For best viewing please use the most current version of Internet Explorer or FireFox.
2015 Annual Meeting
Evening Specialty Conference - Ophthalmic Pathology
Sunday, March 22, 2015 - 7:30pm to 9:30pm
CC 208
Clinical histories are printed below. For the fastest viewing of virtual slides, click:

under each thumbnail image below. You must have Aperio ImageScope installed on your PC.
If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP eAcademy Virtual Slides. Click the icon on the right to get your free copy:  
Or, click on slide thumbnail images to view each slide
in a Web-based slide viewer, which is somewhat slower.
Clinical Summary:

The patient is a 46 year old male with nine year history of diplopia, proptosis, and papilledema.  MRIs of the orbits over the years have shown intraconal masses with encasement of the optic nerves bilaterally, left worse than right.  Brain MRI has shown non-specific lesions, particularly involving the brain stem.  The patient had a malignant melanoma of the right shoulder in 2011 with previous dysplastic nevi in various locations.  He also has a history of pericardial effusion.




Case title: Hereditary Benign Intraepithelial Dyskeratosis
Clinical Summary:
Case 1:
 
•45 y.o. Native-American male from North Carolina
•No significant PMH
•Longstanding history of “red eye”
•Chronic “pins in eye” sensation O.D.
•Denies trauma or foreign body exposure
•No contact lens use
•No other ocular history

 

Case 2:

1999: A 6 y.o. girl presented with a diagnosis of Marfan syndrome. Her father, uncle, and four cousins (paternal) were also diagnosed with Marfan syndrome. Ocular examination showed iris dilator dysgenesis, megalocornea, myopia, and ectopia lentis. Visual acuity was 20/400 OU with and without correction. She was alert and oriented. The eyelids and orbit were normal. Pupils were 2 mm OU and did not show any noticeable reactivity to light, and exhibited iridodonesis (vibration or agitated motion of the iris with eye movement). The cornea measured 13 mm in diameter. Visual fields were grossly full to confrontation OU. There was superior lateral dislocation of both lenses, and there was high myopia OU with the axial length of the globe estimated to be 30-35 mm OU. There was no evidence of retinal detachment at this time. The eyes were unusually large, but there was no evidence of ptosis or proptosis. A heart murmur present. She obtained normal developmental milestones, and complained of loose ligaments and joint pain. She was very tall, and had very long limbs and long fingers.

A lensectomy OS was performed. Intraoperatively, a spherical lens was identified superonasally with absent zonules inferotemporally. One month later she returned with rhegmatogenous RD OS with loss of vision, and underwent repair with encircling band scleral buckle.

2004: Returns with secondary glaucoma, recurrent retinal detachments OU, RD repair OD  scleral buckle and pars plana vitrectomy, scleromalacia, posterior staphyloma OU, flattening of anterior chamber, and lensectomy OD.

2012: 19 y.o. Height: 188 cm (6’2’’) Weight 69.5 kg. BMI: 19.7

Acanthotic epithelium with hyperkeratosis and dyskeratosis
Acanthotic epithelium with hyperkeratosis and dyskeratosis
Higher magnification showing dyskeratotic cells
Higher magnification showing dyskeratotic cells
Enucleated globe showing increased anterior-posterior diameter consistent with myopia in a patient with Marfan syndrome
Enucleated globe showing increased anterior-posterior diameter consistent with myopia in a patient with Marfan syndrome
Flat ciliary body with few ciliary processes and  only a few bundles of circular muscle
Flat ciliary body with few ciliary processes and only a few bundles of circular muscle
Case title: 24-year old with a conjunctival abnormality
Clinical Summary:

24 year-old male from Catania, Italy presenting with recurrent conjunctival abnormalities. 

Case title: Eye 01. Left eye enucleation of an 18-year-old African-American female s/p a penetrating wound in the superior limbal area.
Clinical Summary:

An 18-year-old African-American female suffered a penetrating wound to the right eye in the superior limbal area.  The wound was repaired with excision of a prolapsed iris and vitreous loss.  Two weeks post injury she developed endophthalmitis and was treated with a one week course of antibiotics and steroids.  A month after the injury the patient complained of persistent pain and decreased vision with only hand motion in her right eye and decreased vision on her left eye of 20/200.  Systemic and topical steroids were resumed.  Six weeks after the injury the right eye was enucleated. 

The slide submitted is from the enucleated eye.

Case title: Corneal unknown case
Clinical Summary:

~31 year old male referred for foreign body sensation and decreased vision in the right eye
“Got something” in his eye 2 months prior
Treated by local optometrist with bandage contact lens and artificial tears for a few days
Placed on tobramycin/dexamethasone ointment
2 weeks later, developed an “infection” and was started on the topical antiviral trifluridine for presumed HSV keratitis
Superficial keratectomy (corneal epithelial scraping) performed
Pain continued to worsen despite treatment

~Past ocular history
--Myopia with contact lens wear
--No prior history of eye surgery or trauma
-Past medical history
--Intermittent cold sores on lips
--Otherwise negative
-Social history
--Construction worker
-Eye medications
--Trifluridine every 2 hours, right eye
--Gatifloxacin every 2 hours, right eye
--Prednisolone 6x daily, right eye
-Other medications
--None

~Visual acuity with correction (glasses)
--OD 20/300, no improvement with pinhole
--OS 20/30-1, pinhole 20/20-1
-Intraocular pressure (tonopen)
--OD 17
--OS 17
-Pupils
--OD 8mm > non-reactive, no RAPD
--OS 6mm > 5mm, no RAPD
-Fundus exam
--OD – hazy view but grossly normal
--OS - normal

~Patient treated as HSV stromal keratitis with persistent epithelial defect
-His keratitis and symptoms continue to worsen

~Superficial keratectomy repeated

Clinical photo, initial presentation
Clinical photo, initial presentation
Clinical photo -initial presentation
Clinical photo -initial presentation
Clinical photo 2 weeks after presentation
Clinical photo 2 weeks after presentation
In vivo confocal microscopy of cornea - 2 weeks post presentation
In vivo confocal microscopy of cornea - 2 weeks post presentation
Cytospin cytology of corneal scraping - H&E, 20X magnification
Cytospin cytology of corneal scraping - H&E, 20X magnification
Cytospin cytology of corneal scraping - H&E, 50X magnification
Cytospin cytology of corneal scraping - H&E, 50X magnification
Cytospin cytology of corneal scraping - H&E, 200X magnification
Cytospin cytology of corneal scraping - H&E, 200X magnification
Cytospin cytology of corneal scraping - H&E, 300X magnification
Cytospin cytology of corneal scraping - H&E, 300X magnification