Transcript Ophthalmic Pathology - MAPA (Mid

A joint conference with MAPA and PANE 2009
Ophthalmic Pathology
Emiko Furusato, M.D.
Department of Neuropathology and Ophthalmic Pathology
Armed Forces Institute of Pathology
Contents
• Grossing the globe
• Ocular histology
• 10 Representative cases
Grossing the ocular specimen
• Four basic steps
1.
2.
3.
4.
Orient the specimen and determine laterality
Measurements
Transillumination (TI)
Sectioning the globe
Grossing the ocular specimen
1. Orient the specimen and determine laterality
• Anatomic landmarks that orient the specimen
– Cornea: Horizontal meridian is wider
– Long posterior ciliary vessels: Blue line marks
horizontal meridian posteriorly
– Inferior oblique: Inferotemporal quadrant, nasal
end near fovea, no tendon
– Superior oblique: Superiorly and temporally, shiny
tendinous insertion
Superior oblique muscle
Long ciliary vessel
Optic nerve
Temporal side
Nasal side
Inferior oblique muscle
Vortex vein
Posterior aspect of left eye
Superior oblique muscle
Optic nerve
Nasal
Nasal
sideside
Temporal side
Inferior oblique muscle
Long ciliary vessels
Posterior aspect of right eye
Horizontal diameter :11 mm
Nasal side
Temporal side
Vertical diameter: 10mm
Anterior aspect of right eye
Grossing the ocular specimen
2. Measurements
• Globe:
– AP (antero-posterior including the cornea),
Horizontal, Vertical, length of the optic nerve
– Normal eye (24 mm = one inch) in diameter
• Cornea: Horizontal and vertical planes
– 12 (horizontal) x11mm (vertical) or 11X10mm.
• Diameter of pupil
• Note dimensions of any lesions such as wounds,
tumors, etc
Grossing the ocular specimen
3.Transillumination (TI)
Grossing the ocular specimen
3.Transillumination (TI)
• Transilluminated prior to dissection.
• Use dissecting microscope illuminator in a darkened
room.
• Applications
– Uveal malignant melanoma
– Dark shadow on the sclera
Dark band of ciliary body
Pupil
Pigmented tumor show round shadow
Ciliochroidal melanoma
Lens
Ciliary body
Optic nerve
Retinal detachment
Grossing the ocular specimen
4.Sectioning for the globe
Pupillary Optic nerve (PO) section
Optic nerve
Superior calotte
Inferior calotte
Initial cut: Cornea side down
Grossing the ocular specimen
4.Sectioning the globe
Inferior calotte
Second cut: Cut surface down
Grossing the ocular specimen
4.Sectioning the globe
Posterior synechiae
Cornea
Lens
Retinal detachment
Choroid
Subretinal exudate
Ocular Histology
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•
Conjunctiva
Cornea
Iris / Ciliary body
Lens
Retina
Choroid
Ocular Histology
Histology:
Conjunctiva
•Conjunctiva
‒ Epithelium, goblet cells
‒ Stroma
•Topographic zones
‒ Tarsal (palpebral)
‒ Fornix
‒ Bulbar
Ocular Histology
Histology:
Cornea
• Epithelium
– Nonkeratinizing, 5-layered
• Bowman’s layer
– Thick collagenous layer underlying the
basal cell basement membrane
• Stroma
– Collagen lamellae secreted by fibroblasts
interrupted by large artifactual clefts
• Descemet’s membrane
• Endothelium
– Single layer of cuboidal cells
Ocular Histology
Histology: Iris & Ciliary body
•
Iris (anterior to posterior 4 zone)
– Anterior border layer
– Stroma
– Partially pigmented epithelium
– Completely pigmented posterior pigment epithelium
 Sphinctor muscle appears as a ring in the pupillary stroma
• Ciliary body
- Nonpigmented ciliary epithelium
- Pigmented ciliary epithelium
- Stroma, ciliary muscle
Histology : Iris/
ciliary body
• Iris
– Anterior limiting
layer’-Stroma
• Sphincter pupillae
•Pigment
epithelium( double
layer)
•Ciliary body
•Nonpigmented
epithelium-Pigmented
epithelium’-Stroma,
ciliary muscle
Ocular Histology
Histology : Lens
•Lens capsule
•Anterior: single-layer, cuboidal,
inverted lens epithelium secretes
the overlying thick
basemembrane
•Posterior: No epithelium
therefore, remains thinner than
anterior capsule
• Lens cortex and nucleus
•Layers of lens cells (‘fibers’) that
become compressed as they
move inward
Ocular Histology
Histology : Retina
Internal limiting membrane
Nerve fiber layer
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
External limiting membrane
Photoreceptors, Rods and cones
Retinal pigment epithelium
Histology : Choroid/Sclera
•Choroid
–Bruch’s membrane
–Choriocapillaris
–Chroidal stroma
–Suprachroidal (potential)
space
•Sclera
–Stroma
–Episclera
Physiologically thin
( limbus, behind the
insertion of the rectus
muscles and around Optic
nerve)
10 Representative cases
Conjunctival Cases
Case 1