Histopathology of pigment dispersion syndrome and glaucoma: A Case Report.

Pigment dispersion syndrome (PDS) can have varied manifestations. Anterior and posterior segment involvement by dispersed pigments was documented in gross pathology and by staining under microscopy. Pigmentary changes in the sclera, cornea, anterior chamber, iris, trabecular meshwork, lens, and retinal pigment epithelium and optic nerve findings were consistent with PDS. External scleral and vitreous pigmentation has never been reported before in the scientific literature. Retinal pigment degeneration and granule dispersion were seen throughout the retina which could be a contributing factor in the etiology of PDS.

Idiopathic inflammatory diseases of orbit and ocular adnexa: Histopathological and immunochemical analysis.

Purpose: : To present histopathological and immunohistochemical analysis of idiopathic inflammatory diseases of orbit and ocular adnexa. Methods: Design- A retrospective laboratory-based study. The study was carried out in an ocular pathology laboratory in a tertiary institute of northeast India where analysis of 93 cases was done in 5 years, during the period from 2011 to 2016. Hematoxylin--eosin and special stains were done for the diagnoses. Immunohistochemistry (IHC) panel was also carried out. For infectious pathology, Grocott's methenamine silver (GMS) stain for fungus, tissue Gram's stain for bacteria's, and acid-fast stains for tubercular bacilli were done. IHC panels were done for CD 20 (B-cells), CD-3 (T-cells), CD-45 (Leukocyte common antigen, LCA), BCL-2, CD-138 (Plasma cells), Kappa, Lambda, IgG-4 in tissue, IgG-4 in serum, etc. IHCs were done using kit methods (standardized) and adequate controls were taken for each sample. Results: 93 cases of nonspecific orbital inflammation were reported out of 1,467 specimens. Orbital pseudotumors (idiopathic orbital inflammatory disease, IOID) were seen in 27 cases (sclerosing variety-6); benign lymphoid hyperplasia in two cases; reactive lymphoid hyperplasia in 10 cases; atypical plasma lymphoproliferative reactive (polyclonal immunophenotypically, IgG4 negative) lesions in four cases; IgG-4 related disease in one case; nonspecific inflammatory reactions (conjunctiva, sclera, and lid) in 49 cases. In all the diagnoses, infections and lymphomas were excluded. Conclusion: Biopsy supported study on nonspecific orbital inflammation was important to know the pattern.

Long-term outcomes of labial mucosal graft in conjunctivo-rhinostomy surgery.

OBJECTIVE: To report the long-term outcomes of the conjunctivo-rhinostomy surgery with labial mucosal graft performed for the patients of proximal lacrimal drainage system disorders. METHODS: Retrospective, single surgeon (KB), non-comparative study including patients having complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent conjunctivo-rhinostomy with labial mucosal graft insertion. Preoperatively, tear film break-up time and a fluorescein dye disappearance test was performed for each patient. A phaco aspiration tubing segment was used for supporting the mucosal graft for first 4 weeks followed by its removal. Minimum follow-up was 12 months. fluorescein dye disappearance test and nasal endoscopy were performed at each follow-up visit. Total resolution of epiphora and negative fluorescein dye disappearance test was defined as complete success. RESULTS: Eighteen patients (12 males, 6 females) with a mean age of 39.94 years (range 7-76 years) all had a unilateral presentation. The indication for surgery was trauma (n = 11), failed dacryocystorhinostomy (DCR) with canalicular obstruction (n = 4), chronic ocular inflammation with complete punctal occlusion (n = 2), and post-radiotherapy (n = 1). At a mean follow-up of 5.38 years, complete success was observed in 12 (66.67%), partial success in 4 (22.22%) while in 2 (11.11%) patients, the procedure failed. CONCLUSION: Labial mucosal graft in conjunctivo-rhinostomy is a successful adjunct which provides satisfactory long-term outcomes. Our surgical technique of directly suturing the mucosal graft to surrounding muscle provides better functionality to the system with eyelid blinking.

Immunohistochemistry on pattern of ocular & adnexal tumours in a tertiary eye care centre of Northeast India.

BACKGROUND & OBJECTIVES: Ocular and adnexal tumours are important causes of morbidity in India and globally. Immunohistochemistry (IHC) is a vital molecular pathology tool, which helps to diagnose a tumour with more accuracy. The present study was undertaken to document the profile of ocular and adnexal tumour with IHC at a tertiary eye care center in Northeast India. METHODS: This was a prospective and laboratory-based study. Histopathological and IHC study of the ocular and adnexal tumour was carried out from 2012 to 2014. Selection of pathological cases was made on the result of the histological diagnosis. All samples were subjected to IHC using kits for different antibodies as per indications. RESULTS: In total, 645 tumours were included in our study, with 449 benign conditions and 196 were malignant tumours. Total IHCs were done in 87 tumours and 238 of antibodies were used. Non-Hodgkin's lymphomas (B-cell, low-to-intermediate type and mucosal-associated lymphoid tumours) were the most common tumor. INTERPRETATION & CONCLUSIONS: Clinical utility of the IHCs in different ophthalmic tumours can enable pathologists to make an accurate diagnosis and thus help in the overall management of the patient care. IHC may be carried out using various methods and some of the methods practiced are time consuming and tedious. In this study, kit methods were used which were found to be simpler and less time-consuming.

Cyclophotocoagulation-induced sympathetic ophthalmia in a Coats' disease patient supported by histopathology and immunohistochemistry.

We describe a case of a 13-year-old male patient of Coats' disease who developed sympathetic ophthalmia (SO) following contact diode laser cyclophotocoagulation. There was no history of invasive surgery or any perforating injuries preceding cyclodestructive therapy. The eye had neovascular glaucoma secondary to Coats' disease, which was treated once with contact cyclophotocoagulation. Subsequently, the intraocular pressure slowly decreased, and the eye became phthisical. Intraocular inflammation developed in the fellow eye and SO was suspected, which was confirmed by characteristic findings seen on fluorescein angiography. The case was successfully managed with the help of topical and systemic immunosuppression. Enucleation with silicone ball implantation was performed in the right phthisical eye and specimen was sent for histopathological examination. Histopathology and immunostaining supported the diagnosis of SO.

IgG4-related intraocular inflammation masquerading as ciliary body melanoma in a young girl.

Immunoglobulin G4 (IgG4-related diseases) affects various tissues and organs of the human body. Orbital, adnexal, and scleral inflammations were already reported in the medical literature. To the best of our knowledge, we report the first case of intraocular IgG4-associated inflammatory mass in the ciliary body mimicking as a melanoma in a 23-year-old female from Northeast India. Characteristic histopathology, immunohistochemistry in the tissue, protein chemistry, and raised serum IgG4 were supportive for the diagnosis. As this newly diagnosed disease has multi-organ affection and little is known about its pathogenesis particularly in eye and adnexa, the present case will open many challenges in clinico-pathological diagnosis and research in the future.

Profile of ocular and adnexal tumours at a tertiary institute of northeast India.

PURPOSE: To present the profile of patients with ocular and adnexal tumours presenting at a tertiary eye care institute in northeast India in ten years between 2003 and 2013. DESIGN: Hospital based retrospective review of medical records. METHOD: The clinical history, site of involvement and pathological diagnoses were retrieved from ocular pathology registers from October 2003-October 2013. This included conjunctival, orbital, adnexal and intraocular tumours. All specimens were fixed, processed and stained. Immunohistochemistry was carried out where ever indicated to come to a final diagnosis. RESULTS: In all 1003 cases were included in our study, with 622 (62.01%) benign tumours and 381 (37.98%) malignant tumours. 54.63% were males and 45.36% were females. Amongst the conjunctival tumours, squamous cell carcinoma (SCC) (72.5%) and nevus (39.6%) were the most common malignant and benign tumour, respectively. Non-Hodgkin's lymphoma (NHL) (60%) was the most common malignant orbital tumour. Retinoblastoma (RB) (81.5%) was the most common intraocular malignancy, followed by melanoma (18.4%). Basal cell carcinoma (BCC) (35.1%) was the most common malignancy in the lid. CONCLUSION: NHL and SCC were the most frequently seen malignant tumours in adults while RB was the most common intraocular tumour in children.

An unusual case of retrobulbar arachnoid cyst and its management.

Arachnoid cysts are collection of cerebrospinal fluid contained inside a cavity lined by leptomeninges. It constitutes 1% of all intracranial tumours mostly present in the middle cranial fossa. Retrobulbar arachnoid cyst in elderly persons are a rare occurrence. We report a rare case of retrobulbar arachnoid cyst with ophthalmic manifestations and its effective management. CT-guided aspiration of the cyst and subsequent cytological and biochemical test revealed an arachnoid cyst. Patient is on a 5-year follow up without recurrence and improvement of the vision in the affected eye.

Primary primitive neuroectodermal tumor of the orbit.

Primitive neuroectodermal tumor (PNET) is a small round cell malignant tumor of neuroectodermal origin. Most of the PNETs occur in the central nervous system (CNS). PNETs recognized outside of CNS are diagnosed as peripheral PNET (pPNET). This tumor which expresses MIC-2 gene (CD99) seems to be least aggressive after complete tumor resection. We describe a rare case of PNET in a young girl.