A leiomyoma of the iris documented by immunohistochemistry and electron microscopy.

PURPOSE: To report an iris leiomyoma documented in accordance with today's stricter diagnostic criteria. METHODS: Light microscopy, immunohistochemistry and electron microscopy were performed on the 3 mm ball-like, greyish-white vascularized tumour of the iris, close to the sphincter pupillae. RESULTS: Light microscopy of the extirpated neoplasm showed the characteristic appearance of a leiomyoma with densely packed spindle-shaped cells, with oval nuclei and granular cytoplasm. On electron microscopic examination the tumour exhibited the characteristic features of a smooth muscle neoplasm. The immunohistochemistry was consistent with a myogenic tumour because the tumour cells were positive for smooth muscle actin and desmin, but negative for S-100 and melanin. CONCLUSION: The case illustrated the necessity of performing ancillary procedures such as electron microscopy and immunohistochemistry to substantiate a correct, although rare diagnosis.

Benzoporphyrin-lipoprotein-mediated photodestruction of intraocular tumors.

Benzoporphyrin derivative (BPD), a sensitizer currently in clinical trials, was evaluated for the treatment of experimental Greene melanoma implanted in the rabbit iris. To improve tumor targeting, BPD was complexed with low-density lipoprotein (LDL) representing an endogenous carrier system for BPD as previously described. Twelve tumors were irradiated at a sensitizer dose of 2 mg kg-1 body weight using a dye laser at 692 nm. Tumor responses were documented by photography, angiography and light and electron microscopy. All tumors treated with 80 J cm-2 regressed irreversibly. The principal mechanism of tumor necrosis was thrombosis following disruption of endothelial membranes. Ultrastructure data suggested tumor cell damage, although evidence for this being the result of direct PDT-mediated tumor cell death was less clear. These data suggest that BPD-LDL may be used to improve the selectivity of photodynamic tumor therapy possibly by the increased uptake of lipoprotein-delivered sensitizer to neovascular endothelial cells.

Congenital adenoma of the iris and ciliary body: light and electron microscopic observations.

A 23-year-old man had a lesion in the right inferior iris which appeared to have enlarged since it was first seen when the patient was aged 5 years. The lesion was excised by a partial iridocyclectomy. Histopathologically the neoplasm was composed of both pigmented and non-pigmented cells. Pseudoacini, containing acid mucopolysaccharides, were present throughout the tumour matrix. Electron microscopically the non-pigmented cells were found to possess a convoluted plasmalemma, abundant rough endoplasmic reticulum, and numerous desmosomes and gap junctions. The pigmented cells contained large, round, mature melanosomes, occasional premelanosomes, and desmosomes, which resembled the posterior pigment epithelium of the iris. The intercellular matrix contained fine collagen fibrils resembling vitreous. We believe that this neoplasm represents a congenital adenoma of the ciliary body and iris.

Ultrasound biomicroscopy of anterior segment tumors.

BACKGROUND: Ultrasound biomicroscopy is a new method of imaging the anterior segment of the eye at microscopic resolution using high frequency ultrasound. METHODS: A prospective study was performed to evaluate the use of ultrasound biomicroscopy in imaging anterior segment tumors. Forty-five patients underwent clinical examination followed by slit-lamp photography, anterior segment B-scan ultrasonography, and ultrasound biomicroscopy according to an established protocol. RESULTS: All lesions were clearly imaged by ultrasound biomicroscopy, while only 17 were detectable by conventional B-scan ultrasound. Ultrasound biomicroscopy allowed precise measurement and visualization of subsurface features in small tumors. Differentiation between solid and cystic lesions was easily achieved. The margins of ciliary body tumors could be more accurately defined. Histopathologic correlation was possible in four cases managed surgically. Ultrasound biomicroscopy images compared favorably with low-power microscopy. No complications were encountered. CONCLUSION: Ultrasound biomicroscopy proved a valuable new noninvasive technique in the evaluation of anterior segment tumors.

Intraocular and orbital malignant schwannomas in F344 rats.

Intraocular and orbital malignant Schwannomas in two F344 rats are presented. The two Schwannomas were identified among approximately 60,000 male and 60,000 female F344 rats. The intraocular malignant Schwannoma occurred in the iris, invading the corneal stroma through the destroyed Descemet membrane. The malignant orbital Schwannoma occurred in the left orbit, invading the contralateral orbit along the optic nerve. Histologically, the intraocular Schwannoma consisted predominantly of a perivascular fascicular pattern of plump spindle cells associated with marked cytoplasmic vacuolization. The orbital Schwannoma consisted of Antoni type A and B pattern, but Antoni B tissues predominated. Antoni A tissues consisted of closely packed, elongated spindle cells arranged in interlacing fascicles, while Antoni B tissues were highly cellular and consisted of anaplastic, small cells associated with marked cyst formation. Immunohistochemically, the intraocular Schwannoma had a positive immunoreactivity for S-100 protein, while the orbital Schwannoma had a negative immunoreactivity. Ultrastructurally, the cells of both intraocular and orbital Schwannomas had long, thin cell processes and pericytoplasmic basal laminae. Particularly, the plump spindle cells of the intraocular Schwannoma were most strikingly characterized by the well developed, extremely attenuated cell processes arranged in a lamellar or spiral pattern. These cell processes and cell bodies were associated with numerous desmosomes. Intracytoplasmic filamentous granules and bodies, consisting of intermediate filaments approximately 7 nm in width, were additional characteristics of the plump spindle cells.

Structure of Lisch nodules in neurofibromatosis type 1.

Postmortem examination of the eyes of a patient with neurofibromatosis Type I was performed by light and electronmicroscopy. Lisch nodules were examined and found to consist of a condensation of spindle cells on the anterior iris surface. When nodules were pigmented an underlying stromal naevus was present. Lisch nodules are confirmed as being of melanocytic origin.

Nucleolar organiser regions in iris melanocytic tumours: an accurate predictor?

A silver staining technique which demonstrates the nucleolar organiser region (NOR) was used in paraffin sections of iris naevi and melanomas. The technique shows argyrophilic NOR associated proteins (AgNORs) which are seen in nuclei as black dots. In nine iris naevi the AgNOR count ranged from 1.54 to 3.82 (mean 2.73), in 21 melanomas from 1.89 to 8.31 (mean 4.67). Mean AgNOR counts greater than four dots per nucleus were only seen in malignant lesions, thereby differentiating between benign and malignant tumours, whenever high AgNOR counts were found. We subsequently examined three tumours in the intermediate group of aggressive naevi, Jakobiec group 6: there were counts averaging 4.08 but with a wide standard deviation of counts indicating that the behaviour of this group of aggressive tumours is likely to depend on the percentage of cells bearing the higher numbers of NORs, which may represent mitotic potential or increased metabolic rate.

Diffuse iris nevus in oculodermal melanocytosis: a light and electron microscopic study.

We studied by light and electron microscopy the diffuse iris nevus of an eye in a 16-year-old patient with oculodermal melanocytosis and choroidal malignant melanoma. The nevus cells in the anterior border layer of the iris appeared to be poorly differentiated, showing moderate infolding of the nuclear membrane with heterochromatin clumping, watery cytoplasm, abundant mitochondria, fine filaments, rough endoplasmic reticulum, and numerous pinocytotic vesicles. Small scattered immature melanosomes and occasional giant melanosomes were observed in these cells. Deep in the iris stroma, however, nevus cells were found singly or in small groups, and were associated with an increasing number of melanized melanosomes and cytoplasmic filaments and reduced numbers of other cytoplasmic organelles, such as mitochondria and free ribosomes. Differentiation of the iris nevus cells appeared to progress from the anterior border layer toward the iris stroma. This observation suggests that intrastromal nevi may be more benign than nevi with surface plaque. The ultrastructural characteristics of the diffuse nevi of oculodermal melanocytosis were compared with those of other iris nevi.