Purpose: To report the clinicopathologic features of three patients with CD30+ lymphoid proliferations of the eyelid.
Design: Retrospective case series.
Participants: Patients with cutaneous CD30+ lymphoproliferative lesions of the eyelid.
Methods: Three patients with CD30+ non-mycosis fungoides T cell lymphoid infiltrates of the eyelid were identified. The histories, clinical findings, pathologic features including immunohistochemical staining, treatments and outcomes were reviewed and compared.
Main Outcome Measures: Pathologic findings including immunohistochemical analysis.
Results: The patients included an 81-year-old man, an 18-year-old man, and a 42-year-old woman, with CD30+ lymphoid proliferations of the eyelid and adjacent soft tissue. The first patient had an isolated crateriform eyelid lesion that was classified as lymphomatoid papulosis (LyP). The second patient had an isolated multinodular lesion of the eyelid that was classified as cutaneous anaplastic large cell lymphoma (cALCL). The third patient presented with eyelid edema with an underlying mass and was found to have widely disseminated anaplastic large cell lymphoma (ALCL). Diagnoses were dependent on clinical findings.
Conclusions: CD30+ lymphoid proliferations represent a spectrum of conditions ranging from indolent LyP, to moderately aggressive cALCL, and to highly aggressive ALCL. Interpretation of the pathologic findings in CD30+ lymphoid proliferations is based in part on clinical findings.
Objective: To report the clinicopathologic features of 2 patients with carcinosarcoma of the orbit.
Design: Case reports.
Participants: Two patients with orbital carcinosarcoma were identified.
Methods: Retrospective chart review with clinicopathologic correlation and literature review.
Main Outcome Measures: Clinical examination, imaging studies, and histopathologic findings.
Results: Two patients, a 56-year-old woman and a 91-year-old woman, with orbital carcinosarcoma were identified. Both tumors contained sarcomatous and carcinomatous components and invaded periorbital structures.
Conclusions: Carcinosarcoma may arise in the orbit or extend into the orbit from the paranasal sinuses. This malignant neoplasm should be aggressively treated with a combination of surgical resection, chemotherapy, and radiation therapy.
Objective: To correlate the pathologic findings of temporal artery biopsies in patients clinically defined as positive, presumed, or negative for giant cell arteritis (GCA).
Design: Retrospective case series.
Participants and Controls: Patients evaluated for giant cell arteritis.
Methods: Temporal artery biopsies examined between 1989 and 2007 were studied. Clinical information and residual tissue for immunohistochemical staining was identified in 107 patients. Clinical information was used in order to make a diagnosis of “positive”, “presumed”, or “negative” GCA. The biopsies were reviewed in a masked fashion and classified as “positive”, “indeterminate”, or “negative” based on published, classic pathologic diagnosis (CPD) criteria. All biopsies were immunostained for CD3 and CD68 and graded as “negative”, “mildly” (+), “moderately” (++), or “markedly” (+++) positive. Clinical and pathologic results were correlated and a modified pathologic diagnosis classification (MPD) scheme was developed. The modified scheme was compared in a masked fashion with the final clinical diagnosis and positive and negative predictive values (PVs) were calculated.
Main Outcome Measures: Pathologic diagnosis and final clinical diagnosis.
Results: Using the MPD classification, there were 25%, 16% and 61% positive, indeterminate, and negative biopsies, respectively. There was excellent correlation between the modified pathologic criteria and final clinical diagnosis (correlation coefficient 0.997, p value <0.0001, kappa 0.81). The positive predictive values (PVs) for CPD and MPD were 85% and 96%, respectively. The negative PVs for CPD and MPD were 64% and 61%, respectively. Positive and negative biopsies strongly correlated with clinical diagnoses of positive and negative for GCA, respectively whereas indeterminate cases moderately correlated with presumed GCA. The diagnosis did not change from the original biopsy in 11 patients who had a second biopsy. Immunostaining for CD 68 was helpful in several indeterminate cases.
Conclusions: We recommend using the modified histologic classification of temporal artery biopsies. There are indeterminate cases that cannot be further defined using current pathologic classification criteria. A second biopsy has very limited value. Immunostaining for CD68 stain may be helpful in indeterminate cases, although the diagnosis in these cases is based on clinical judgement.
Purpose: To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet’s stripping without endothelial replacement.
Design: Interventional case report.
Methods: A 34 year-old female with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet’s stripping endothelial keratoplasty (DSEK) in the right eye and Descemet’s stripping (DS) only in her contralateral eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs endothelial dystrophy (Fuchs) and posterior polymorphous membrane dystrophy (PPMD) from Descemet’s membrane specimens removed from each eye. Following primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached, was removed and was not replaced. The cornea cleared and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet’s stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation.
Main Outcome Measures: Postoperative visual acuity and central endothelial cell repopulation
Results: Endothelial migration after Descemet’s stripping alone in the second eye, with probably host endothelial cell repopulation in the right eye.
Conclusions: Endothelial cell migration after Descemet’s stripping procedure without insertion of endothelial graft can occur, resulting in host endothelial cell repopulation with corneal clearing and improved visual acuity.
Purpose: To describe the clinical, histopathologic, immunohistochemical, and ultrastructural features of a case series of benign stromal tumors in the bulbar conjunctiva.
Design: Observational case series.
Participants: Four patients with a conjunctival lesion that were classified histologically as low grade stromal tumors consisting of spindle-shaped cells with occasional pseudonuclear inclusion and multinucleated cells in a partly myxoid matrix.
Methods: Four cases of low grade conjunctival stromal tumors were retrospectively identified in an ophthalmic pathology laboratory database. Patients’ records were analyzed for demographic data, clinical appearance and the post-operative course. Formalin-fixed paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin (H&E) and periodic acid Schiff (PAS). Immunohistochemical stains for vimentin, S100, CD34, SMA (smooth muscle actin), CD68, and factor XIIIa were performed. Transmission electron microscopy (TEM) was performed on three of the cases.
Main Outcome Measures: Histopathologic evaluation (including immunostains and TEM) and clinical correlation.
Results: All four tumors occurred in the bulbar conjunctiva of patients between 41 to 53 years of age. None of the patients developed recurrence after excisional biopsy. Histologically, all tumors exhibited spindle-shaped cells with pseudonuclear inclusions and occasional multinuclear cells. Mitotic figures were not observed. The stroma appeared myxoid to collagenous. Immunohistochemical stains were positive for CD34, vimentin, and focally for CD68, but were negative for S100 and SMA.
Conclusions: We propose to classify these benign lesions which share distinct histopathologic features as “conjunctival stromal tumor (COST)”. A reactive/inflammatory component needs to be considered in the pathogenesis of this lesion.