Eye Pathology

Question 1

What is found in increased quantity in the EOMs in a patient with Graves disease?

Answer 1

Glycosaminoglycans

Question 2

What are 2 complications of Graves orbitopathy?

Answer 2

Visual loss (compression of optic n.)
Corneal complications

Question 3

What effect can Sarcoid have on the eyes? (3)

Answer 3

Bilateral granulomatous inflammation - uveitis.

“Mutton fat” - keratic precipitates in anterior segment of eye.

“Candlewax drippings” - perivascular inflammation of retina.

Question 4

What is the most common malignancy of the periocular skin?

Which age does it tend to affect?

What is seen on histology?

What is the morpheaform?

Answer 4

Basal cell carcinoma

Younger patients with sun exposure

“Nodulo-ulcerative” - pearly nodules, telangiectatic vessels, central ulcer (rodent ulcer), rolled edges
Peripheral palisading of nuclei

Cords of tumor cells are embedded in densely fibrotic stroma and are deeply infiltrative

Question 5

What patients does Sebaceous carcinoma have a predilection to?

What syndrome is associated?

What is seen on histology? (2)

What stain is used?

What antigens are positive?

What is a clue that a patient may have this malignancy?

Answer 5

> 40 y/o women; Asian

“Masquerade syndrome” - unilateral keratoconjunctivitis unresponsive to therapy

Comedocarcinoma: necrotic centrally
Pagetoid cells

Oil red O

+EMA, focally +BRST-1, P-16

Recurrent chalazians

Question 6

Where does Sebaceous carcinoma metastasize to?

What is the mortality rate?

Answer 6

Regional LN, lung, liver and brain

15%

Question 7

What is pinguecula?

Answer 7

Thin epithelium, fragmented stromal collagen and basophilic degeneration.

Question 8

What is pterygium?

What is recurrent pterygium?

Answer 8

Encroaches onto cornea in winglike fashion - destroys Bowman’s layer and causes a corneal scar

Exuberant granulation tissue

Both are benign processes

Question 9

What is lentigo?

Answer 9

Linear melanocyte hyperplasia restricted to the basal layer

Question 10

What are nevi?

What is junctional, compound and intradermal nevi?

Answer 10

Melanocytes that have become round and grown into an aggregate of “nests”

Junctional - epidermal nests along the dermoepithelial junction
Compound - junctional grows into underlying dermis as nests or cords
Intradermal - epidermal nests are lost completely

Question 11

What is the most common intraocular tumor in adults?

What is it from?

Answer 11

Melanoma

Metastases to the eye

Question 12

What is the most common primary intraocular tumor in adults?

What genes are seen in 85% of these tumors?

What morphology suggests a poor prognosis?

Where does it metastasize to?

Answer 12

Uveal melanoma

GNAQ and GNA11
-nevi with these rarely transform to melanoma

Epithelioid: large nuclei, prominent nucleoli with infiltrating WBCs

Liver first

Question 13

What is unique about a corneal transplant?

What is the main problem with the transplant of a cornea?

Answer 13

Corneal stroma lacks a blood supply and lymphatics, therefore it is unlikely to reject

If there is a pre-existing infection or the transplant is damaged somehow

Question 14

What is a cataract?

What is the main risk factor?

What causes age-related cataracts?

Answer 14

Lenticular opacities that can be congenital or acquired

DM

Nuclear sclerosis: opacification of lens nucleus

Question 15

What occurs in posterior subcapsular cataracts?

What does Morgagnian (hypermature) cataracts cause?

What is phacolysis? How does it cause phacolytic glaucoma (a form of secondary open angle glaucoma)?

Answer 15

Migration of the lens epithelium posterior to the lens equator

Liquification of the lens cortex

Proteins from the liquified lens leaks through the lens capsule and may clog the trabecular meshwork and increase intraocular pressure = phacolytic glaucoma
-iatrogenic process from repair of cataracts that causes glaucoma

Question 16

What is glaucoma?

Answer 16

A collection of diseases with distinctive changes in the visual field and in the optic cup.

Leads to increased intraocular pressure!

Question 17

What is open-angle glaucoma?

Answer 17

Complete open access to trabecular meshwork, leading to increased resistance to aqueous outflow and increased intraocular pressure.

Question 18

What is angle-closure glaucoma?

Answer 18

Peripheral zone of iris adheres to trabecular meshwork and physically impedes outflow

Question 19

What gene, on which chromosome, is defective in Retinoblastoma?

How many genes must be mutated?

Rb arising in the context of a germline mutation are often:

Answer 19

Rb from chr. 13

One normal gene is enough to suppress the mutated gene, but one mutated gene is somewhat unstable and can induce the mutation of the normal gene.

Germline -bilateral

Question 20

What are the most common symptoms of Retinoblastoma?

What gross change can occur due to the shedding of cells into the anterior chamber?

What is the most common route to escape?

Answer 20

Leukocaria (white pupillary reflex), strabismus and ocular inflammation

Nodules may form around the iris or settle inferiorly = pseudohypopyon

Optic n. - direct infiltration into the brain (poor prognosis)

Question 21

What do cells in Rb look like histologically?

What is the classic feature of Rb?

Answer 21

Round, oval or spindle-shaped hyperchromatic nuclei with scant cytoplasm

Flexner-Wintersteiner: single row of eosinophilic columnar cells with peripherally oriented nuclei surround the central lumen