OPHTHALMIC PATHOLOGY FOR THE NON-SPECIALIST

Course Directors: J. GODFREY HEATHCOTE, M.B.,Ph.D. The University of Western Ontario London, Ontario JANICE R. SAFNECK, M.D. The University of Manitoba Winnipeg, Manitoba Clinical histories are printed below. Click on the case numbers for text and references of each case. Click on the slide images for a larger view of each slide. Case 1 - Sebaceous Carcinoma with Infiltration of Orbit A recurrent eyelid tumor in a 69-year-old woman treated by orbital exenteration Case 1, Slide 1 - Sebaceous Carcinoma with Infiltration of Orbit: Lobular growth pattern of carcinoma Case 1, Slide 2 - Sebaceous Carcinoma with Infiltration of Orbit: Comedo necrosis Case 1, Slide 3 - Sebaceous Carcinoma with Infiltration of Orbit: Malignant cells with pale, foamy cytoplasm Case 2 - Squamous Cell Carcinoma of Conjunctiva and Cornea A recurrent conjunctival tumor in a 62-year-old man treated by orbital exenteration Case 2, Slide 4 - Squamous Cell Carcinoma of Conjunctiva and Cornea: Upper fornix with carcinoma-in-situ of bulbar and palpebral conjunctival epithelium Case 2, Slide 5 - Squamous Cell Carcinoma of Conjunctiva and Cornea: Squamous cell carcinoma-in-situ of bulbar conjunctiva Case 3 - Compound Cystic Nevus of Conjunctiva A 9-year-old girl was noted to have an enlarging pigmented lesion in bulbar conjuctiva at 3 o'clock adjacent to the limbus. Case 3, Slide 6 - Compound Cystic Nevus of Conjunctiva: Gross photograph of conjunctival nevus showing a tan lesion measuring 7 x 3 x 2 mm. Suture designates medial and nasal margin. Case 3, Slide 7 - Compound Cystic Nevus of Conjunctiva: Epithelial inclusion cysts and nevus cells within epithelium and subepithelial tissue. Case 4 - Conjunctival Malignant Melanoma Arising in Primary Acquired Melanosis An 83-year-old woman developed a pigmented lesion on her left bulbar conjunctiva. The lesion was excised and diagnosed as a junctional nevus. One and one half years later, she was noted to have a focal corneal pannus with a few flecks of pigment and this was biopsied. Case 4, Slide 8 - Conjunctival Malignant Melanoma Arising in Primary Acquired Melanosis: Conjunctival malignant melanoma, essentially amelanotic, invading cornea Case 4, Slide 9 - Conjunctival Malignant Melanoma Arising in Primary Acquired Melanosis: Malignant melanoma with a rare mitotic figure Case 4, Slide 10 - Conjunctival Malignant Melanoma Arising in Primary Acquired Melanosis: Primary acquired melanosis with atypia. Collections of melanocytic cells are present within the lower two-thirds of the conjuctival epithelium. The cellular infiltrate visible in the substantia propria is inflammatory. Case 4, Slide 11 - Conjunctival Malignant Melanoma Arising in Primary Acquired Melanosis: Primary acquired melanosis with atypia showing atypical melanocytes with an occasional mitotic figure (centre) Case 5 - Sclerosing Inflammatory Pseudotumor of Orbit A 5-year-old boy was admitted with a diagnosis of orbital cellulitis. A CT scan revealed an orbital mass that was biopsied. Case 5, Slide 12 - Sclerosing Inflammatory Pseudotumor of Orbit: Fibro-fatty tissue with areas of dense collagen, fibroblasts and scattered inflammatory cells Case 5, Slide 13 - Sclerosing Inflammatory Pseudotumor of Orbit: Plump fibroblasts; eosinophils in inflammatory infiltrate Case 6 - Malignant Melanoma of Choroid and Ciliary Body An 84-year-old man presented with decreased visual acuity in his right eye of 8 days duration. Case 6, Slide 14 - Malignant Melanoma of Choroid and Ciliary Body: Cut surface of eye showing a pale tan nodular lesion with focal hemorrhage, basal diameter of 12 mm and elevation of 9 mm, arising from the choroid. Tumor has penetrated both the choroid and retina and abuts the posterior surface of the lens. Case 6, Slide 15 - Malignant Melanoma of Choroid and Ciliary Body: The tumor is a spindle cell melanoma which is essentially amelanotic. Note the mitotic figure. Case 7 - Microphthalmos (Fryns Syndrome) Eye removed post-mortem from a female infant of 33 weeks gestation with multiple congenital anomalies and apparent anophthalmos. Case 7, Slide 16 - Microphthalmos (Fryns Syndrome): Anterior segment of eye with corneal scar, hypoplastic iris, cataractous lens and dysplastic retina. Case 7, Slide 17 - Microphthalmos (Fryns Syndrome): Parakeratosis of corneal epithelium, loss of Bowman's membrane, anterior stromal scar and neovascularization. Case 7, Slide 18 - Microphthalmos (Fryns Syndrome): Dysplastic retina with rosettes and retrolental fibrovascular membrane. Case 8 - Penetrating Ocular Trauma An 87-year-old woman fell and hit her right eye on the corner of her dresser. Case 8, Slide 19 - Penetrating Ocular Trauma: Front view of a partially collapsed globe displaying rupture at the limbus superiorly with reddish material protruding from the wound. Blood is visible through the wrinkled cornea. Case 8, Slide 20 - Penetrating Ocular Trauma: Cut surface of eye revealing abundant intraocular hemorrhage beneath partially detached ciliary body, retina and choroid. No lens is visible. Blood is present within the wound. Case 8, Slide 21 - Penetrating Ocular Trauma: Photomicrograph of limbal rupture with ciliary body protruding through the defect. Case 9 - Bacterial Endophthalmitis A 72-year-old woman with an indwelling bladder catheter developed a mixed bacterial urinary tract infection. She was receiving a course of intravenous antibiotics when vision in her left eye markedly decreased. Case 9, Slide 22 - Bacterial Endophthalmitis: Cut surface of globe showing yellow to white material particularly prominent around anterior segment structures, as well as within vitreous cavity and posteriorly in the region of the optic nerve head. Case 9, Slide 23 - Bacterial Endophthalmitis: Pupil-optic nerve section showing a cellular infiltrate in the anterior chamber extending across the pupil, surrounding the lens, within vitreous (especially near the ciliary body and ora serrata) and near the optic nerve head. Case 9, Slide 24 - Bacterial Endophthalmitis: Abundant acute inflammation in retina and vitreous as well as chronic non-granulomatous inflammation in the choroid. Case 10 - Iris Neovascularization with Retinal Detachment A 74-year-old woman with neovascular glaucoma was treated with laser photocoagulation of the ciliary body. The eye was subsequently enucleated. Case 10, Slide 25 - Iris Neovascularization with Retinal Detachment: Funnel-shaped, tractional retinal detachment; cataract. Case 10, Slide 26 - Iris Neovascularization with Retinal Detachment: Microcystoid change in outer plexiform layer of detached retina; absence of photoreceptors ;pre-retinal membrane. Case 10, Slide 27 - Iris Neovascularization with Retinal Detachment: Mildly degenerate retina with pre-retinal and sub-retinal membranes. Case 11 - Congenital Glaucoma (Buphthalmos) A 28-year-old woman had an abnormal left eye from infancy that became blind and painful. Case 11, Slide 28 - Congenital Glaucoma (Buphthalmos): The enlarged cornea shows a small ulcer, white areas corresponding microscopically to band keratopathy and fibrosis, laterally at the limbus an elevated area of Salzmann's nodular degeneration and peripheral vascularization. Conjunctival and episcleral vessels are congested. Case 11, Slide 29 - Congenital Glaucoma (Buphthalmos): Pupil-optic nerve section of the globe with enlarged anterior chamber, peripheral anterior synechiae, staphyloma posteriorly in relation to the macula and cupped optic nerve head. Case 11, Slide 30 - Congenital Glaucoma (Buphthalmos): Retina with loss of ganglion cell layer. Case 12 - Age-related Macular Degeneration Eye removed post-mortem from an 86-year-old blind woman who died of congestive heart failure Case 12, Slide 31 - Age-related Macular Degeneration: Gross photograph showing irregular, elevated opacity with central pigmentation at macula Case 12, Slide 32 - Age-related Macular Degeneration: Sub-retinal fibrous tissue (disciform scar) at macula containing proliferated retinal pigment epithelial cells. Case 12, Slide 33 - Age-related Macular Degeneration: Fibrovascular scar with retinal pigment epithelium beneath macula. Appendix Opinions stated and/or conclusions reached in this syllabus are the responsibility of the authors and are not necessarily endorsed by the Academy.