Transcript Dr. Emiko Furusato - Midatlanticpas.org

• Diagnosis
– Chronic glaucoma with secondary angle closure
following central retinal vein occlusion with
hemorrhagic infarction of retina and
neovascularization of iris.
– Disciform macular degeneration
Choroid Cases
Case 8
Case History
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41 yo male; Shadow over his left eye for 6M
IOP : normal,
Vision: 20/20 OD, and 20/25 OS.
Left fundus revealed a large grayish yellow
mushroom–like mass that elevated the retina
superonasally.
Case History
• Tumor contained very little pigment and was
not completely opaque on transillumination.
• Visual field test revealed a scotoma
corresponding to the tumor.
• Right eye : perfectly normal.
• Clinical diagnosis: Amelanotic melanoma of
the chroid.
Case History
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Gross description: 25 x 24 x 23 mm.
Optic nerve was cut flush with the globe.
Slightly hazy cornea: 13.5 x 11 mm.
Globe transmitted light well except for a
round shadow 15x15mm, posteriorly.
• Eye was opened horizontally.
Case History
• Anterior segment was not remarkable.
• Lens was in place and vitreous clear.
• Arising within the choroid nasally, the
posterior margin of the mass extended to the
edge of the optic nerve head nasally.
• The retina overlying the mass contained small
amounts of pigment.
Spindle cell type X10
Spindle cell type X40
• Diagnosis.
– Malignant melanoma of choroid, spindle cell type
( fascicular pattern )
– Retinal invasion,
– Retinal detachment.
Uveal melanoma
• Most common primary intraocular tumor of
adult.
• Arise from dendritic melanocytes of the uvea
• Caucasians 8.5 x than African Americans.
• Most posterior uveal melanomas present with
painless visual loss
• Uveal melanomas spread first to the liver
Cell type
Spindle cell type
Epithelioid cell type
Uveal melanoma
• Prognostic factor
– Size : Tumor height
– Cell type : Epithelioid cells
– Proliferative index
– Tumor-infiltrating lymphocytes associated with
adverse outcome
– Extra ocular extention
– Monosomy 3 and trisomy 8
– The presence of looping pattern
Case 9
Case History
• 18 yo female sustained a penetrating superior
limbal wound of right eye.
• Next day the wound was repaired with
excision of the prolapsed iris.
• One month later, the patient conplained
persistent pain in the right eye and failing
vision in left eye.
• Enunciation of the right eye were performed.
X10
Dalen-Fuchs nodule
Choriocapiralis
Sympathetic Ophthalmia (SO)
• Bilateral granulomatous panuveitis following
surgical / accidental trauma to one eye, likely
an autoimmune inflammatory response
against ocular antigens.
• Uveitis ranges from 5 days up to 50years after
injury; however, over 90 % cases occur from 2
weeks to within 1 year.
Sympathetic Ophthalmia (SO)
• Histologic findings
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Diffuse granulomatous uveal inflammation
Eosinophils may be plentiful
Plasma cells are few or moderate in number.
Neutrophils rare or absent
Sparing of choriocapillaris
Epithelioid cells with phagocytosed pigment
Dalen-Fuchs nodules
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Epithelioid cells between Bruch’s membrane and
retinal pigment epithelium
Lens Cases
Case 10
Case History
• Clinical history not available.
• Gross description not available.
Lens x2
Thinning of nerve fiber layer
Mild optic atrophy
• Diagnosis
– Phacolytic glaucoma
Phacolytic glaucoma
• Secondary open angle glaucoma
– Hyper mature (White) cataract
– Milky material may be seen in the AC
• Denatured lens protein leak through the intact
lens capsule in advanced cases and stimulates
a bland macrophagic response.
• Obstruction of the trabecular meshwork by
macrophages that have ingested lens material
and free high-molecular-weight lens protein
Phacolytic glaucoma
• Histologic findings
– Hypermature cataract
– Macrophages filled with eosinophilic lens
material are seen in the aqueous fluid and on
and in the iris, occluding the anterior –chamber
angle.
– The macrophages are not present on the corneal
endothelium.
References
• Ocular Pathology sixth edition,
Myron Yanoff Joseph W. Sassani
• Eye Pathology An atlas and Basic text, Eagle
• Robbins and Cotran Pathologic Basis of
Disease 7th edition, Kumar Abbas Fausto
• AFIP ATLAS OF TUMOR PATHOLOGY Series 4,
Tumors of the Eye and Ocular Adnexa, Font,
Croxatto, Rao
Thank you!