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Non-neoplastic globe pathology

Non-neoplastic globe pathology. Case 1. White mass in vitreous. THIS MASS IN THE VITREOUS CAVITY IS COMPOSED OF WALL-TO-WALL NEUTROPHILS. Gram + (dark blue) cocci. Endogenous bacterial endophthalmitis. Endophthalmitis.

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Non-neoplastic globe pathology

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  1. Non-neoplastic globe pathology

  2. Case 1

  3. White mass in vitreous

  4. THIS MASS IN THE VITREOUS CAVITY IS COMPOSED OF WALL-TO-WALL NEUTROPHILS

  5. Gram + (dark blue) cocci.

  6. Endogenous bacterial endophthalmitis

  7. Endophthalmitis • Inflammation of one or more coats of the eye and adjacent intraocular spaces. • Infectious (exogenous or endogenous) and non-infectious (lens induced, foreign body)

  8. Infective endophthalmitis • Causes after surgery: Gram + bacteria:Staphs, streps, corynebacterium, propionibacterium Gram- bacteria: pseudomonas, proteus, haemophilus, klebsiella, E-coli, enterobacter. Fungi: Aspergillus, candida, penicillium • Causes of endogenous endophthalmitis Fungi: Candida and Aspergillus Bacteria: Neisseria meningitidis, streptococcus, staphs, bacillus cereus, nocardia

  9. Case 2

  10. History • Male adult • Leukaemia • On chemo. • Brain abscess • Dies • Total body biopsy (Autopsy). • Eyes examined by ophthalmic pathologist.

  11. Retina in reasonable good shape

  12. Full thickness necrosis of neural retina, featuring a homogeneous eosinophilic appearance with loss of cell details and ghost outlines of cells. Very little inflammation.

  13. Cysts containing bradyzoites (multiple black dots in pink cysts)

  14. TOXOPLASMOSIS • Unicellular protozoal parasite. • Definitive host is CAT • Intermediate hosts: humans, rodents, fowl.

  15. Toxoplasmosis • Parasite invades retinal cells directly • Focal retinitis with an overlying vitritis • In this case presented with ARN (well recognised).

  16. Toxoplasmosis • Years later-reactivation can occur in areas of scars • Congenital and acquired forms • Congenital form-associated with encephalomyelitis, hepatosplenomegaly and retino-choroiditis

  17. Histology of Toxoplasmosis • Protozoa in 3 forms • Free trophozoite-lives in intracellular vacuole. • Pseudocyst form-many protozoa enclosed by retinal cell membrane. • Bradyzoite surrounded by self-made membrane-becomes cyst and can be extruded from retinal cells. Cyst forms when environment hostile. Cyst can remain latent.

  18. Case 3 Red eye Patient just arrived from South-East Asia

  19. Exudate in AC Thickened iris

  20. Granulomatous inflammation

  21. Pink, acid fast bacilli, stained with Ziehl-Neelsen stain. Other ways of detecting TB-Culture, PCR.

  22. TB UVEITIS

  23. TB AND THE EYE • Direct innoculation, contiguous or blood-borne. • Lids, conj, orbit, cornea, episclera and sclera, retina, optic nerve all involved. • Cornea-immune mediated reaction (interstitial keratitis). • Choroid vulnerable-rich blood supply

  24. NON-INFECTIVEINFLAMMTION

  25. 1

  26. Non-caseating naked granulomas, in retina

  27. SARCOID AND EYE • Idiopathic • Afro-caribbeans • 30 % ocular involvement • Uvea, retina, lacrimal gland • Anterior uveitis, pars planitis, retinal periphlebitis • Nodules on lids, conj, band keratopathy • Non-necrotising granulomatous inflammation + fibrosis later on. • Naked granulomas. • Can undergo necrosis • Diagnosis of exclusion.

  28. 3

  29. Iris expanded

  30. Higher power shows diffuse population of small lymphocytes Mostly T cells (CD 3+).

  31. UVEITIS • EXOGENOUS-POST TRAUMA • ENDOGENOUS-IDIOPATHIC and those with specific causes: Anterior (iritis), intermediate (cyclitis), posterior (choroiditis) Associations-juvenile RhA, ank spond (HLA B27) Reiter’s, uc, enteritis (salmonella, shigella, yersinnia), psoriatic, behcet’s Fuch’s uveitis syndrome, VKH. Causes-sarcoid, tb, leprosy, syphilis, parasites, fungi (candida, coccidio, histo, blasto), HSV, VZV, EBV,

  32. Complications of uveitis • Cornea-endothelial cell loss-BK, band keratopathy • AC-scar formation-iris obliteration • Iris-atrophy, necrosis, loss of muscle, PAS, rubeosis, ectropion uveae, immobile pupil, iris bombe • Lens-posterior cataract secondary to lens epithelial migration.

  33. Complications of uveitis • Ciliary body-atrophy, cyclitic membrane • Vitreous-vascularisation, condensation, PVD • Choroid-atrophy, scarring, chorioretinal scar. • Retina-perivasculitis, cmo, exudative detachment, rpe alterations. • Glaucoma-clogging due to cells, PAS, pupil block, bombe, trabeculitis

  34. 4

  35. Diffuse chronic inflammation of sclera-brawny type

  36. Chronic inflammatory cells

  37. Palisaded granulomatous Inflammation of sclera with collagen degeneration (necrobiosis). This is seen in nodular variant scleritis Often see this pattern of inflammation in connective tissue disorder assoc. scleritis

  38. Granulomatous inflammation again

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