2016 Annual Meeting

Ophthalmic Pathology Unexpected and Challenging Cases

Room CC 605 - March 3, 2016 - 7:30pm to 9:30pm

Moderators:
Patricia Chevez-Barrios, MD
Panelists:
Sander Dubovy, MD, Diva Salomao, MD, Abelardo Rodriguez, MD, Tatyana Milman, MD

Pre-Meeting Materials

Case 1

Faculty:
Sander Dubovy, MD

Clinical History:

The patient is a 43 year old African American female with a 4-month history of bulging of the eyes, bilateral eye pain OD > OS and intermittent binocular diplopia. The patient has a past medical history of diabetes insipidus in the setting of a pituitary mass, pericardial effusion, bilateral hydronephorosis with acute renal failure, retroperitoneal mass and fibrosis, congestive heart failure in the setting of a right atrial mass. The patient underwent a lacrimal gland biopsy. On neuro- imaging the lacrimal gland was enlarged and demonstrated radiographic evidence of involvement but this showed just 2 small foci of lymphoid infiltrate, both of which showed no evidence of abnormality and was negative for gene rearrangement.

Morphological Findings (click to enlarge):

Figure 1 Orbital biopsy H&E 20x
Figure 2 Orbital biopsy H&E 40x
Figure 3 Orbital biopsy CD68 20x
Figure 4 Orbital biopsy S100 20x
Figure 5 Orbital biopsy CD1a 20x
Figure 7 Lacrimal gland biopsy H&E 20x
Figure 6 Bone Scan

Case 2

Faculty:
Diva Salomao, MD

Clinical History:

12 years old female referred for evaluation of right orbital inflammatory pseudotumor. Three years ago, presented with right sided proptosis and vision changes. Orbital MRI on 10/12 showed enhancing intra-orbital mass. Biopsy showed nonspecific inflammation (Figures 1-4). She was diagnosed with orbital pseudotumor and treated with immunosuppression, starting with IV steroids, with improvement of her vision. MRI on 12/2012 showed improvement in the right orbital mass. The vision worsened when steroids were tapered. She received another pulse of IV steroids, but did not experienced improvement in the vision at that time. She was then treated with 3 doses of infliximab induction therapy and 3 doses of maintenance therapy with her last dose on 5/2/13. She did not have further improvement in vision and it has remained stable since. June 2013, she developed complete right 6th nerve palsy and was treated with IV steroids followed by PO steroids for 2 weeks, which led to resolution of the palsy. MRI on 5/15 showed infiltration and enhancement of the right parapharyngeal fat, right cavernous sinus, and right middle cranial fossa. Repeat biopsy of the right nasopharyngeal lesion showed nonspecific chronic inflammation (Figures 5-7). She then received low dose radiation (20Gy) from 6 to 7/15.

Morphological Findings (click to enlarge):

Figure 1 Right Orbital Mass Biopsy - Oct 2012 - HE X 20
Figure 2 Right Orbital Mass Biopsy - Oct 2012 - HE X 100
Figure 3 Right Orbital Mass Biopsy - Oct 2012 - HE X 200
Figure 4 Right Orbital Mass Biopsy - Oct 2012 - HE X 400
Figure 5 Nasopharyngeal Mass Biopsy - May 2015 - HE x 100
Figure 6 Nasopharyngeal Mass Biopsy - May 2015 - HE x 200
Figure 7 Nasopharyngeal Mass Biopsy - May 2015 - HE x 400
Figure 8 Right Orbit MRI
Figure 9 Right Orbit MRI

Case 3

Faculty:
Abelardo Rodriguez, MD

Case 4

Faculty:
Tatyana Milman, MD

Clinical History:

An otherwise healthy male infant was noted at birth to have a skin-colored, vascular, right upper eyelid nodule, which by 2 months of age enlarged in size to 2 cm despite the use of topical steroidal and antibiotic ointments. A concern for amblyopia and consideration of a potential malignancy prompted surgical excision.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12

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