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Tam EK, Laver NV, Thakore-James M, Mooney MA, Daly MK, Lefebvre DR. ARHGEF-10 gene mutation presenting as orbital inflammatory syndrome. BMJ Case Rep 2022; 15:e245475. [PMID: 35260397 PMCID: PMC8905991 DOI: 10.1136/bcr-2021-245475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/03/2022] Open
Abstract
Rho guanine nucleotide exchange factor 10 (ARHGEF-10) is a RHO GTPase that has a role for neural morphogenesis, however its effect on the eyes remains unknown. Here, we report a 44-year-old man who presented with eyelid swelling along with a history of bilateral hand contractures, high-arched feet and muscle wasting, who was found to have an ARHGEF-10 mutation. Neuroimaging was significant for numerous nerve-based cystic abnormalities in the bilateral orbits and throughout the neuraxis, and an orbital biopsy revealed S-100 and SOX-10 positive lesion consistent with pseudocysts. While the role of ARHGEF-10 remains unclear, further research is warranted to further describe its clinical manifestations.
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Affiliation(s)
- Emily K Tam
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Nora V Laver
- Department of Pathology and Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Manisha Thakore-James
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Michael A Mooney
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA, USA
| | - Mary K Daly
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Daniel R Lefebvre
- Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Greig EC, Laver NV, Mendonca LS, Levine ES, Baumal CR, Waheed NK, Duker JS. SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN SMALL CHOROIDAL MELANOMAS AND CHOROIDAL NEVI. Retina 2021; 41:1182-1192. [PMID: 33315830 PMCID: PMC8140669 DOI: 10.1097/iae.0000000000003053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the use of swept-source optical coherence tomography angiography to detect distinct vascular features in small choroidal melanomas and choroidal nevi. METHODS Patients with a choroidal nevus or a treatment-naïve choroidal melanoma were imaged with color fundus photography, ultrasound, and swept-source optical coherence tomography angiography (12 × 12 mm). High-risk features including overlying fluid, orange pigment, shaggy photoreceptors, acoustic hollowness, depth >2 mm, and basal diameter >5 mm were assessed. Optical coherence tomography angiography vascular markers included: choroidal vessel visualization, choroidal vessel depth, and choriocapillaris flow signal, assessed qualitatively by comparison with surrounding, unaffected choriocapillaris. RESULTS Twenty-nine lesions were included in this study, seven flat choroidal nevi, 17 elevated choroidal nevi, and 5 choroidal melanomas. Distinct vascular patterns were noted between flat nevi, elevated nevi, and small choroidal melanomas. Choroidal melanomas displayed two types of vasculature: "nevus-like" vasculature with straight parallel vessels and complex vasculature with vascular loops and crosslinking. Visualized choroidal vessels were significantly deeper in melanomas (110 µm) than elevated (84 µm) or flat nevi (70 µm). In a size-matched subanalysis of 5 elevated choroidal nevi and 5 choroidal melanomas, choroidal melanomas had increased mean choroidal vessel depth (P = 0.015), deepest choroidal vessel visualized (P = 0.034), and presence of a deep choroidal vessel >155 µm (P = 0.048). CONCLUSION Swept-source optical coherence tomography angiography may detect distinct vascular features in choroidal nevi and small choroidal melanomas.
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Affiliation(s)
- Eugenia Custo Greig
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Yale School of Medicine, New Haven, Connecticut; and
| | - Nora V. Laver
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Luisa S.M. Mendonca
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Emily S. Levine
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Caroline R. Baumal
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K. Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Jay S. Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
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Boal NS, Distefano AG, Christiansen SP, Laver NV. Unilateral Familial Exudative Vitreoretinopathy: Clinical Profile and Pathology. Case Rep Ophthalmol 2021; 12:386-391. [PMID: 34054489 PMCID: PMC8136333 DOI: 10.1159/000516004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of a newborn with unilateral retinal detachment that could not be repaired. At examination under anesthesia, the retina was markedly abnormal and a presumptive diagnosis of retinal dysplasia was made. Several years later, the eye was enucleated because it was blind and painful. Final pathology was consistent with familial exudative vitreoretinopathy (FEVR). The literature describing unilateral retinal dysplasia is sparse. This case adds to the clinical spectrum of pathologic findings in FEVR.
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Affiliation(s)
- Nina S Boal
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alberto G Distefano
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Pediatric Ophthalmology, Boston Medical Center, Boston, Massachusetts, USA
| | - Nora V Laver
- Ophthalmic Pathology, Departments of Ophthalmology, Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
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Werner AC, Laver NV, Landmann DS. Primary Cutaneous Follicle Center Lymphoma of the Eyelid: A Case Report and Review of the Literature in Light of Recent Changes to the WHO Classification of Lymphoid Neoplasms. Ocul Oncol Pathol 2019; 5:147-152. [PMID: 30976595 DOI: 10.1159/000491381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
Primary cutaneous follicle center lymphoma (PCFCL) is a unique entity that represents up to 11% of all cutaneous lymphomas. PCFCL is associated with an indolent course and excellent 5-year survival rates, but can progress to secondary systemic involvement if left untreated. Histopathologic features of PCFCL can vary depending on the size, duration, and clinical stage of the lesion, making diagnosis somewhat challenging. Here, we present a case of a 50-year-old woman with an eyelid lesion that was initially classified as an inflamed cyst based on biopsy, but 1 year later, was determined to be PCFCL after repeat biopsy revealed different histology. In light of the recent changes to the WHO classification of lymphoid neoplasms, we review the unique clinical and histopathologic features of PCFCL that distinguish it from other more aggressive forms of cutaneous lymphoma in terms of course, prognosis, and management.
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Affiliation(s)
- Astrid C Werner
- Tufts Medical Center - New England Eye Center, Boston, Massachusetts, USA
| | - Nora V Laver
- Tufts Medical Center - New England Eye Center, Boston, Massachusetts, USA
| | - Dan S Landmann
- Hackensack University Medical Center, Hackensack, New Jersey, USA
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Morkin MI, Hofmann RJ, Laver NV. Subepithelial conjunctival nevus with atypia: Expanding our understanding of a challenging diagnosis. Human Pathology: Case Reports 2018. [DOI: 10.1016/j.ehpc.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mendoza-Santiesteban CE, Palma JA, Hedges TR, Laver NV, Farhat N, Norcliffe-Kaufmann L, Kaufmann H. Pathological Confirmation of Optic Neuropathy in Familial Dysautonomia. J Neuropathol Exp Neurol 2017; 76:238-244. [PMID: 28395083 PMCID: PMC5409127 DOI: 10.1093/jnen/nlw118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical data suggest that optic neuropathy and retinal ganglion cell loss are the main cause of visual decline in patients with familial dysautonomia, but this has not previously been confirmed by pathological analyses. We studied retinas and optic nerves in 6 eyes from 3 affected patients obtained at autopsy. Analyses included routine neurohistology and immunohistochemistry for neurofilaments, cytochrome c oxidase (COX), and melanopsin-containing ganglion cells. We observed profound axon loss in the temporal portions of optic nerves with relative preservation in the nasal portions; this correlated with clinical and optical coherence tomography findings in 1 patient. Retinal ganglion cell layers were markedly reduced in the central retina, whereas melanopsin-containing ganglion cells were relatively spared. COX staining was reduced in the temporal portions of the optic nerve indicating reduced mitochondrial density. Axonal swelling with degenerating lysosomes and mitochondria were observed by electron microscopy. These findings support the concept that there is a specific optic neuropathy and retinopathy in patients with familial dysautonomia similar to that seen in other optic neuropathies with mitochondrial dysfunction. This raises the possibility that defective expression of the IkB kinase complex-associated protein (IKAP) resulting from mutations in IKBKAP affects mitochondrial function in the metabolism-dependent retinal parvocellular ganglion cells in this condition.
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Affiliation(s)
- Carlos E. Mendoza-Santiesteban
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Jose-Alberto Palma
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Thomas R. Hedges
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Nora V. Laver
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Nada Farhat
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Lucy Norcliffe-Kaufmann
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
| | - Horacio Kaufmann
- From the New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts (CEM, TRH, NVL, NF); Department of Neurology, Dysautonomia Center, NYU Langone Medical Center, New York University, New York (CEM, JAP, LNK, HK); and University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida (CEM)
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Morkin MI, Kapadia MK, Laver NV. Pigmented Spindle Cell Nevus of Reed of the Eyelid. Ocul Oncol Pathol 2017; 3:176-180. [PMID: 29134183 DOI: 10.1159/000454864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/25/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To report the clinical, pathological, and immunohistochemical features of the first pigmented spindle cell nevus (PSCN) of Reed documented to have appeared in the eyelid. Methods The findings of clinical and histopathological examination are presented, along with differential diagnoses and a review of the pertinent literature. Case A 3-year-old boy presented with a rapidly growing, heavily pigmented left lower lid papule raising the concern of malignancy, warranting excisional biopsy. Nests of predominantly junctional Mart-1-positive spindle cells were identified by histopathological examination. The cells were largely uniform in size, elongated, surrounded by granular and coarse melanin, with a Ki-67 proliferation index of 0-2%. Five-month follow-up did not evidence any recurrence or invasive behavior of this benign melanocytic tumor. Conclusion This is the first documented case of PSCN of Reed, a distinct entity from Spitz nevus, presenting in the eyelid. The differential diagnoses include spindle cell and superficially spreading malignant melanoma as well as dysplastic nevus. Integration of clinical and histopathological findings with immunohistochemical and fluorescence in situ hybridization markers plays a central role in the diagnosis.
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Affiliation(s)
- Melina I Morkin
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Mitesh K Kapadia
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Nora V Laver
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
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Laver NV. Reply. Ophthalmology 2015; 123:e5. [PMID: 26707443 DOI: 10.1016/j.ophtha.2015.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nora V Laver
- Tufts Medical Center, New England Eye Center, Boston, Massachusetts.
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Klein KA, Lally DR, Taney LS, Laver NV, Duker JS. Retinal Pigment Epithelial Adenocarcinoma Presenting as an Amelanotic Mass. Ophthalmic Surg Lasers Imaging Retina 2015; 46:369-72. [DOI: 10.3928/23258160-20150323-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mehta M, Rasheed RA, Duker J, Reichel E, Feinberg E, Husain D, Foster CS, Laver NV. Vitreous evaluation: a diagnostic challenge. Ophthalmology 2014; 122:531-7. [PMID: 25439597 DOI: 10.1016/j.ophtha.2014.09.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/02/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To categorize vitrectomy cytologic diagnoses and ancillary tests to address appropriate processing of low-volume vitreous samples. DESIGN Retrospective case series. PARTICIPANTS Five thousand seven hundred thirty-six vitreous samples. METHODS Cytologic diagnoses of therapeutic and diagnostic vitrectomy samples and their processing protocols from 3 teaching institutions were reviewed. MAIN OUTCOME MEASURES Diagnostic results were categorized as negative for malignancy, suspicious for malignancy, and positive for malignancy. All ancillary studies performed were documented, including special stains, immunohistochemistry analysis, cytokine levels, and polymerase chain reaction (PCR) analysis. RESULTS Of the 5736 vitreous samples analyzed, 4683 (81.64%) were from Tufts Medical Center (TMC), 955 (16.65%) were from Boston Medical Center (BMC), and 98 (1.70%) were from Massachusetts Eye Research and Surgery Institution (MERSI). Cases from TMC and BMC were therapeutic and diagnostic vitrectomies, and MERSI cases were diagnostic vitrectomies. Most vitrectomies showed negative results for malignancy: 99.47% of TMC cases, 99.89% of BMC cases, and 79.6% of MERSI cases. These included vitreous hemorrhage and inflammatory or infectious findings. Ancillary studies performed in this category included Periodic Acid-Schiff staining for fungi, PCR analysis for toxoplasmosis, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex virus I and II, and vitreous cultures for infections (coagulase-negative Staphylococcus, Candida, Fusarium, and Propionibacterium species). Interleukin (IL) 10-to-IL-6 ratios were performed on 38.7% of cases from MERSI. Fourteen cases from TMC were suspicious for malignancy based on cytologic evaluation. Eleven cases from TMC, 1 case from BMC, and 20 cases from MERSI showed positive results for malignancy and included B-cell lymphoma, retinoblastoma, melanoma, and metastatic adenocarcinoma. The ancillary testing included PCR for heavy chain immunoglobulin gene rearrangements, immunohistochemistry for EBV, in situ hybridization for κ and λ light chains, and cytogenetics. CONCLUSIONS This is the largest data pool of reported cytologic diagnoses of diagnostic and therapeutic vitrectomy samples. Cytologic evaluation of therapeutic vitrectomy samples provides a valuable baseline of nonpathologic findings that assist in differentiation between malignancy, infections, and inflammatory conditions. Allocation of small-volume vitreous samples to select ancillary testing from the plethora of available diagnostic tests requires preoperative communication between surgeons and pathologists to ensure appropriate and timely treatment methods.
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Affiliation(s)
- Manisha Mehta
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts
| | - Reena A Rasheed
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
| | - Jay Duker
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts
| | - Elias Reichel
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts
| | - Edward Feinberg
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Deeba Husain
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Charles Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nora V Laver
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts; Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts.
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Gagne NL, Leonard KL, Huber KE, Mignano JE, Duker JS, Laver NV, Rivard MJ. BEDVH-A method for evaluating biologically effective dose volume histograms: Application to eye plaque brachytherapy implants. Med Phys 2012; 39:976-83. [DOI: 10.1118/1.3679010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
CONTEXT Intraocular melanoma of the ciliary body and choroid is the most common primary ocular malignant tumor in adults and the most common noncutaneous melanoma. OBJECTIVE To describe the most salient clinical features, histopathologic findings, and treatment modalities of intraocular melanoma, as well as the novel therapies currently being tested. DATA SOURCES Clinically, it is important to determine which lesions carry a worse prognosis so as to offer patients the best treatment modalities available. Tumor location, size, histopathology, cytogenetic abnormalities, and tumor profiling are all used in determining the risk of death from metastatic disease of uveal melanocytic lesions. Despite successful local tumor control, up to 50% of patients have metastatic disease within 15 years of diagnosis; there is no effective treatment for metastatic disease. CONCLUSIONS Pathologists should be aware of the importance of tumor gross description, cellular histopathology classification, the use of fine-needle aspiration biopsy coupled with cytogenetics, and the new classification of uveal malignant melanomas that is based on chromosome 3 status.
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Affiliation(s)
- Nora V Laver
- Tufts Medical Center, Boston, Massachusetts 02111, USA.
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Abstract
CONTEXT Intraocular melanoma of the ciliary body and choroid is the most common primary ocular malignant tumor in adults and the most common noncutaneous melanoma. OBJECTIVE To describe the most salient clinical features, histopathologic findings, and treatment modalities of intraocular melanoma, as well as the novel therapies currently being tested. DATA SOURCES Clinically, it is important to determine which lesions carry a worse prognosis so as to offer patients the best treatment modalities available. Tumor location, size, histopathology, cytogenetic abnormalities, and tumor profiling are all used in determining the risk of death from metastatic disease of uveal melanocytic lesions. Despite successful local tumor control, up to 50% of patients have metastatic disease within 15 years of diagnosis; there is no effective treatment for metastatic disease. CONCLUSIONS Pathologists should be aware of the importance of tumor gross description, cellular histopathology classification, the use of fine-needle aspiration biopsy coupled with cytogenetics, and the new classification of uveal malignant melanomas that is based on chromosome 3 status.
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Affiliation(s)
- Nora V Laver
- Tufts Medical Center, Boston, Massachusetts 02111, USA.
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Gendron RL, Laver NV, Good WV, Grossniklaus HE, Miskiewicz E, Whelan MA, Walker J, Paradis H. Loss of Tubedown Expression as a Contributing Factor in the Development of Age-Related Retinopathy. ACTA ACUST UNITED AC 2010; 51:5267-77. [DOI: 10.1167/iovs.09-4527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Robert L. Gendron
- From the Division of Basic Medical Sciences, Department of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Nora V. Laver
- New England Eye Center, Ocular Pathology Laboratory, Boston, Massachusetts
| | - William V. Good
- Smith Kettlewell Eye Research Institute, San Francisco, California; and
| | - Hans E. Grossniklaus
- L. F. Montgomery Pathology Laboratory, Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Ewa Miskiewicz
- From the Division of Basic Medical Sciences, Department of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Maria A. Whelan
- From the Division of Basic Medical Sciences, Department of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Jacqueline Walker
- From the Division of Basic Medical Sciences, Department of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Hélène Paradis
- From the Division of Basic Medical Sciences, Department of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
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Kondratiev S, Heher K, Baker BJ, Laver NV. Melkersson-Rosenthal Syndrome Presenting as Chronic Eyelid Swelling. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-3. [PMID: 20337335 DOI: 10.3928/15428877-20100215-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2009] [Indexed: 11/20/2022]
Abstract
Melkersson-Rosenthal Syndrome (MRS) is a rare disorder characterized by orofacial edema, facial palsy, and fissured tongue. A 64-year-old man presented with a fissured tongue and persistent chronic right upper eyelid edema of 15 years duration. The diagnostic biopsy revealed non-necrotizing granulomatous inflammation adjacent to blood and lymphatic vessels. Characteristic granulomas with focal occlusion of dilated lymphatic channels were present. Special stains for fungi, acid-fast microorganisms and bacteria were negative. Ptosis due to a mechanical effect of the persistent eyelid edema required surgical treatment including debulking and advancement of the levator muscle. At 6 months after surgery the patient showed symmetrical eyelid position without edema. The case demonstrates an uncommon presentation of Melkersson-Rosenthal syndrome with prominent upper eyelid edema and lingua plicata, which was initially misdiagnosed. The clinical findings coupled with the characteristic granulomatous lymphangitis present in the biopsy are crucial for a definite diagnosis.
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Abstract
A 56-year-old woman referred to the ophthalmic service for evaluation of a lesion on her right cornea. There was no history of trauma or infection to the eye and there was no history of previous eye surgery or topical medications to the eye. Ophthalmic examination revealed a raised lesion with gelatinous appearance present at the nasal corneal limbus. Histologically, the corneal stroma was replaced by a myxoid matrix with scattered elongated spindle cells with no atypia consistent with corneal myxoma. Due to the rarity of the disease, our case highlights the importance of recognizing this entity. The treatment of choice is local excision.
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Cockerham GC, Laver NV, Hidayat AA, McCoy DL. An immunohistochemical analysis and comparison of posterior polymorphous dystrophy with congenital hereditary endothelial dystrophy. Cornea 2002; 21:787-91. [PMID: 12410038 DOI: 10.1097/00003226-200211000-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the immunohistochemical profiles of the abnormal endothelial cells of posterior polymorphous dystrophy (PPMD) and congenital hereditary endothelial dystrophy (CHED). METHODS Formalin-fixed, paraffin-embedded sections of seven corneas with the diagnosis of PPMD (seven patients), six corneas with the diagnosis of CHED (four patients), and five control corneas were stained with hematoxylin-eosin. Adjacent histologic sections were stained with monoclonal antibodies that react with pancytokeratin, AE1/AE3, cytokeratin (CK) 7, CK 20, CAM 5.2, and epithelial membrane antigen. The immunoreactivity of the corneal endothelium was assessed by light microscopy. RESULTS The endothelial cells stained positive for pancytokeratin and CK 7 in seven of seven corneas of patients with PPMD and five of six corneas of patients with CHED; variable positivity was seen to AE1, AE3, and CAM 5.2. The endothelium was uniformly negative to staining by CK 20. The epithelium stained positive with pancytokeratin, AE1, and AE3. All control corneas were negative for pancytokeratin, CK 7, and CK 20. CONCLUSION The abnormal endothelium in both PPMD and CHED expresses similar CKs, including CK 7, which is not present in normal endothelium or surface epithelium. This may indicate a shared developmental abnormality in these conditions, as previously suggested by ultrastructural studies and genetic mapping.
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Affiliation(s)
- Glenn C Cockerham
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
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Hidayat AA, Mafee MF, Laver NV, Noujaim S. Langerhans' cell histiocytosis and juvenile xanthogranuloma of the orbit. Clinicopathologic, CT, and MR imaging features. Radiol Clin North Am 1998; 36:1229-40, xii. [PMID: 9884699 DOI: 10.1016/s0033-8389(05)70242-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical, radiologic, and histopathologic features of two main disorders of the orbit are discussed. Group I, Langerhans cell histiocytosis (histiocytosis X, Class I), is caused by proliferation of X histiocytic Langerhans' cells. Group II is juvenile xanthogranuloma, and Class II is related to the proliferation of non-X histiocytic (monocyte-macrophage) cells. The two diseases are of unknown cause and differ in their clinical, radiologic, and histopathologic features.
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Affiliation(s)
- A A Hidayat
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Laver NV, Rubinfeld RS, Baum M, de Brito PA. Cytomorphology of a mixed pigmented/nonpigmented pleomorphic adenoma of the ciliary body: a diagnostic pitfall in the evaluation of intraocular tumors. Diagn Cytopathol 1996; 14:259-62. [PMID: 8732658 DOI: 10.1002/(sici)1097-0339(199604)14:3<259::aid-dc12>3.0.co;2-k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intraoperative cytology is an alternative and sometimes preferred method to frozen section in the rapid evaluation of surgical biopsies. This report describes the cytological, histological, and immunohistochemical features of a case of mixed pigmented/nonpigmented pleomorphic adenoma of the ciliary body with clinical and morphological features reminiscent of malignant melanoma. The characteristic cyto-histomorphology of this unusual tumor and its distinguishing features from malignant melanoma are discussed.
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Affiliation(s)
- N V Laver
- Department of Pathology, Georgetown University Medical Center, Washington, DC, USA
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