Corneal xanthogranuloma in association with multiple endocrine neoplasia 1: a clinicopathologic case report and review of the literature

Juvenile xanthogranuloma [JXG] is a benign inflammatory condition of uncertain pathogenesis. It is characterized by skin and ocular involvement - typically in the iris - in children. It has been reported in older age groups and has been also observed to involve other ocular structures such as the cornea and conjunctiva. In this case report, we are presenting an extensive right eye corneal lesion in a 43-year old male which showed the typical histopathological feature of JXG and in association with multiple endocrine neoplasia [type 1]. Similar cases in the Englishlanguage literature have been also reviewed

Candida parapsilosis corneal graft infection from a single eye center: histopathologic report of 2 cases

Fungal keratitis accounts for 6-53% of all cases of ulcerative keratitis in variable studies. The majority of cases are due to septate fungi. The abnormal cornea in cases of dry eye syndrome, chronic ulceration, erythema multiform and possibly HIV infection is infected more commonly with Candida, most commonly Candida albicans. Candida parapsilosis affects neonates and intensive care unit [ICU] patients and it has been recently found with increasing frequency. In a previous study on mycotic keratitis in our tertiary eye hospital, filamentous fungi were more commonly isolated than yeasts. We are presenting 2 successive cases of corneal graft infection by Candida parapsilosis referred to us from another eye center to attract the attention of ophthalmologists and health workers to such an infection

Epithelial lacrimal gland tumors: a comprehensive clinicopathologic review of 26 lesions with radiologic correlation

To study the prevalence, clinicopathological and radiological correlations of epithelial lacrimal gland tumors and compare these with similar published literature. The study was also designed to look at the natural history of benign mixed tumors [BMT] in regard to recurrence and malignant degeneration. This was a retrospective study of all suspected epithelial tumors of the lacrimal gland surgically excised at King Khaled Eye Specialist Hospital [KKESH] for the period: 1983-2008. Exclusion criteria included structural lesions [dacryops] and inflammatory lesions. We included 26 cases of epithelial lacrimal gland tumors [from 24 patients]. The histopathologic slides and the radiologic findings were reviewed. The corresponding demographic and clinical data were obtained by chart review using a data sheet. BMT accounted for 12/26 of the lesions while malignant lesions including adenoid cystic carcinoma [ACC] were more common [14/26]. The mean age was 44.27 years [range 12-75]. Commonest clinical presentation was proptosis. Median duration of symptoms in the BMT cases was 30 months and 7 months in the ACC group. The 12 BMT cases were primary in 9 and recurrent in 3 patients. The 11 ACC cases showed mostly cribriform pattern and low histopathologic grade. We had 2 cases of malignant mixed tumor [MMT] one of which arising in a recurrent tumor. One case of primary mucoepidermoid carcinoma with histopathologic grade 2 was noted. Radiologically, a well-defined appearance with bone remodeling was observed in BMT in contrast to invasive appearance with destruction in malignant lesions. Our series information indicated a different distribution of benign and malignant epithelial lesions with a slightly higher rate of malignancy. BMT was the commonest benign tumor where recurrence was a squeal of incomplete surgical excision. ACC was the commonest malignant tumor with shorter duration of symptoms and radiologic evidence of invasiveness that correlated with the histopathologic features

Corneal graft reversal histopathologic report of two cases

Graft reversal is a rare cause for failed PKP. In this case report we are presenting 2 graft failure cases in which the corneal grafts were reversed unintentionally. The onset of signs of graft failure, however was variable. We have included their clinical course and the histopathologic findings of the removed corneal grafts. A total of 6 cases including ours have been reported so far. The aim of this report is to attract the attention of corneal surgeons to an additional rare cause for failed penetrating keratoplasty [PKP] which is donor graft reversal

Pigmented hypopyon in association with monocytogenes endophthalmitis: an interesting case report following refractive surgery procedure with literature review

Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case. We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases. Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber [AC] aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision. We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis

Ocular adnexal lymphoproliferative disorders in an ophthalmic referral center in Saudi Arabia

To study the pattern of ocular adnexal lymphoproliferative disorders [OALD] in an ophthalmic referral center in Saudi Arabia and to review their, histopathological characteristics with clinical correlation. Retrospective chart review of 40 cases of patients who underwent incisional biopsy with the suspected diagnosis of per-iocular and/or adnexal lymphoid lesions over the period: 2000-2012 at the King Khaled Eye Specialist Hospital [KKESH], Riyadh, Saudi Arabia. The routine histopathologic slides are reviewed by a single pathologist to identify cases of Benign Reactive Lymphoid Hyperplasia [RLH], Atypical Lymphoid Hyperplasia and probable lymphoma. The identification of the specific types of lymphoma is performed at a tertiary general hospital: King Faisal Specialist Hospital and Research Centre [KFSH and RC]. Results: Forty patients are included with an age range of 11-91 years and a median of 36 years. The males constitute 70% and females 30% of the cases. The right eye and/or orbit are involved in 48%. The left eye is involved in 45% while a bilateral disease is found in 7.5%. The median duration of symptoms is 5 months. The site distribution is conjunctiva [42.5%], orbit [25%] lacrimal gland [12.5%], eyelid [10%], lacrimal sac [7.5%] and caruncle [2.5%]. One case is excluded after histopathologic diagnosis of malignant melanoma. Diagnosis in the remaining 39 cases includes: RLH in 14 cases [35%], atypical lymphoid hyperplasia in three cases [9%], and lymphoma in 22 cases [56%]. Classification of the lymphoma group is: extranodal marginal zone lymphoma [EMZL] in 9/22 cases [41 %], diffuse large B cell lymphoma [DLBCL] in 4/22 cases [18%], Castelman's disease in 3/22 cases [14%], Burkitt's lymphoma in 2/22 cases [9%], follicular lymphoma and T cell-rich B cell lymphoma: one case each [4.5%].Two cases remain unclassified. Conclusion: We have a wide age range which is comparable to other studies. Our results show male predominance and the commonest site of involvement is conjunctiva!, however if RLH cases are excluded, the commonest site for lymphoma is orbit/lacrimal gland in 45% followed by conjunctival in 23%. The commonest type of lymphoma is: EMZL in 41% followed by DLBCL in 18% then other types of lymphoma including follicular lymphoma

Microsporidial keratitis: literature review and report of 2 cases in a tertiary eye care center

Microsporidia are getting more recognized as causative organism of ocular, gastrointestinal, renal, pulmonary, and sinus diseases, in both immunocompetent and immunosuppressed patients. Ocular microsporidiosis can be isolated or may present as part of systemic infection. Recent reports showed increasing number of cases of ocular microsporidiosis in immunocompetent individuals. The ocular type occurs mainly in two forms: keratoconjunctivitis form which is mostly seen in immunocompromised individuals and stromal keratitis form seen in immunocompetent individuals. The ocular cases which present with superficial keratitis in acquired immune deficiency syndrome [AIDS] patients differ from the cases seen in immunocompetent individuals which present mainly as deep stromal keratitis. We are presenting the only two documented cases of microsporidial keratitis diagnosed over 25 years of practice in our institution. The cases are diagnosed by identification of the Acid-fast organisms. Ultrastructure and additional information on species identification in one of the cases. Both cases are eventually managed by therapeutic PKP. Diagnosis and treatment modalities are discussed based on a comprehensive literature review

Primary orbital liposarcoma: histopathologic report of two cases

Liposarcoma is a malignant tumor of adipose tissue. Considered the most common soft tissue sarcoma in adults, orbital liposarcoma is extremely rare. Most cases of orbital liposarcoma are primary and rarely metastatic. We report two cases of primary orbital liposarcoma with clinical presentation, radiologic studies [available for one case], and detailed histopathologic features. A brief review of primary orbital liposarcoma is also presented

Histopathologic findings in two cases with history of intrastromal corneal ring segments insertion

Intrastromal corneal ring segments [INTACS] implantation for mild myopia or keratoconus is simple and effective in most cases. Rarely, major complications can occur due to implantation. In this case report, we present two examples of possible intraoperative and postoperative complications of INTACS. The first case had histopathologic documentation of Descemet's membrane perforation as an intraoperative complication and the second case had accumulation of foamy histiocytes along the lamellar channels which has not been previously reported. These complications suggest further study is required on the long term effect of INTACS implantation on corneal tissue

Surgical treatment and histopathology of a symptomatic free-floating primary pigment epithelial iris cyst in the anterior vitreous

We report the surgical removal of an iris pigment epithelial cyst that was floating freely in the posterior chamber of an 18-month-old child. The reason for surgical removal was disturbance in near vision secondary to the movement of the cyst across the visual axis. Visual disturbance secondary to a unilateral anterior vitreous iris cyst at this age is a rare presentation and, to the best of our knowledge, has not been reported previously as an indication for surgery. We performed histopathological study of the cyst aspirate to determine its contents and its possible origin

Epithelioid sarcoma of the orbit

Epithelioid sarcoma is an aggressive and rare malignancy first recognized by Enzinger in 1970. It is known most commonly to affect the distal upper extremities in young adults. The classical "distal" form has a male predominance and can also involve other less frequent sites including lower extremities, proximal upper extremities, and the trunk. The "proximal" variant of this tumor is deep seated, tends to occur in older patients and predominantly develops in the pelvis, perineum, and genital tract. In the orbit, only a single report of two cases, which had a typical histopathologic appearance, has been previously published. We present the third case of orbital primary epithelioid sarcoma

Conjunctival nevi: clinical and histopathologic features in a Saudi population

Conjunctival nevi are benign lesions with wide variation in clinical and histopathological features. The differentiation between benign nevi and other pigmented lesions is essential. The aim of our study was to identify the distribution of the histopathologic types of conjunctival nevi among the Saudi population and to provide the basic knowledge needed for proper clinical diagnosis. This retrospective study of surgically excised benign conjunctival nevi was conducted at a tertiary care eye hospital from 1995 to 2006. Clinical data was collected from medical records and the histopathologic features reviewed by a single pathologist. A total 105 conjunctival nevi were included from 104 consecutive patients [mean age, 26 years, 54 males and 50 females]. The anatomical location was the bulbar conjunctiva in 83%, juxtalimbal in 12%, caruncle in 4% and palpebral in 1%. The lesion was removed for cosmetic reasons in 38% while 8% of the lesions were removed to rule out malignancy. The compound nevus was the commonest [72%] in all age groups, followed by subepithelial nevus [24%] and finally junctional nevus [3%]. The distribution of the histopathologic types of this tumor in our population matches the pattern in other areas of the world with the compound nevus being the commonest lesion. However, fewer lesions among our patients are removed to rule out malignancy

Malignant fibrous histiocytoma in a patient with history of treated retinoblastoma

Retinoblastoma is one of the most important childhood tumors with genetic implications and necessity for family counseling and long term follow up. We are presenting a 22 year-old Saudi male with history of bilateral retinoblastoma, who was initially treated by enucleation of his left eye. The histopathology showed a moderately differentiated tumor with vitreous seeding and he received chemotherapy in addition to radiotherapy to his right eye. He presented 20 years later with a right orbital tumor, frozen globe and proptosis. The excisional biopsy of his orbital mass revealed a spindle cell sarcoma with features of malignant fibrous histiocytoma. His clinical and radiological findings are presented together with the histopathologic features of his orbital tumor and brief review of secondary tumors in retinoblastoma patients