DZI20-173

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Request type Study

Subspecialty Eye

Set MEEI Eye Pathology Collection

Topic Retina

Presenter Stagner, Anna M.,MD

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Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	Routine autopsy in a centenarian with bilateral central scotomas for many years.	null	Neovascular age related macular degeneration with subfoveal disciform scar. Note the cystoid macular edema (fluid in the outer plexiform layer).
Case 2	74 year old man with ocular surface neoplasia and pre-existing poor vision	null	Dry age related macular degeneration with geographic atrophy. Note the distinct area of photoreceptor and retinal pigment epitheilal loss. Additionally • the cornea displays invasive adenosquamous carcinoma.
Case 3	1 year old with leukocoria	null	Retinoblastoma. Note the origin of the small round blue cell tumor from the retina. The tumor is more well-differentiated (flurettes • Flexner-Winterstiner rosettes) toward the optic nerve and more anaplastic-appearing in other areas with extensive dystrophic calcification. There is also subretinal seeding with re-invasion of of the retina.
Case 4	Middle-aged female with chronic ocular inflammation.	Aja51	Ocular/CNS large B cell lymphoma. There is extensive atrophy and degeneration of the retina. In areas one can find collections of lymphoma cells on the inner aspect of Bruchs membrane; in some areas it is apparent that the tumor cells are between the retinal pigment epithelium and Bruchs membrane. There are non-neoplastic lymphocytes in the adjacent choroid that serve to highlight the histologic differences between lymphoma cells and normal lymphocytes (lymphoma cells are larger and have hyperchromatic nuclei with apoptotic and associated necrotic debris). Typically these tumors do not invade or form tumors in the uveal tract • but this case is unusual because there is a prominent nodule of tumor in the ciliary body.
Case 5	Middle-aged patient with HIV and loss of vision.	Aja51	Cytomegalovirus retinitis. On one side of the optic nerve head the retina is atrophic with no neural structures remaining. On the other side there is atrophic retina followed by intact retina. In the boundary between the intact and absent retina one can see the boundary zone with numerous nuclear and cytoplasmic inclusions that represent viral cytopathic effect. Such inclusions are also seen in the optic nerve just posterior to the lamina cribrosa. They are also seen at the extreme periphery of the retina • near the ora serrata • on the side of the eye with mostly atrophic retina. Incidentally • in the region of intact retina away from the boundary region of active virus replication • one can see occasional areas of chorioretinal scars with absence mostly of the outer retina and retinal pigment epithelium. Those are the residual of photocoagulation scars due to laser panretinal photocoagulation that the patient received to treat early diabetic retinopathy. Note that there are also a few intraretinal hemorrhages • also attributed to diabetic retinopathy.