Biomedical subjects
Publications and source records attributed to M Yanoff.
We reviewed 17 cases of inverted follicular keratosis. The median age of the patients at the time of surgery was 69 years. Follow-up in 14 cases showed no recurrences of inverted follicular keratosis, which is a benign skin lesion, often mistaken clinically and pathologically for a malignancy. Inverted follicular keratosis is characterized histologically by the presence of squamous eddies, acantholysis, acanthosis, and hyperkeratosis.
A case of fibrous histiocytoma required 4 surgical excisions over an 11-year period. The technique of frequent observation and early excision of recurrences is probably the best approach to established histiocytomas. Complete primary excision seems to offer the best chance of definitive cure.
Two cases of osseous choristoma are described. One of the tumours was found in the conjunctiva of the right lower lid, an apparently unique location. The other more typical epibulbar tumour was found in the superior temporal quadrant of the episclera between the lateral and superior rectus muscles. In both instances the tumour was suspected of being a dermoid.
An infant with extensive CNS malformations and aplasia of the optic system in association with grossly normal-appearing eyes was studied. The neural malformations included partial agenesis of the medulla, pons, and cerebellum and striking maldevelopment of the telencephalon and diencephalon, with lissencephaly, complete arrhinencephaly, and agenesis of the optic system. Because the optic vesicles are outgrowths from the diencephalon, the absence of some structures derived from them is not surprising.
A history of blindness in one eye since childhood, the fundus appearance of the other eye, and the family history of elevated plasma levels of carcinoembryonic (CEA) antigen and colorectal carcinoma led us to diagnose bilateral spontaneously regressed retinoblastoma. Massive gliosis of the retina was found in the eye enucleated because of blindness and pain. The diagnosis of regressed retinoblastoma should be considered where the pathologic diagnosis of an enucleated eye is massive gliosis of the retina, but where no known cause is present.
A thirty-two-year old woman with known sarcoidosis was seen in the Ophthalmology Clinic because of discomfort in the left eye and orbit when looking up. A CT scan showed a small mass in the posterior left orbit. Conjunctival biopsy of the left eye showed a granuloma consistent with sarcoid. Rapid resolution of her condition occurred with prednisone therapy. One year later she had a recurrence with inability to elevate or depress the left eye. Similar, but more extensive, changes were seen on a CT scan. Conjunctival biopsy again was positive. With steroid therapy rapid and complete resolution occurred both clinically and as demonstrated by a CT scan. The relationship between her orbital mass and systemic sarcoidosis is discussed.
A 5-year-old boy had an excisional biopsy of a pigmented scleral lesion thought clinically to be a foreign body, probably graphite from a pencil. Histological study demonstrated that the pigmented lesion was an intrascleral nerve loop (Axenfeld).
The clinical, histochemical, light and electron microscopic evaluation of a case of lattice corneal dystrophy, appears clinically as an atypical granular dystrophy. There is structural and histochemical differentiation of the two dystrophies. Electron microscopy is often an invaluable aid in establishing a definitive diagnosis. The possible sources of the filamentous material found in lattice corneal dystrophy are discussed. It seems that not only keratocytes, but also corneal epithelial cells, occasionally may have the ability to elaborate the abnormal material that is considered to be amyloid in nature.
Two separate pedigrees had typical Meesmann's dystrophy of the corneal epithelium. Histologic examination of one patient from each pedigree showed two characteristic findings in corneal epithelium; the previously designated "peculiar substance" in the cells, and the vacuolated homogeneous substance mostly within the cysts. The primary disturbance probably involves the cytoplasmic ground substance that ultimately may result in complete homogenization of cells and the formation of cysts. Thickening of the epithelial basement membrane is variable and is a nonspecific response by the epithelial basal cells.
A 26-year-old boxer sustained a rhegmatogenous retinal detachment that was repaired successfully. Repeated blunt trauma caused a second retinal detachment two years later. Three attempts at repair by scleral buckling with diathermy and drainage of subretinal fluid were unsuccessful, and the eye was enucleated. Pathologic examination showed internal erosion of the intrascleral silicone implant into the vitreous compartment. Conjunctival-like epithelium lined the intrascleral bed of the implant and extended through the internal erosion onto intraocular structures, and this conjunctival epithelium was traced onto the external surface of the eye. Repeated dissection and applications of diathermy, combined with drainage of subretinal fluid, had weakened the sclera so that the silicone implant eroded internally and epithelium grew into the eye.
Results of a study of 100 consecutive enucleated globes showed an incidence of 22% of corneal endothelialization of the anterior chamber angle. Endothelialization had been overlooked in 15 of the 22 eyes in the original pathologic descriptions of the globes.
Two middle-aged patients developed pigmented intrastromal iris nevi and an associated loss of the surrounding iris stromal markings suggestive of a surface iris membrane. Because of the fear of malignant melanoma with superficial growth, we excised the lesions. Histopathologic examination of the specimens revealed that the pigmented lesions were benign iris nevi and that the surrounding membrane was caused by endothelial cell growth onto the iris from peripheral anterior synechiae. These synechiae occurred anterior to Schwalbe's line in the same sector as the nevi and had been noted preoperatively at gonioscopic examination, but their diagnostic significance was not appreciated.
A set of dizygotic twins, both born prematurely, developed herpes simplex encephalitis shortly after birth. The second twin had unilateral keratoconjunctivitis and bilateral endophthalmitis and subsequently died from disseminated herpes infection. Herpes simplex, type 2, was isolated from conjunctiva of both eyes, cerebrospinal fluid, nasopharynx and trachea. Histologic examination of the eyes reveaed bilateral endophthalmitis with a necrotizing retinitis. Intranuclear inclusion bodies were demonstrated by light microscopy in the retina, choroid and iris, and virus particles were demonstrated by electron microscopy in the retina. The other twin recovered from a much milder disseminate herpes simplex infection without apparent ocular involvement. During pregnancy, the mother had vaginitis which was suspected, but not documented, as being herpetic in origin. The father was diagnosed as having a penile infection caused by herpes simplex.
The techniques for processing ophthalmic tissue in our laboratory are described in detail. The procedure for grossing of specimens, and the different time tables for processing are given. We have been able to achieve easily reproducible results using the methods described.
Full-thickness explants of five human corneas grown in organ culture demonstrate that the migration of epithelium and endothelium is mutually limited once contact between the two cell types has been established. Two human corneas, however, failed to show this contact inhibition, and corneal epithelium surrounded completely the explant; both corneas showed cornea guttata. The implications of corneal epithelium-endothelium contact inhibition, and the failure of such inhibition, are discussed.
All 100 eyes treated with transconjunctival cryotherapy to seal peripheral retinal breaks had a final vision as good or better than when they were first seen. Three of the 100 eyes developed clinical retinal detachments subsequent to the initial cryotherapy, necessitating scleral buckling procedures; all 3 had a final vision of 6/6 in the involved eye. No other complications occurred. Indications for treating retinal breaks or for not treating, are presented. In general, all symptomatic retinal breaks and asymptomatic ones if in aphakic eyes, when crescentic or linear at the margin of lattice, or if horseshoe, are treated. Other instances in which asymptomatic retinal breaks are treated are the following: (1) eyes on long-term miotics: (2) cases in which a retinal detachment is present in the fellow eye: (3) the break(s) are in an only eye; (4) cataract extraction is being considered; (5) 4 diopters of myopia or greater are present; or (6) subretinal fluid of more than 1 but less than 2 disc diameters in size is noted. Other retinal breaks not associated with subclinical or clinical retinal detachments are placed under observation at periodic intervals.
A 70-year-old man had a rapid growth of a pigmented eyelid lesion, previously stationary for at least 50 years. Because of the suspicion of malignant melanoma, the lesion which resembled a cutaneous horn was excised. Histologic examination demonstrated a benign epithelial tumor, inverted follicular keratosis.