally underwent cataract surgery in her left eye one year ago. Visual acuity did not improve postoperatively and has continued to decline. She also has developed pain in her left eye. A penetrating keratoplasty is performed on her left eye.
Case 1A - Figure 1
(H&E, 1.25x) Full thickness corneal button from a penetrating keratoplasty. Overall corneal thickness is increased secondary to stromal edema. |
Case 1A - Figure 2
(PAS, 10x) Bullous keratopathy: diffuse epithelial thinning with focal disruption consistent with a ruptured bulla, epithelial basement membrane thickening, supepithelial fibrosis, focal destruction of Bowman's membrane, anterior keratocyte depletion, anterior stromal scarring and posterior stromal edema. |
Case 1A - Figure 3
(PAS, 20x) Higher power view of anterior cornea highlighting diffuse epithelial thinning, epithelial basement membrane thickening, supepithelial fibrosis, focal destruction of Bowman\'s membrane, anterior keratocyte depletion and anterior stromal scarring |
Case 1A - Figure 4
(PAS, 20x) Endothelial failure: Descemet's membrane stains positively with PAS, severe endothelial cell loss. |
for Text and References
Submitted by: Patricia Chevez-Barrios -
The Methodist Hospital, Houston, TX
The patient is a 56 year-old female with history of slowly decrease in visual acuity for several years with a sister that had similar symptomas and necessitated a corneal graft. Visual acuity in both eyes was 20/200. On slit lamp examination the cornea shows bilateral central white deposits in the stroma that are granular with clear spaces in between. No epithelial defects or endothelial lesions were seen. The patient also had 1+ subcapsular lens opacities. The remainder of the ocular examination was within normal limits. She underwent keratectomy (corneal graft) of the left eye.
Case 2 - Figure 1
Clinical picture of cornea with well-defined deposits in the stroma with clear spaces. |
Case 2 - Figure 2
H&E stain of keratectomy specimen with eosinophilic deposits in stroma and Bowman's layer. |
Case 2 - Figure 3
Trichrome Masson stain of keratectomy specimen showing bright red deposits in stroma and Bowman's layer. |
for Text and References
Submitted by: Gordon K. Klintworth -
Duke Univ Medical Center, Durham, NC
A 55 year old Caucasian woman presented with progressive clouding of her vision over an eight year period. None of her family were known to have any eye disease. Bilateral corneal opacities were centered over the visual axis. Her vision could not be corrected by refraction and to restore vision a penetrating keratoplasty was performed.
Case 3 - Figure 1
Acellular abnormal material in posterior corneal stroma. Masson trichrome stain |
Case 3 - Figure 2
Acellular abnormal material in posterior corneal stroma. Hematoxylin and eosin stain. |
Case 3 - Figure 3
Multifocal markedly eosinophilic spindle shaped acellular regions in superficial corneal stroma. Hematoxylin and eosin stain. |
Case 3 - Figure 4
Higher magnification of Fig 2. Hematoxylin and eosin stain. |
Case 3 - Figure 5
Extensive acellular eosinophilic accumulation adherent to the corneal stroma. Descemet membrane is not evident. Hematoxylin and eosin stain. |
Case 3 - Figure 6
Multifocal acellular spindle shaped foci in the superficial corneal stroma. Note similarity to Case 3-Fig 3. Masson trichrome stain. |
for Text and References
Submitted by: Lynn Schoenfield -
Cleveland Clinic, Cleveland, OH
Case 4a: 49 year old male with presumed fungal endophthalmitis.
Case 4b: 82 year old female with corneal melt syndrome.
Case 4c: 74 year old male with HPN and DM with previous corneal transplant and expected
endophthalmitis. He subsequently required enucleation, which revealed endophthalmitis
and necrotizing keratitis.
Case 4d: 79 year old male with perforated ulcer. He subsequently required enucleation.
Case 4e: 59 year old female with keratitis and history of contact lens use.
Case 4f: 80 year old female with chronic corneal ulcer.
Case 4a - Slide 1
Acanthamoeba: H&E and GMS stains showing double- walled cysts measuring approximately 20 microns in size.
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Case 4a - Slide 2
Acanthamoeba: H&E and GMS stains showing double- walled cysts measuring approximately 20 microns in size.
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Case 4b - Slide 1
Staphylococcus aureus: H&E and gram stains, the latter showing few clusters of gram positive cocci.
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Case 4b - Slide 2
Staphylococcus aureus: H&E and gram stains, the latter showing few clusters of gram positive cocci.
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Case 4c - Slide 1
Candida parapsilosis: H&E and GMS stains showing yeasts and keratitis.
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Case 4c - Slide 2
Candida parapsilosis: H&E and GMS stains showing yeasts and keratitis.
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Case 4c - Slide 3
Candida parapsilosis: H&E and GMS stains showing yeasts and keratitis.
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Case 4d - Slide 1
Aspergillus fumigatus: H&E and PAS stains showing necrotizing keratitis with ulcer and associated septated fungi.
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Case 4d - Slide 2
Aspergillus fumigatus: H&E and PAS stains showing necrotizing keratitis with ulcer and associated septated fungi.
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Case 4e - Slide 1
Fusarium species: H&E and PAS stains showing necrotizing keratitis with ulcer and associated large irregular septated fungi.
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Case 4e - Slide 2
Fusarium species: H&E and PAS stains showing necrotizing keratitis with ulcer and associated large irregular septated fungi.
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Case 4f - Slide 1
Herpes virus: H&E stain and immunoperoxidase stain for Herpes virus showing typical multinucleated giant cells with intranuclear inclusions which are positive for Herpes virus with immunoperoxidase staining.
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Case 4f - Slide 2
Herpes virus: H&E stain and immunoperoxidase stain for Herpes virus showing typical multinucleated giant cells with intranuclear inclusions which are positive for Herpes virus with immunoperoxidase staining.
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for Text and References
Submitted by: Nora V. Laver -
Tufts Medical Center, Boston, MA
88-year-old female referred to the eye clinic for a papillomatous growth in the right eye involving the cornea and nasal conjunctiva, progressively increasing in size. The patient denied pain or discomfort, floaters, or change in vision. Her ocular history was significant for central retinal vein occlusion in her right eye ten years ago. She also had glaucoma with suspected narrow angles, no previous surgery or laser treatment. Her medical history was significant for hypertension, pacemaker and hypothyroidism.
Case 5 - Slide 1
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Case 5 - Figure 1
Nodular lesion with prominent vascularity arising in the bulbar nasal limbus involving the cornea and adjacent conjunctival epithelium. Notice the whitish are in the center of the lesion. |
Case 5 - Figure 2
Higher magnification of the lesion visualized with slit-lamp microscopy highlighting the fleshy and papillomatous configuration of the lesion. |
Case 5 - Figure 3
(2x and 4x). Papillomatous squamous growth with mild to moderate dysplastic changes. |
Case 5 - Figure 4
(2x and 4x). Papillomatous squamous growth with mild to moderate dysplastic changes. |
Case 5 - Figure 5
(2x and 4x). Papillomatous squamous growth with mild to moderate dysplastic changes. |
Case 5 - Figure 6
(2x, 4x, 10x, 20x). Flat squamous intraepithelial neoplasia, severe dysplasia/carcinoma in situ. |
Case 5 - Figure 7
(2x, 4x, 10x, 20x). Flat squamous intraepithelial neoplasia, severe dysplasia/carcinoma in situ. |
Case 5 - Figure 8
(2x, 4x, 10x, 20x). Flat squamous intraepithelial neoplasia, severe dysplasia/carcinoma in situ. |
Case 5 - Figure 9
(2x, 4x, 10x, 20x). Flat squamous intraepithelial neoplasia, severe dysplasia/carcinoma in situ. |
Case 5 - Figure 10
(2x, 4x, 10x, 20x). Flat squamous intraepithelial neoplasia, severe dysplasia/carcinoma in situ. |
Case 5 - Figure 11
(10x). P16 immunohistochemical stain highlights the area of severe dysplasia/carcinoma in situ. |
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