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2013-2014 2 nd circulation

This collection of case studies highlights various ocular pathologies, including infections, tumors, and dystrophies. Each case presents different diagnostic challenges and provides insights into the appropriate diagnosis and management.

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2013-2014 2 nd circulation

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  1. 2013-20142nd circulation Dr HS Mudhar and Dr l Irione.

  2. Number of returns • 26

  3. Case 1 • H13.11805 • F 63 Left cornea; and anterior chamber infection.

  4. Case 1 responses • Amoebic/acanthamoebic keratitis: 23 • Acute keratits (gram and PCR for viral infection): 1 • Acute keratitis ?amoebic?fungal (fungal stains, giemsa,iron heamatoxylin) 1 • Acute keratitis (gram, grocott) 1 • ORIGINAL ANSWER:ACANTHAMOEBA KERATITIS

  5. Case 2 • H13.19069 • Left canaliculitis

  6. Case 2 responses • Actinomyces +/-dacryolith 20 • Mycetoma likely actionomyces 1 • Fungal infection possibly actino (gram grocott pas) 1 • Organism fungal? Actino? (grocott, pas gram). 1 • Dacryolith organism? (DPAS, gram) 1 • Splendore Hoeppli phenomenon (grocott gram) 1 • Mycetoma-acute canaliculitis 1 • ORIGINAL ANSWER: GRAM POSITIVE FILAMENTOUS BACTERIA CONSISTENT WITH ACTINOMYCES

  7. Case 3 • 40257/13 • M55 Vitreous opacities-cell block prep of vitreous

  8. Case 3 responses • Asteroid hyalosis 20 • 50:50 asteroid v amyloid (appropriate specials mentioned to distinguish) 1 • Asteroid 70%: Amyloid 30% 1 • No answer 1 • Silicone oil from vitrectomy 1 • Proteinaceous exudate (clinical correlation and PAS) 1 • Morgagnian droplets from ruptured liquefied degeneration of lens cortex 1 • ORIGINAL ANSWER: ASTEROID HYALOSIS

  9. Case 4 • 30590/13 • F10 Pigmented lesion bulbar conjunctiva getting larger

  10. Case 4 • Benign neavus (inflammation, juvenile, cyst 23 • Spitz naevus 1 • benign conj adenoma/hyperplasia or benign conj myoepithelial adenoma/hyperplasia (immuno for keratins and S100) 1 • squamous cell papilloma 1 • ORIGINAL ANSWER:INFLAMED JUVENILE COMPOUND MELANOCYTIC NAEVUS (?BACKGROUND OF ALLERGY AS EOSINOPHILS PRESENT)

  11. Case 5 • 24103/13 • M45 ITU patient developed ‘hot’ eye. No previous ocular trauma or surgery. Vitreous biopsy. • MST

  12. Case 5 • Fungal infection/vitritis/endophthalmitis ? Aspergillus 12 • Fungal vitritis /endophthalmitis (liaise with microbiology for species) 5 • Mycosis 1 • Candida infection 2 • Fungal infection? Mucor 2 • Aspergillosis 1 • Invasive fungal infection-aspergillosis 1 • Aspergillus infection of choroid 1 • Fungal emboli 1 • ORIGINAL ANSWER:ACUTE FUNGAL ENDOPHTHALMITIS OF ENDOGENOUS TYPE

  13. Case 6 • D13/087761 • F50 Firm lesion on right lower lid. Noticeably increasing in size over 2 months, PMH breast ca. On tamoxifen.

  14. Case 6 responses • Met breast ca (signet rings/lobular) 19 • Met breast ca (90%) exclude skin primary 1 • Adeno ca presume met likely from breast 1 • Lipogranuloma-chalazion 1 • Met breast ca (70%) v primary adnexal tumour (30%)-immuno panel 1 • Invasive ca likely breast primary or from other organ sites (immuno panel) 2 • Met signet ring ca (immuno-compare with original histology and immuno panel) 1 • ORIGINAL DIAGNOSIS:METASTATIC BREAST CARCINOMA

  15. Case 7 • D13/89250 • Malignant lesion on eyelid. Clinical diagnosis BCC.

  16. Case 7 responses • Malignant melanoma (with naevus) 22 • Malignant neoplasm-malignant melanoma 1 • Naevus 50%: melanoma 50% refer to skin patholgist 1 • Malignant melanoma (need to exclude carcinoma-immuno panel) 1 • Epithelioid tumour (melanoma 80% met ca 20%-immuno panel) 1 • ORIGINAL ANSWER:NODULAR MALIGNANT MELANOMA

  17. Case 8 • 2776/13 • M69 Incidental finding on CT: mass over orbital floor. Profuse bleeding during surgery

  18. Case 8 responses • Vascular anomoly/malformation 12 • Angioma/Haemangioma (cavernous) 12 • Cirsoid aneurysm4/angiolipoma4/haemagioma1/cav haemagioma1 1 • Angiolipoma 1 • ORIGINAL ANSWER: VASCULAR MALFORMATION

  19. Case 9 • 2415/13 • F32 left limbal dermoid

  20. Case 9 responses • Limbal dermoid/choristoma 21 • Collagenous fibroma 1 • Fibrolipoma 1 • Dermolipoma 1 • Keloid 1 • Connective tissue naevus 1 • ORIGINAL ANSWER: LIMBAL CONJUNCTIVAL DERMOID

  21. Case 10 • M10893/13 • M27 right lamellar keratoplasty for corneal dystrophy (bilateral).

  22. Case 10 responses • Macular corneal dystrophy 17 • Corneal mucopolysaccharide deposition (macular dystrophy favoured over systemic) 3 • Macular 80%-:Schyder 10%:crystalline 10% (special stains) 1 • Dystrophy 50%exogenous material (50) connective tissue stains, history, PAS 1 • Looks like lipid deposition, given age most likely Schnyder corneal dystrophy (80); macular dystrophy (10); fleck dystrophy (10); oil red O, sudan black, alcian blue, colloidal iron, clinical correlation 1 • Odd manifestation of macular; something lipid like Schnyder; clinical information; AB; Oil red O 1 • Schyner corneal dytrophy; clinical apperance, genetics, family history 1 • Keratoconus (PAS, masson trichrome, congo red, EVG) 1 • ORIGINAL ANSWER: Mucopolysaccharidosis / macular corneal dystrophy

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