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Balasubramaniam SC, Dalvin LA, Bakri SJ. Prevalence of intraocular tumours detected by ultrasonography in eyes with opaque media. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:46-49. [PMID: 36244400 DOI: 10.1016/j.jcjo.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the prevalence of intraocular tumours detected by screening ultrasonography in eyes with opaque media. METHODS Retrospective review of B-scan ultrasonography in eyes with opaque media and diagnosis of blindness or phthisis between January 1, 1994, and December 31, 2013. Ultrasounds for diagnostic purposes in acute endophthalmitis, retinal detachment, or vitreous hemorrhage were excluded. RESULTS There were 119 blind eyes with opaque media examined with B-scan ultrasonography. Mean patient age was 59 years, with visual acuity of hand motions or worse in 89 eyes (74.8%), elevated intraocular pressure in 23 eyes (19.3%), and pain in 30 eyes (25.4%). Follow-up was ≥1 year in 69 eyes (58%) with a mean 64 months (median, 56 months; range, 12-129 months). Of these 69 eyes, ultrasound frequency was more often than annual in 2 eyes (2.9%), annual in 2 eyes (2.9%), every 13-60 months in 43 eyes (62%), every 61-120 months in 19 eyes (27.5%), and less often than every 120 months in 3 eyes (4.3%). Sixteen eyes with opaque media only received ultrasound at presentation, and 6 eyes had screening ultrasonography only prior to evisceration or enucleation. No intraocular tumours were detected in any eye during the study period. CONCLUSIONS In this series, no intraocular tumours were detected by screening ultrasonography in eyes with opaque media. Larger studies with long-term follow-up are required to determine the utility and cost-effectiveness of serial ultrasonography monitoring. Ultrasound may have its highest utility in the setting of initial evaluation, clinical change, and preoperative work-up to avoid evisceration in the setting of occult malignancy.
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Affiliation(s)
| | | | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, MN.
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2
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Ghose N, Vempuluru VS, Jakati S, Kaliki S. Concurrence of peripunctal nevus and uveal melanoma with scleral pigment dispersion presenting as phthisis bulbi. BMJ Case Rep 2021; 14:14/4/e240854. [PMID: 33863771 PMCID: PMC8055113 DOI: 10.1136/bcr-2020-240854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report demostrates an unusual occurence of peripunctal nevus and uveal melanoma, in which the clinical diganosis of uveal melanoma was masked by the atypical presentation as phthisis bulbi. Nevertheless, peculiar scleral pigment hinted at a possible intraocular tumour. The importance of meticulous clinical examination in assessment of ocular and periocular pigmented lesions is demonstrated. Further, clinicopathological differentials of correlation scleral pigmentation in diffuse necrotic uveal melanoma are illustrated.
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Affiliation(s)
- Neha Ghose
- Ocular Oncology, The Operation Eyesight Univeraal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vijitha S Vempuluru
- Ocular Oncology, The Operation Eyesight Univeraal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Saumya Jakati
- Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- Ocular Oncology, The Operation Eyesight Univeraal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Lamagna B, Uccello V, Prisco F, Russo V, Lamagna F, Navas L, Mennonna G, Murino C, Meomartino L. Iris melanoma associated with unilateral phthisis bulbi in a 13-year-old domestic shorthair female cat. Vet Q 2019; 39:131-135. [PMID: 31401942 PMCID: PMC6831019 DOI: 10.1080/01652176.2019.1655604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Barbara Lamagna
- Surgery Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Valeria Uccello
- Surgery Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Francesco Prisco
- Pathology Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Valeria Russo
- Pathology Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Francesco Lamagna
- Surgery Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Luigi Navas
- Surgery Unit of the Department of Veterinary Medicine and Animal Production , Naples , Italy
| | - Giuseppina Mennonna
- Interdepartmental Radiology Centre, University of Naples "Federico II" , Naples , Italy
| | - Carla Murino
- Interdepartmental Radiology Centre, University of Naples "Federico II" , Naples , Italy
| | - Leonardo Meomartino
- Interdepartmental Radiology Centre, University of Naples "Federico II" , Naples , Italy
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Salomão DR, Schmitt NJ, Wenger DE, Schlafmann S, Fritchie K. Extraskeletal Osteosarcoma: A Rare Case Arising in Phthisis Bulbi with a Review of the Literature. Ocul Oncol Pathol 2019; 5:114-118. [PMID: 30976589 DOI: 10.1159/000487544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/09/2018] [Indexed: 11/19/2022] Open
Abstract
A 60-year-old male presented with an increasingly painful and swollen phthisical eye. Enucleation revealed a large mass obliterating the eye with extension into the adjacent extraocular muscle. Histologic examination showed high-grade osteosarcoma. Systemic work-up showed no disease elsewhere, and a diagnosis of orbital extraskeletal osteosarcoma was rendered. Complete resection was not possible, and neoadjuvant radiation was given. The patient subsequently developed pulmonary metastasis and died of disease 5 months after initial diagnosis. Given the highly aggressive nature of this malignancy, raising awareness that extraskeletal osteosarcoma may arise in the background of phthisis bulbi will facilitate timely and accurate diagnosis and treatment.
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Affiliation(s)
- Diva R Salomão
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sue Schlafmann
- Department of Pathology, North Memorial Health Care, Robbinsdale, Minnesota, USA
| | - Karen Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Brownstein S, Jastrzebski A, Saleh S, Jordan DR, Gilberg SM, Leonard BC, Hurley BR. Unsuspected and misdiagnosed posterior uveal melanoma following enucleation and evisceration in Ottawa-Gatineau. Can J Ophthalmol 2018; 53:155-161. [PMID: 29631828 DOI: 10.1016/j.jcjo.2017.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a gap in the recent literature on the topic of clinically misdiagnosed and unsuspected posterior uveal melanomas (PUM) with a calculation of the frequency of these events for a specific geographical area. As the only ophthalmic pathology laboratory in our region, we determined the rate of these outcomes over a 16-year period. METHODS We retrospectively reviewed 2558 consecutive ophthalmic pathologic specimens in the Ottawa-Gatineau region, of which 334 were eviscerations and 227 were enucleations. We calculated the frequency of clinically misdiagnosed PUM and of clinically unsuspected PUM. We also determined the rate of uveal melanoma undergoing enucleation. RESULTS From 100 diagnoses of PUM, 2 (2.0%) cases were clinically unsuspected and 2 (2.0%) cases were clinically misdiagnosed. The rate of uveal melanoma undergoing enucleation was 5.6 cases per 1 000 000 of population per annum. From 2009 to 2012, the incidence of this event was 3.8 cases per 1 000 000 per annum, which was lower than the previous three 4-year increments. CONCLUSIONS We present the first and only single-centred, population-based data on the rates of unsuspected PUM and of clinical misdiagnosis of PUM in the era of modern diagnostic imaging. Our rate of clinical misdiagnosis is within the range of recent reports of this event. Unsuspected PUM occurred at a rate substantially lower than previously published. The incidence of uveal melanoma undergoing enucleation has decreased despite an increase in population, which reflects a shift in management from enucleation to radiation therapy.
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Affiliation(s)
- Seymour Brownstein
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont..
| | - André Jastrzebski
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Solin Saleh
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - David R Jordan
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Steven M Gilberg
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Brian C Leonard
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Bernard R Hurley
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
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Matayoshi S, Takahashi WY, Mendonça Natalino RJ. Massive retinal gliosis without retina. Can J Ophthalmol 2016; 51:e46-9. [PMID: 27085274 DOI: 10.1016/j.jcjo.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 09/01/2015] [Accepted: 12/06/2015] [Indexed: 10/21/2022]
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Jakobiec FA, Thanos A, Stagner AM, Grossniklaus HE, Proia AD. So-called massive retinal gliosis: A critical review and reappraisal. Surv Ophthalmol 2015; 61:339-56. [PMID: 26703887 DOI: 10.1016/j.survophthal.2015.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/16/2022]
Abstract
Massive retinal gliosis, a nonneoplastic retinal glial proliferation, was first described in detail over 25 years ago, before the era of immunohistochemistry, in a series of 38 cases-to which can be added 30 case reports or small series (no more than 3 cases) subsequently. We analyze a new series of 3 nontumoral intraretinal glioses and 15 cases of tumoral retinal gliosis, not all of which, strictly speaking, were massive. The data from this series are compared with the findings in previously published cases. Included are 2 cases of massive retinal gliosis diagnosed from evisceration specimens. In reviewing all published and current cases, we were able to establish 3 subgroups of retinal tumoral glioses rather than a single "massive" category: focal nodular gliosis, submassive gliosis, and massive gliosis. Among 43 reported cases, including the present series, but excluding the previous large series of 38 cases in which substantial clinical data were omitted, there were 19 men and 24 women. Their mean and median ages were 36.2 years and 36 years, respectively, with a range of 2 to 79 years. All lesions were composed of mitotically quiet, compact spindled fibrous astrocytes devoid of an Alcian blue-positive myxoid matrix. The most common associated ocular conditions were phthisis bulbi and congenital diseases or malformations. Histopathologically, all 3 tumoral categories were accompanied by progressively more extensive fibrous and osseous metaplasia of the pigment epithelium, the latter forming a clinically and diagnostically useful, almost continuous, outer rim of eggshell calcification in the submassive and massive categories that should be detectable with appropriate imaging studies. In decreasing order of frequency, microcysts and macrocysts, vascular sclerosis, exudates, calcospherites, and Rosenthal fibers were observed among the proliferating fibrous astrocytes. Immunohistochemistry was positive for glial fibrillary acidic protein in all cases and nestin in most (an intermediate cytoplasmic filament typically restricted to embryonic and reparative neural tissue). The nonneoplastic nature of all categories of gliosis was confirmed by absent TP53 (tumor suppressor gene) dysregulation, Ki-67 negativity, and intact p16 expression (the protein product of the p16 tumor suppressor gene) in the overwhelming majority of cases. These findings indicate an intrinsic attempt to regulate and maintain a low level of glial cell proliferation that becomes unsuccessful as the disease evolves. The categories of tumoral proliferation appeared to constitute a spectrum. We conclude that focal nodular tumors encompass lesions previously called retinal vasoproliferative lesions, which display the same histopathologic and immunohistochemical findings as 3 major categories of retinal gliosis characterized herein.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
| | - Aristomenis Thanos
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Hans E Grossniklaus
- L.F. Montgomery Pathology Laboratory, Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia, USA
| | - Alan D Proia
- Department of Pathology, Duke University, Durham, North Carolina, USA; Department of Ophthalmology, Duke University, Durham, North Carolina, USA
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Taha H, Amer HZ, El-Zomor H, Alieldin A, Nour R, Konsowa R, Zekri W, El Nadi E, Alfaar AS. Phthisis bulbi: clinical and pathologic findings in retinoblastoma. Fetal Pediatr Pathol 2015; 34:176-84. [PMID: 25839785 DOI: 10.3109/15513815.2015.1014951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Phthisis bulbi represents an ocular end-stage disease characterized by shrinkage and disorganization of the eye. We aim at identifying the pathologic changes of phthisis bulbi associated with retinoblastoma. DESIGN Retrospective observational case series study. METHODS 16 enucleated eyes were enrolled retrospectively between 2007 and 2012. Pathologic gross and microscopic findings were assessed. RESULTS Cases showed grossly shrunken eyes with a mean volume of 4.3 cc. Sclera was markedly thickened in the majority of cases with mean of 2272.8 μ. Choroid showed an average thickness of 1029 μ. Necrosis, dystrophic calcification, ossification, gliosis, residual viable tumor was identified in many cases. Pathologic high risk factors were seen in three specimens. CONCLUSIONS We conclude that retinoblastoma must be considered in the differential diagnosis of phthisis bulbi in the pediatric patients and active tumor was present in half of the patients.
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Houston SKS, Bourne TD, Lopes MBS, Ghazi NG. Bilateral massive retinal gliosis associated with retinopathy of prematurity. Arch Pathol Lab Med 2009; 133:1242-5. [PMID: 19653718 DOI: 10.5858/133.8.1242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2009] [Indexed: 11/06/2022]
Abstract
Massive retinal gliosis (MRG) is a rare, benign intraocular condition that may develop in association with long-standing eye conditions including chronic inflammation, vascular disorders, glaucoma, trauma, or congenital abnormalities. It is thought to represent a nonneoplastic reactive tissue response to retinal injury. Here, we describe an unusual case of bilateral MRG in association with retinopathy of prematurity. To our knowledge, this may be the first report of such an occurrence. The differential diagnosis of MRG is discussed with specific emphasis on its relationship to vasoproliferative tumor of the retina and presumed acquired retinal hemangiomas. In addition, we hypothesize that MRG, vasoproliferative tumor of the retina, and presumed acquired retinal hemangiomas may represent different phenotypes along a spectrum of the same disease process.
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Pereira PR, Odashiro AN, Souza Filho JP, Saraiva VS, Camoriano DG, Burnier MN. Malignancy in the blind painful eye--report of two cases and literature review. Diagn Pathol 2006; 1:45. [PMID: 17118184 PMCID: PMC1679807 DOI: 10.1186/1746-1596-1-45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 11/21/2006] [Indexed: 12/03/2022] Open
Abstract
Background Few cases of malignant tumors arising in a blind painful eye have previously been described. We described two cases of a blind painful eye containing an unsuspected tumor, which were enucleated to relieve the pain. Case presentations Case 1: A 57 year-old Caucasian man presented with recurrent orbital cellulitis and endophthalmitis in the left eye (OS). The OS was blind and painful and an enucleation was performed showing a uveal melanoma by histopathological exam. Case 2: A 54 year-old Caucasian man with previous history of a rhegmatogenous retinal detachment in his left eye presented a blind painful eye. Enucleation was performed revealing a well-differentiated B-cell lymphoma of uveal tract with extra ocular extension. Conclusion In the management of a blind painful eye, it is extremely important to rule out an intraocular malignancy particularly in those patients who have not been followed by an ophthalmologist.
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Affiliation(s)
- Patrícia Rusa Pereira
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
| | - Alexandre Nakao Odashiro
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
- LAC, Pathology and Cytopathology Laboratory, Campo Grande, MS, Brazil
- Universidade para o Desenvolvimento do Estado e Região do Pantanal, UNIDERP, Campo Grande, MS, Brazil
| | - João Pessoa Souza Filho
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
| | - Vinicius S Saraiva
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
| | - David Gerardo Camoriano
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
| | - Miguel N Burnier
- Henry C. Witelson Ocular Pathology Laboratory, Department of Ophthalmology McGill University, Montreal, Canadá
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Boonman ZFHM, van Mierlo GJD, Fransen MF, de Keizer RJW, Jager MJ, Melief CJM, Toes REM. Maintenance of Immune Tolerance Depends on Normal Tissue Homeostasis. THE JOURNAL OF IMMUNOLOGY 2005; 175:4247-54. [PMID: 16177064 DOI: 10.4049/jimmunol.175.7.4247] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ags expressed at immune privileged sites and other peripheral tissues are able to induce T cell tolerance. In this study, we analyzed whether tolerance toward an intraocular tumor expressing a highly immunogenic CTL epitope is maintained, broken, or reverted into immunity in the event the anatomical integrity of the eye is lost. Inoculation of tumor cells into the anterior chamber of the eye of naive B6 mice leads to progressive intraocular tumor growth, an abortive form of CTL activation in the tumor-draining submandibular lymph node, and systemic tolerance as evidenced by the inability of these mice to reject an otherwise benign tumor cell inoculum. Loss of anatomical integrity of the eye as a consequence of phthisis resulted in loss of systemic tolerance and the emergence of effective antitumor immunity against an otherwise lethal tumor challenge. Phthisis was accompanied by dendritic cell maturation and preceded the induction of systemic tumor-specific CTL immunity. Our data show that normal tissue homeostasis and anatomical integrity is required for the maintenance of ocular tolerance and prevention of CTL-mediated immunity. These data also indicate that tissue injury in the absence of viral or microbial infection can act as a switch for the induction of CTL immunity.
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