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Eiger-Moscovich M, Shields CL, Eagle RC, Milman T. BRCA-associated protein1 (BAP1) immunohistochemical stain reliability in postbrachytherapy uveal melanoma enucleation specimens. Indian J Ophthalmol 2024; 72:S459-S467. [PMID: 38324631 DOI: 10.4103/ijo.ijo_648_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
PURPOSE The BRCA-associated protein1 (BAP1) immunohistochemical (IHC) stain has emerged as a powerful and inexpensive prognostic tool in uveal melanoma (UM), correlating with UM genetics and outcome. The data on the reliability of BAP1 immunohistochemistry in previously irradiated UM is scant. We aim to assess BAP1 IHC in post-Iodine-125 plaque brachytherapy-treated UM-enucleated eyes. METHODS In a case-control study, the medical records of all patients who underwent enucleation for UM at a major Ocular Oncology Service from December 1 st , 2007 to December 31 st , 2014 were reviewed. All cases with either chromosome 3 (ch3) status or sufficient follow-up (>5 years or metastasis) were selected. Nuclear BAP1 (nBAP1) immunoreactivity was interpreted as intact (positive in >90% of nuclei), lost (positive in <5% of nuclei), or heterogeneous (positive in 5-90% of nuclei). Retina and intratumoral blood vessels served as internal positive controls. RESULTS A comparison of 34 postbrachytherapy UM secondary-enucleated eyes with 47 nonbrachytherapy primary enucleated controls revealed no significant difference with respect to nBAP1 IHC (lost in 41% vs 51%, P = 0.19), ch3 status (ch3 monosomy in 59% vs 60%, P = 0.48), and outcome (metastatic disease in 44% vs 47%, P = 0.8). Association of nBAP1 IHC with ch3 status and outcome [intact nBAP1/(ch3 disomy and/or no metastasis) and lost nBAP1 (ch3 monosomy and/or metastasis)] in post-brachytherapy UM was significantly lower when compared with non-brachytherapy tumors [21/30 (70%) vs 41/44 (93%), P = 0.004*]. CONCLUSION Although nBAP1 IHC stain is a strong prognostic tool in UM, its association with ch3 status, and outcome in postbrachytherapy UM was significantly lower compared with nonbrachytherapy tumors due to pitfalls in the interpretation of nBAP1 immunoreactivity in irradiated UM. This test should be used judiciously in the prognostication of postbrachytherapy-enucleated UM.
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Affiliation(s)
- Maya Eiger-Moscovich
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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2
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Shi C, Lytle A, Milman T, Penne R, Bagg A. Composite Histiocytic Sarcoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma of the Ocular Adnexa. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00377. [PMID: 38624159 DOI: 10.1097/iop.0000000000002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Histiocytic sarcoma (HS) is a rare and aggressive hematologic neoplasm characterized by the proliferation of malignant histiocytes. It infrequently presents with periorbital involvement. Here we present the first documented case of ocular adnexal histiocytic sarcoma composite with chronic lymphocytic leukemia/small lymphocytic lymphoma and provide compelling evidence for the transdifferentiation of chronic lymphocytic leukemia/small lymphocytic lymphoma to histiocytic sarcoma in an 80-year-old woman. Comprehending the clinicopathological characteristics of histiocytic sarcoma and various other histiocytic proliferations and neoplasms affecting orbital and ocular structures is imperative for ophthalmic surgeons and pathologists.
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Affiliation(s)
- Chenxu Shi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Andrew Lytle
- Centre for Lymphoid Cancer, BC Cancer and Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tatyana Milman
- Department of Ophthalmology Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Robert Penne
- Department of Ophthalmology Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
- Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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3
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Sehgal A, Milman T, Li Q, Pulido JS. Histological Findings in the Eyes of Abcc6 Knockout Rat Model of Pseudoxanthoma Elasticum. Transl Vis Sci Technol 2024; 13:29. [PMID: 38656313 PMCID: PMC11044839 DOI: 10.1167/tvst.13.4.29] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose To describe the ocular findings of murine pseudoxanthoma elasticum (PXE) models with ATP-binding cassette subfamily C member 6 (Abcc6) gene knockout. Methods This experiment was conducted in four Abcc6-/- rats and compared with six wild-type Abcc6+/+ control rats. The animals underwent necropsy at 6 months of age. Histological examination of the eyes was performed. Results Histological examination of eight eyes from four Abcc6-/- rats revealed multiple nodular foci of calcification in the uvea, sclera, and conjunctiva, focally in perivascular distribution, as well as linear and nodular calcification of Bruch's membrane. Calcific foci were not associated with inflammation in the knockout rats. There was no evidence of calcification in control eyes. Discussion The Abcc6-/- rat model shows that PXE can affect multiple ocular tissues beyond the calcification in Bruch's membrane noted in human eyes. Nodular calcific foci probably correspond to comet lesions seen in patients with PXE. The presence of ectopic calcium without inflammation distinguishes it from inflammatory calcium deposition in atherosclerosis. Further studies are needed to determine why PXE does not cause inflammatory infiltration. Translational Relevance The Abcc6-/- murine model may be suitable for studying ocular PXE pathophysiology and ectopic calcification and developing effective therapies.
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Affiliation(s)
- Anahita Sehgal
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Qiaoli Li
- Department of Biochemistry and Molecular Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose S. Pulido
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Bower Laboratory for Translational Medicine Vickie and Jack Farber, Vision Research Center at Wills Eye Hospital, Wills Eye Hospital, Philadelphia, PA, USA
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4
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Justin GA, Huang C, Nguyen MK, Lee J, Seddon I, Wesley TA, Bakri SJ, Campbell JP, Cavuoto K, Collins M, Gedde SJ, Kossler AL, Milman T, Shukla A, Sridhar J, Syed ZA, Williams BK, Woreta FA, Patel SN, Yonekawa Y. An Analysis of Solicitations from Predatory Journals in Ophthalmology. Am J Ophthalmol 2024:S0002-9394(24)00087-4. [PMID: 38490339 DOI: 10.1016/j.ajo.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To evaluate trends associated with email communication from potentially predatory publishers to faculty in ophthalmology. DESIGN Cross sectional study METHODS: Ophthalmologists (n=14) from various subspecialties and institutions were recruited to participate. Participants identified unsolicited emails they had received originating from publishers in May 2021. Information collected included details on email contents and publisher organizations. Trends in communications from predatory publishers were evaluated. RESULTS Over a 30-day study period, a total of 1813 emails were received from 383 unique publishers and 696 unique journals with a mean (SD) of 4.73 (2.46) emails received per day per participant. Of the 1813 emails identified, 242 (13%) emails were invitations to conferences, whereas 1440 (80%) were solicitations for article submissions to open-access pay-to-publish journals. A total of 522 (29.0%) emails were related to ophthalmology, and reference to a prior publication of the participant occurred in 262 emails (14%). Of the 696 unique journals identified, 174 (25%) journals were indexed on PubMed and 426 (61%) were listed on Beall's list. When comparing journals listed on PubMed versus those that were not, PubMed indexed journals had a higher impact factor (2.1 vs 1.5, p=0.002), were less likely to use "greetings" (76% vs 91%, p<0.001), had fewer spelling/grammar errors (40% vs 51%, p=0.01), and were less likely to offer rapid publication (16% vs 25%, p=0.02). CONCLUSION Unsolicited requests to publish occur frequently and may diminish the quality of the scientific literature. We encourage individuals in ophthalmology to be aware of these trends in predatory publishing.
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Affiliation(s)
- Grant A Justin
- Duke Eye Center, Duke University Health System, Durham, NC; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Charles Huang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA; Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael K Nguyen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA; Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica Lee
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA; Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian Seddon
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
| | | | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Megan Collins
- Department of Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Andrea L Kossler
- Byers Eye Institute, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Aakriti Shukla
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Basil K Williams
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Fasika A Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Retina Vitreous Consultants, Pittsburgh, PA, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Gonzalez Martinez OG, Watson A, Shields CL, Milman T. Disseminated Extranodal NK/T-Cell lymphoma, Presenting as an Orbital Mass. Ophthalmic Plast Reconstr Surg 2024; 40:e68. [PMID: 37351864 DOI: 10.1097/iop.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Orlando G Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Alison Watson
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Pilotte J, Huang AS, Khoury S, Zhang X, Tafreshi A, Vanderklish P, Sarraf ST, Pulido JS, Milman T. Detection of TTR Amyloid in the Conjunctiva Using a Novel Fluorescent Ocular Tracer. Transl Vis Sci Technol 2024; 13:11. [PMID: 38359019 PMCID: PMC10876017 DOI: 10.1167/tvst.13.2.11] [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] [Received: 08/15/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024] Open
Abstract
Background Transthyretin amyloidosis (ATTR) is a significant cause of cardiomyopathy and other morbidities in the elderly and Black Americans. ATTR can be treated with new disease-modifying therapies, but large shortfalls exist in its diagnosis. The objective of this study was to test whether TTR amyloid can be detected and imaged in the conjunctiva using a novel small-molecule fluorescent ocular tracer, with the implication that ATTR might be diagnosable by a simple eye examination. Methods Three approaches were used in this study. First, AMDX-9101 was incubated with in vitro aggregated TTR protein, and changes in its excitation and emission spectra were quantified. Second, a cadaver eye from a patient with familial amyloid polyneuropathy type II TTR mutation and a vitrectomy sample from an hATTR patient were incubated with AMDX-9101 and counterstained with Congo Red and antibodies to TTR to determine whether AMDX-9101 labels disease-related TTR amyloid deposits in human conjunctiva and eye. Last, imaging of in vitro aggregated TTR amyloid labeled with AMDX-9101 was tested in a porcine ex vivo model, using a widely available clinical ophthalmic imaging device. Results AMDX-9101 hyper-fluoresced in the presence of TTR amyloid in vitro, labeled TTR amyloid deposits in postmortem human conjunctiva and other ocular tissues and could be detected under the conjunctiva of a porcine eye using commercially available ophthalmic imaging equipment. Conclusions AMDX-9101 enabled detection of TTR amyloid in the conjunctiva, and the fluorescent binding signal can be visualized using commercially available ophthalmic imaging equipment. Translational Relevance AMDX-9101 detection of TTR amyloid may provide a potential new and noninvasive test for ATTR that could lead to earlier ATTR diagnosis, as well as facilitate development of new therapeutics.
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Affiliation(s)
| | - Alex S. Huang
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | | | - Xiaowei Zhang
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Jose S. Pulido
- Vickie and Jack Farber Vision Research Center and MidAtlantic Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Tatyana Milman
- Vickie and Jack Farber Vision Research Center and MidAtlantic Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
- Pathology Department, Wills Eye Hospital, Philadelphia, PA, USA
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7
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Mudhar HS, Krishna Y, Cross S, Auw-Haedrich C, Barnhill R, Cherepanoff S, Eagle R, Farmer J, Folberg R, Grossniklaus H, Herwig-Carl MC, Hyrcza M, Lassalle S, Loeffler KU, Moulin A, Milman T, Verdijk RM, Heegaard S, Coupland SE. A Multicenter Study Validates the WHO 2022 Classification for Conjunctival Melanocytic Intraepithelial Lesions With Clinical and Prognostic Relevance. J Transl Med 2024; 104:100281. [PMID: 37924948 DOI: 10.1016/j.labinv.2023.100281] [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] [Received: 07/30/2023] [Revised: 09/16/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
Several nomenclature and grading systems have been proposed for conjunctival melanocytic intraepithelial lesions (C-MIL). The fourth "WHO Classification of Eye Tumors" (WHO-EYE04) proposed a C-MIL classification, capturing the progression of noninvasive neoplastic melanocytes from low- to high-grade lesions, onto melanoma in situ (MIS), and then to invasive melanoma. This proposal was revised to the WHO-EYE05 C-MIL system, which simplified the high-grade C-MIL, whereby MIS was subsumed into high-grade C-MIL. Our aim was to validate the WHO-EYE05 C-MIL system using digitized images of C-MIL, stained with hematoxylin and eosin and immunohistochemistry. However, C-MIL cases were retrieved from 3 supraregional ocular pathology centers. Adequate conjunctival biopsies were stained with hematoxylin and eosin, Melan-A, SOX10, and PReferentially expressed Antigen in Melanoma. Digitized slides were uploaded on the SmartZoom platform and independently scored by 4 ocular pathologists to obtain a consensus score, before circulating to 14 expert eye pathologists for independent scoring. In total, 105 cases from 97 patients were evaluated. The initial consensus diagnoses using the WHO-EYE04 C-MIL system were as follows: 28 benign conjunctival melanoses, 13 low-grade C-MIL, 37 high-grade C-MIL, and 27 conjunctival MIS. Using this system resulted in 93% of the pathologists showing only fair-to-moderate agreement (kappa statistic) with the consensus score. The WHO-EYE05 C-MIL system (with high-grade C-MIL and MIS combined) improved consistency between pathologists, with the greatest level of agreement being seen with benign melanosis (74.5%) and high-grade C-MIL (85.4%). Lowest agreements remained between pathologists for low-grade C-MIL (38.7%). Regarding WHO-EYE05 C-MIL scoring and clinical outcomes, local recurrences of noninvasive lesions developed in 8% and 34% of the low- and high-grade cases. Invasive melanoma only occurred in 47% of the cases that were assessed as high-grade C-MIL. This extensive international collaborative study is the first to undertake a comprehensive review of the WHO-EYE05 C-MIL scoring system, which showed good interobserver agreement and reproducibility.
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Affiliation(s)
- Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Yamini Krishna
- National Specialist Ophthalmic Pathology Service, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Simon Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Raymond Barnhill
- Department of Translational Research, Institut Curie, Paris Sciences and Lettres Research University, and Faculty of Medicine University of Paris Descartes, Paris, France
| | - Svetlana Cherepanoff
- Sydpath, Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ralph Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James Farmer
- Departments of Ophthalmology and Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Departments of Pathology and Laboratory Medicine and Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Folberg
- Departments of Ophthalmology and Pathology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; Departments of Ophthalmology and Pathology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Hans Grossniklaus
- Department of Ophthalmology, Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - Martina C Herwig-Carl
- Department of Ophthalmology, Division of Ophthalmic Pathology, University Hospital Bonn, Bonn, Germany
| | - Martin Hyrcza
- Department of Pathology and Laboratory Medicine, University of Calgary, Arnie Charbonneau Cancer Institute, Calgary, Alberta, Canada
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), Pasteur Hospital, Centre Hospitalier Universitaire de Nice and Institute of Research on Cancer and Aging, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Karin U Loeffler
- Department of Ophthalmology, Division of Ophthalmic Pathology, University Hospital Bonn, Bonn, Germany
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert M Verdijk
- Department of Pathology, Section of Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steffen Heegaard
- Department of Pathology, Eye Pathology Section, and Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
| | - Sarah E Coupland
- National Specialist Ophthalmic Pathology Service, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
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8
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Zhou B, Milman T, Rodriguez FJ, Turbin RE, Langer PD. Hybrid Schwannoma-Perineurioma of the Orbit. Ophthalmic Plast Reconstr Surg 2024; 40:e1-e4. [PMID: 37552498 DOI: 10.1097/iop.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/09/2023]
Abstract
A 52-year-old woman presented with a 6-month history of progressive right proptosis associated with intermittent right retrobulbar and facial pain. MRI revealed a heterogeneously enhancing, well-circumscribed, ovoid, soft tissue mass in the intraconal space near the right orbital apex displacing the optic nerve medially. Excisional biopsy established the diagnosis of a schwannoma-perineurioma hybrid peripheral nerve sheath tumor (HPNST). This case represents only the second reported occurrence, to our knowledge, of an orbital schwannoma-perineurioma HPNST.
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Affiliation(s)
- Benjamin Zhou
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Fausto J Rodriguez
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, California, Los Angeles, U.S.A
| | - Roger E Turbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Paul D Langer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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9
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Safran JP, Hammersmith KM, Milman T. Posterior Polymorphous Corneal Dystrophy: Clinical-Pathologic Correlation. Ophthalmology 2023; 130:1354. [PMID: 37055288 DOI: 10.1016/j.ophtha.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Jordan Philip Safran
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin M Hammersmith
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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10
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Gonzalez Martinez OG, Langer PD, Milman T. Propranolol-induced Involution of Infantile Hemangioma. Ophthalmology 2023; 130:1359. [PMID: 37140507 DOI: 10.1016/j.ophtha.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Orlando G Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul D Langer
- Institute of Ophthalmology and Visual Sciences, Newark University Hospital, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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11
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Gonzalez Martinez OG, Shields CL, Shields JA, Chévez-Barrios P, Walley DR, Eagle RC, Milman T. Unilateral acute iris transillumination syndrome with glaucoma and iris pigment epithelium dispersion simulating iris melanoma. Am J Ophthalmol Case Rep 2023; 32:101912. [PMID: 37680309 PMCID: PMC10481171 DOI: 10.1016/j.ajoc.2023.101912] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To report a patient with a unilateral presentation of glaucoma, pain, and acute iris transillumination syndrome simulating iris melanoma. Observations A 53-year-old male presented with blurred vision and pain in his right eye several weeks following a respiratory sinus infection managed by oral azithromycin. Examination of the right eye was notable for elevated intraocular pressure of 46 mm Hg, an irregular mid-dilated pupil, and diffuse iris transillumination with pigmentary seeding on the iris surface, in the anterior chamber angle, and on the sclera, suspicious for diffuse iris melanoma with glaucoma and extrascleral extension. Ultrasound biomicroscopy (UBM) of the right eye revealed circumferential anterior chamber angle and trabecular meshwork involvement by an infiltrative process corresponding to the pigmented cells noted clinically, while the ciliary body was unremarkable. Following enucleation, histopathology showed extensive necrosis of the iris pigment epithelium, sphincter, and dilator muscles with melanophagic infiltration in the anterior chamber angle and episclera, mild chronic non-granulomatous iridocyclitis, and no evidence of a melanocytic neoplasm. Although immunohistochemical studies for herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, and cytomegalovirus were negative, qualitative real-time polymerase chain reaction on paraffin-embedded tissue detected HSV-1 DNA. The combined clinical, pathologic, and molecular findings were compatible with unilateral acute iris transillumination syndrome, likely HSV-1 associated. Conclusion and Importance Unilateral acute iris transillumination syndrome with diffuse iris pigment epithelial loss can simulate iris melanoma. Prompt herpes viral studies may be informative.
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Affiliation(s)
- Orlando G. Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Patricia Chévez-Barrios
- Department of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medical College, NY, USA
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Debbie Rigney Walley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Ralph C. Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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12
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Bui K, Shields CL, Milman T. Intraocular Involvement by Mycosis Fungoides. Ophthalmology 2023; 130:1352. [PMID: 36925331 DOI: 10.1016/j.ophtha.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Affiliation(s)
- Khanh Bui
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Pathology Department, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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13
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Sklar BA, Pisuchpen P, Bareket M, Milman T, Eagle RC, Minor J, Procopio R, Capasso J, Levin AV, Hammersmith K. Identification and Management of a Novel PRDM5 Gene Pathologic Variant in a Family With Brittle Cornea Syndrome. Cornea 2023; 42:1572-1577. [PMID: 37713669 DOI: 10.1097/ico.0000000000003372] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/16/2022] [Accepted: 07/21/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE The aim of this study was to report a novel PRDM5 pathologic variant and ophthalmic findings in a family with 3 children diagnosed with brittle cornea syndrome (BCS). Histopathologic findings and surgical outcome of a child with BCS who underwent full-thickness corneal transplant are described. METHODS This is an observational case report of a nonconsanguineous Laotian family with 3 siblings diagnosed with BCS. Data collected included visual acuity, cycloplegic refraction, slit-lamp biomicroscopy, dilated fundus examination, corneal pachymetry, corneal topography, and general medical findings. Targeted testing through PRDM5 gene sequencing with copy number variation detection was conducted. RESULTS The 3 siblings included a 12-year-old boy and 8- and 6-year-old sisters, all of whom presented with myopia, blue-tinted sclerae, thin corneas, and variable corneal scarring. All 3 affected children were found to be homozygous for the PRDM5 gene variant c.1117_1123delinsTTTAATGCTTACAAATGTTTG p.Asp373Phefs*57. Coding sequences of PRDM5 and ZNF469 genes were sequenced in their entirety, and this was the only pathologic variant present in this family. The youngest affected sister developed persistent hydrops with severely decreased vision and underwent penetrating keratoplasty. Histopathology revealed severe corneal thinning, diffuse absence of Bowman layer, and ruptured Descemet membrane scrolls. CONCLUSIONS Three siblings with clinical signs of BCS, including corneal thinning, myopia, and blue sclerae, were found to have a novel PRDM5 gene pathologic variant. This pathologic variant has not been previously reported, although 1 downstream nonsense pathologic variant has been reported as pathogenic. The similar phenotypes in all affected patients support the pathogenicity of this variant. Surgical management of BCS presents unique challenges due to severe tissue fragility.
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Affiliation(s)
- Bonnie A Sklar
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia PA
| | - Phattrawan Pisuchpen
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Mor Bareket
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Tatyana Milman
- Eye Pathology Department, Wills Eye Hospital, Philadelphia PA
| | - Ralph C Eagle
- Eye Pathology Department, Wills Eye Hospital, Philadelphia PA
| | - Jade Minor
- Pediatric and Adult Strabismus Service, Wills Eye Hospital, Philadelphia PA
| | | | - Jenina Capasso
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Clinical Genetics, Golisano Children's Hospital, University of Rochester, Rochester, NY; and
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Clinical Genetics, Golisano Children's Hospital, University of Rochester, Rochester, NY; and
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14
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Gonzalez Martinez OG, Shields CL, Milman T. Corneal Molluscum Contagiosum Masquerading as Ocular Surface Squamous Neoplasia. Ophthalmology 2023; 130:1268. [PMID: 36609020 DOI: 10.1016/j.ophtha.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Orlando G Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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15
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Vrabec TR, Anderson DR, Shah PK, Milman T. Sudden vision loss heralding COVID-19-associated aspergillosis. Report of 2 cases. Am J Ophthalmol Case Rep 2023; 32:101924. [PMID: 37860668 PMCID: PMC10582270 DOI: 10.1016/j.ajoc.2023.101924] [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: 05/21/2023] [Revised: 07/08/2023] [Accepted: 08/22/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose To describe clinical, radiographic, laboratory and cytopathologic findings in 2 patients who developed vision loss due to endogenous aspergillus endophthalmitis during hospitalization for COVID-19 pneumonia. Observations Two unvaccinated sexagenarian male smokers lost vision within one month of contracting COVID-19 pneumonia. Initially, both received high dose steroids, nasal cannula oxygen and remdesivir. Immunomodulators tocilizumab or baricitinib were added during week 2 in case 1 and 2 respectively. Upon presentation after discharge from a post-COVID rehabilitation unit, visual acuities were light perception and hand motion. In both cases, inpatient blood and ocular fluid cultures were negative, serum 1,3-beta-D-glucan was positive, and vitreous cytopathology revealed filamentous fungi and PCR was positive for Aspergillus fumigatus. Large solitary intravitreal fungus balls were debulked in patient 1 and excised in patient 2. Final visual acuities were no light perception and 20/200 respectively. MRI revealed previously unsuspected brain and lung lesions consistent with disseminated aspergillosis in patient 2. Conclusions Vision loss due to fungal endophthalmitis may be the first or only sign of systemic aspergillosis associated with COVID-19 pneumonia. Aspergillosis should be suspected in patients who develop vision loss. Diagnosis limited by negative fungal cultures may be confirmed by vitreous cytopathology and PCR. Systemic imaging for disseminated aspergillosis is indicated. Ultimate visual acuity may depend upon surgical approach.
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Affiliation(s)
| | | | | | - Tatyana Milman
- Wills Eye Hospital, Pathology Department, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Vempuluru VS, Singla K, Milman T, Eagle RC, Lally SE, Shields CL. Bilateral Conjunctival Actinic Granuloma With Necrobiotic Vasculitic Pattern: A Diagnosis of Exclusion. Ophthalmic Plast Reconstr Surg 2023; 39:e173-e176. [PMID: 37279029 DOI: 10.1097/iop.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/07/2023]
Abstract
A 53-year-old Caucasian male presented with an inflamed-appearing limbal nodule in his OD, clinically compatible with nodular episcleritis, that was unresponsive to topical corticosteroid therapy. Excisional biopsy of the lesion was performed and histopathological examination revealed foci of necrotizing vasculitis and granulomatous inflammation in a background of intense actinic elastosis. Infectious stains for organisms were negative. A comprehensive systemic evaluation for vasculitides was negative. Three years later, the patient returned with a clinically and histopathologically identical lesion in his OS. Systemic evaluation was noncontributory again, and a diagnosis of bilateral conjunctival actinic granuloma with necrobiotic vasculitic pattern was made.
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Affiliation(s)
| | - Konica Singla
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University
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17
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Cheung J, Rabinowitz MP, Tuluc M, Milman T. Periocular Microcystic Adnexal Carcinoma: A Case Report and a Major Review. Ophthalmic Plast Reconstr Surg 2023; 39:533-541. [PMID: 37279021 DOI: 10.1097/iop.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/07/2023]
Abstract
PURPOSE To describe a patient with periocular microcystic adnexal carcinoma (MAC) and to review the clinical presentation, systemic work-up, histopathologic features, and outcome of all previously reported periocular MAC. METHODS A major literature review. PubMed/MEDLINE and Google Scholar databases were searched for all well-documented cases of periocular MAC. RESULTS The final analysis yielded 93 patients with MAC, 48 (52%) females, 39 (42%) males, and 6 with sex not specified (6%) with an average age of 56 years (range 3 days-95 years). Most tumors were localized to the eyebrow (26/93, 28%) and lower eyelid (20/93, 22%). Of patients with known information, MAC most commonly presented as a nodule (37/68, 54%) or plaque (20/68, 29%) with poorly-defined margins (20/51, 39%) and distortion of eyelid margin (13/51, 25%). Orbital involvement at any point of the disease course was seen in 20 of 93 (22%) patients. An accurate histopathologic diagnosis on initial biopsy was made in 25 of 70 (36%) cases. Initial management included surgical excision (47/93, 51%), Mohs micrographic surgery (17/93, 18%), and excision with frozen section control of margins (8/93, 9%). Aggressive or recurrent MAC was managed with multimodal therapies, including adjuvant radiation (10/34, 29%). The average follow-up after the last treatment was 3 years (median 2, range 0.2-20 years). In total, 33 of 86 (38%) tumors recurred, and 6 of 87 (7%) metastasized. Disease-related mortality occurred in 3 of 79 (4%) of patients. CONCLUSIONS Periocular MAC is frequently misdiagnosed on initial biopsy and has a tendency for recurrence and locally aggressive behavior, highlighting the importance of accurate timely diagnosis, and appropriate management.
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Affiliation(s)
- Jesse Cheung
- Lewis Katz School of Medicine of Temple University, Philadelphia, PA, U.S.A
| | - Michael P Rabinowitz
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Madalina Tuluc
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
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18
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Fenu EM, Milman T, Penne R, Navarro FE, Yang G, Bagg A. Primary cutaneous T-follicular helper lymphoma. EJHaem 2023; 4:1176-1178. [PMID: 38024630 PMCID: PMC10660100 DOI: 10.1002/jha2.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Elena M. Fenu
- Department of Pathology and Laboratory MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tatyana Milman
- Department of OphthalmologyWills Eye Hospital and Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Robert Penne
- Department of OphthalmologyWills Eye Hospital and Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Farah El‐Sharkawy Navarro
- Department of Pathology and Laboratory MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Guang Yang
- Department of Pathology and Laboratory MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Adam Bagg
- Department of Pathology and Laboratory MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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19
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Eder A, Milman T, Singh Mudhar H, Lally SE, Shields CL, Bui K, Wells JR, Grossniklaus HE. Unusual conjunctival melanocytic proliferations. Report of five cases and review of the literature. Surv Ophthalmol 2023:S0039-6257(23)00141-8. [PMID: 37890676 DOI: 10.1016/j.survophthal.2023.10.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Abstract
Indeterminate melanocytic proliferations of the conjunctiva have both benign and malignant features that previously made these lesions nearly impossible to categorize in existing classification schemes. With the evolution of immunohistochemistry and molecular genetics, however, subclassifications have emerged that allow for a more tailored diagnosis and management. These conjunctival melanocytic proliferations include deep penetrating nevus, granular cell nevus, and nevoid melanoma. There remains a small subset of conjunctival melanocytic proliferations that defy precise characterization as nevi, primary acquired melanosis, or melanomas despite currently available ancillary diagnostic modalities and remain indeterminate. We highlight these unusual types of nevi and melanomas, with an update on their morphologic, immunohistochemical, and molecular genetic characteristics.
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Affiliation(s)
- Adrianna Eder
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States
| | - Tatyana Milman
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Dept of Histopathology, Royal Hallamshire Hospital, Sheffield S10 2JF, England, UK
| | - Sara E Lally
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Carol L Shields
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Khanh Bui
- Wills Eye Hospital and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Jill R Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, United States.
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20
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Affiliation(s)
- Tejal Magan
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sathyadeepak Ramesh
- Oculoplastic & Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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21
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Cheng Z, Stefani C, Skillman T, Klimas A, Lee A, DiBernardo EF, Brown KM, Milman T, Wang Y, Gallagher BR, Lagree K, Jena BP, Pulido JS, Filler SG, Mitchell AP, Hiller NL, Lacy‐Hulbert A, Zhao Y. MicroMagnify: A Multiplexed Expansion Microscopy Method for Pathogens and Infected Tissues. Adv Sci (Weinh) 2023; 10:e2302249. [PMID: 37658522 PMCID: PMC10602566 DOI: 10.1002/advs.202302249] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/29/2023] [Indexed: 09/03/2023]
Abstract
Super-resolution optical imaging tools are crucial in microbiology to understand the complex structures and behavior of microorganisms such as bacteria, fungi, and viruses. However, the capabilities of these tools, particularly when it comes to imaging pathogens and infected tissues, remain limited. MicroMagnify (µMagnify) is developed, a nanoscale multiplexed imaging method for pathogens and infected tissues that are derived from an expansion microscopy technique with a universal biomolecular anchor. The combination of heat denaturation and enzyme cocktails essential is found for robust cell wall digestion and expansion of microbial cells and infected tissues without distortion. µMagnify efficiently retains biomolecules suitable for high-plex fluorescence imaging with nanoscale precision. It demonstrates up to eightfold expansion with µMagnify on a broad range of pathogen-containing specimens, including bacterial and fungal biofilms, infected culture cells, fungus-infected mouse tone, and formalin-fixed paraffin-embedded human cornea infected by various pathogens. Additionally, an associated virtual reality tool is developed to facilitate the visualization and navigation of complex 3D images generated by this method in an immersive environment allowing collaborative exploration among researchers worldwide. µMagnify is a valuable imaging platform for studying how microbes interact with their host systems and enables the development of new diagnosis strategies against infectious diseases.
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Affiliation(s)
- Zhangyu Cheng
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Caroline Stefani
- Benaroya Research Institute at Virginia Mason1201 9th AveSeattleWA98101USA
| | | | - Aleksandra Klimas
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Aramchan Lee
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Emma F. DiBernardo
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Karina Mueller Brown
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Tatyana Milman
- Wills Eye Hospital and Jefferson University HospitalPhiladelphiaPA19107USA
| | - Yuhong Wang
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Brendan R. Gallagher
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Katherine Lagree
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Bhanu P. Jena
- Viron Molecular Medicine Institute201 Washington StreetBostonMA02201USA
- Department of PhysiologyWayne State University42 W Warren AveDetroitMI48202USA
- NanoBioScience InstituteWayne State University42 W Warren AveDetroitMI48202USA
- Center for Molecular Medicine & GeneticsSchool of MedicineWayne State University42 W Warren AveDetroitMI48202USA
| | - Jose S. Pulido
- Wills Eye Hospital and Jefferson University HospitalPhiladelphiaPA19107USA
| | - Scott G. Filler
- Lundquist Institute for Biomedical Innovation at Harbor‐UCLA Medical Center1124 W Carson StTorranceCA90502USA
- David Geffen School of Medicine at UCLA10833 Le Conte AveLos AngelesCA90095USA
| | - Aaron P. Mitchell
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
- Department of MicrobiologyUniversity of Georgia210 S Jackson streetAthensGA30602USA
| | - N. Luisa Hiller
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
| | - Adam Lacy‐Hulbert
- Benaroya Research Institute at Virginia Mason1201 9th AveSeattleWA98101USA
| | - Yongxin Zhao
- Department of Biological SciencesCarnegie Mellon University4400 Fifth AvenuePittsburghPA15213USA
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22
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Vempuluru VS, Laiton A, Milman T, Lee JB, Eagle RC, Shields CL. Exogenous Ochronosis With Ocular Involvement From Chronic Use of Teavigo. Ophthalmic Plast Reconstr Surg 2023; 39:e139-e142. [PMID: 37010051 DOI: 10.1097/iop.0000000000002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/04/2023]
Abstract
Exogenous ochronosis refers to accumulation of homogentisic acid metabolites in tissues, manifesting as pigmentation of affected tissues. Phenolic compounds are most commonly implicated, including hydroquinone, quinine, phenol, resorcinol, mercury, and picric acid. The affected connective tissues exhibit brownish discoloration when heavily pigmented and the histopathological appearance is characteristic with "banana-shaped" ochre-colored pigment deposits. Herein, the authors describe a rare case of exogenous ochronosis involving the conjunctiva, sclera and skin, as a result of chronic use of Teavigo (94% epigallocatechin gallate), a polyphenol compound with postulated antioxidant and antiapoptotic activity.
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Affiliation(s)
| | | | | | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University & Jefferson Dermatopathology Center; Philadelphia, Pennsylvania, U.S.A
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23
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Calotti M, Zeiger JS, Milman T, Shields CL. Infected Pigmented Meibomian Duct Cyst Masquerading as a Conjunctival Melanoma. Ophthalmic Plast Reconstr Surg 2023; 39:e169. [PMID: 36852829 DOI: 10.1097/iop.0000000000002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
| | | | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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24
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Milman T, Grossniklaus HE, Goldman-Levy G, Kivelä TT, Coupland SE, White VA, Mudhar HS, Eberhart CG, Verdijk RM, Heegaard S, Gill AJ, Jager MJ, Rodríguez-Reyes AA, Esmaeli B, Hodge JC, Cree IA. The 5th Edition of the World Health Organization Classification of Tumours of the Eye and Orbit. Ocul Oncol Pathol 2023; 9:71-95. [PMID: 37900189 PMCID: PMC10601864 DOI: 10.1159/000530730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Tatyana Milman
- Departments of Ophthalmology and Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Hans E. Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabrielle Goldman-Levy
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tero T. Kivelä
- Ophthalmic Pathology Laboratory, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sarah E. Coupland
- George Holt Chair of Pathology/Consultant Histopathologist, Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Valerie A. White
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Charles G. Eberhart
- Departments of Pathology and Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert M. Verdijk
- Section Ophthalmic Pathology, Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steffen Heegaard
- Department of Pathology, Eye Pathology Section and Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anthony J. Gill
- Department of Pathology, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital St Leonards NSW, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards NSW, St Leonards, NSW, Australia
| | - Martine J. Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abelardo A. Rodríguez-Reyes
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, I.A.P. Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, MDAnderson Cancer Center, Houston, TX, USA
| | | | - Ian A. Cree
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - on behalf of the WHO Classification of Tumours Editorial Board
- Departments of Ophthalmology and Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
- World Health Organization, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Ophthalmic Pathology Laboratory, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- George Holt Chair of Pathology/Consultant Histopathologist, Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
- Departments of Pathology and Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Section Ophthalmic Pathology, Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Eye Pathology Section and Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital St Leonards NSW, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards NSW, St Leonards, NSW, Australia
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, I.A.P. Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, MDAnderson Cancer Center, Houston, TX, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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Syed ZA, Milman T, Fertala J, Steplewski A, Fertala A. Corneal Wound Healing in the Presence of Antifibrotic Antibody Targeting Collagen Fibrillogenesis: A Pilot Study. Int J Mol Sci 2023; 24:13438. [PMID: 37686240 PMCID: PMC10488077 DOI: 10.3390/ijms241713438] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Highly organized collagen fibrils interlacing with proteoglycans form the crucial architecture of the cornea and facilitate its transparency. Corneal scarring from accidental injury, surgery, or infection alters this highly organized tissue, causing severe consequences, including blindness. There are no pharmacological or surgical methods to effectively and safely treat excessive corneal scarring. Thus, we tested the anticorneal scarring utility of a rationally designed anticollagen antibody (ACA) whose antifibrotic effects have already been demonstrated in nonocular models. Utilizing a rabbit model with an incisional corneal wound, we analyzed ACA's effects on forming collagen and proteoglycan-rich extracellular matrices in scar neotissue. We used microscopic and spectroscopic techniques to quantify these components and measure crucial parameters characterizing the structure and organization of collagen fibrils. Moreover, we analyzed the spatial distribution of collagen and proteoglycans in normal and healing corneas. Our study demonstrated significant changes in the quality and quantity of the analyzed molecules synthesized in scar neotissue. It showed that these changes extend beyond incision margins. It also showed ACA's positive impact on some crucial parameters defining proper cornea structure. This pilot study provides a stepping stone for future tests of therapeutic approaches that target corneal extracellular scar matrix assembly.
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Affiliation(s)
- Zeba A. Syed
- Wills Eye Hospital, Philadelphia, PA 19107, USA; (Z.A.S.); (T.M.)
| | - Tatyana Milman
- Wills Eye Hospital, Philadelphia, PA 19107, USA; (Z.A.S.); (T.M.)
| | - Jolanta Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, Room 501, 1015 Walnut Street, Philadelphia, PA 19107, USA; (J.F.); (A.S.)
| | - Andrzej Steplewski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, Room 501, 1015 Walnut Street, Philadelphia, PA 19107, USA; (J.F.); (A.S.)
| | - Andrzej Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, Room 501, 1015 Walnut Street, Philadelphia, PA 19107, USA; (J.F.); (A.S.)
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Vempuluru VS, Lally SE, Milman T, Shields CL. Orbital Metastasis From Anorectal Mucosal Melanoma. Ophthalmic Plast Reconstr Surg 2023:00002341-990000000-00251. [PMID: 37581880 DOI: 10.1097/iop.0000000000002489] [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] [Indexed: 08/16/2023]
Affiliation(s)
| | | | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A
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Cheng Z, Stefani C, Skillman T, Klimas A, Lee A, DiBernardo EF, Brown KM, Milman T, Gallagher BR, Lagree K, Jena BP, Pulido J, Mitchell AP, Filler SG, Hiller L, Lacy-Hulbert A, Zhao Y. A New Expansion Microscopy Method Optimized for Microbiology. Microsc Microanal 2023; 29:994. [PMID: 37613535 DOI: 10.1093/micmic/ozad067.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Zhangyu Cheng
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | | | | | - Aleksandra Klimas
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Aramchan Lee
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Emma F DiBernardo
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Karina M Brown
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Tatyana Milman
- Wills Eye Hospital and Jefferson University Hospital, Philadelphia, PA, USA
| | - Brendan R Gallagher
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Katherine Lagree
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Bhanu P Jena
- Viron Molecular Medicine Institute, Boston, MAUSA
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI, USA
- NanoBioScience Institute, School of Medicine, Wayne State University, Detroit, MI, USA
- Center for Molecular Medicine & Genetics, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Jose Pulido
- Wills Eye Hospital and Jefferson University Hospital, Philadelphia, PA, USA
| | - Aaron P Mitchell
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Department of Microbiology, University of Georgia, Athens, Georgia, USA
| | - Scott G Filler
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Luisa Hiller
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | | | - Yongxin Zhao
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Daher ND, Milman T, Syed ZA. Migratory subconjunctival cyst. J Fr Ophtalmol 2023:S0181-5512(23)00279-6. [PMID: 37414670 DOI: 10.1016/j.jfo.2023.01.039] [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: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 07/08/2023]
Affiliation(s)
- N D Daher
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - T Milman
- Pathology Department, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Z A Syed
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
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Milman T, Gonzalez Martinez OG, Calotti M, Henry RK, Eagle RC. Consultations in Eye Pathology: Experience at the Ophthalmology Specialty Hospital. Arch Pathol Lab Med 2023:493847. [PMID: 37347189 DOI: 10.5858/arpa.2022-0507-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/23/2023]
Abstract
CONTEXT.— Ophthalmic pathology is a discipline that relies heavily on a knowledge of clinical ophthalmology. The diagnosis of ocular and periocular lesions can be challenging because some lesions and diseases are unique to this region, whereas others may demonstrate site-specific differences from nonocular counterparts. Because of these challenges, ocular and periocular biopsies are frequently referred to specialized ophthalmic pathology centers for second opinion diagnoses. OBJECTIVE.— To analyze the referral patterns, diagnostic challenges, and diagnostic discrepancies for second opinion referrals at a dedicated ophthalmic pathology laboratory with an emphasis on lesions of special interest in ophthalmic pathology. DATA SOURCES.— Data sources included the pathology records of all slides and blocks received in consultation at the referral eye pathology center between December 1, 2015, and December 1, 2022, the personal experience of senior authors, and published peer-reviewed literature. CONCLUSIONS.— Corneal, intraocular, and conjunctival biopsies are the most common types of cases received in consultation without the referring pathologist's diagnosis, likely reflecting diagnostic challenges. Degenerative intraocular processes occasionally raise concern for a neoplasm. Conjunctival melanocytic lesions are the most common conjunctival biopsies referred for second opinion diagnosis and require careful tissue sampling and clinical-pathologic correlation. Careful clinical-pathologic correlation, a high level of suspicion, and adequate sampling also are required for the accurate diagnosis of periocular sebaceous carcinoma. The diagnostic discrepancies involving uveal, retinal, conjunctival, eyelid, and temporal artery biopsies are most likely to adversely influence patient management and possible outcome. Such specimens may benefit from referral to specialized ophthalmic pathology laboratories.
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Affiliation(s)
- Tatyana Milman
- From the Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania (Milman, Gonzalez Martinez, Eagle)
- The Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Milman)
| | - Orlando G Gonzalez Martinez
- From the Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania (Milman, Gonzalez Martinez, Eagle)
| | - Martin Calotti
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Calotti)
| | - Roger K Henry
- The Institute of Ophthalmology and Visual Science, Rutgers University, Newark, New Jersey (Henry)
| | - Ralph C Eagle
- From the Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania (Milman, Gonzalez Martinez, Eagle)
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Tekumalla S, Xu D, Awh K, Philp N, Milman T, Garg S. DIAGNOSTIC YIELD OF IN VITRO VITREOUS BIOPSY FOR INTRAOCULAR LYMPHOMA AT VARIABLE VITREOUS CUTTER SPEEDS USING 25-GAUGE VITRECTOMY. Retina 2023; 43:1005-1009. [PMID: 36735414 DOI: 10.1097/iae.0000000000003753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Primary vitreoretinal lymphoma is the most common intraocular lymphoproliferative disorder. We evaluated the diagnostic yield of pars plana vitrectomy, specifically using modern high cut rate dual-cycle cutters, on in vitro cell viability and diagnostic yield. METHODS Human Burkitt lymphoma cell line Namalwa at 2 x 10^5 cells/mL was aspirated by 25-gauge dual-blade guillotine-type vitrectomy at five speeds (500, 1,000, 4,000, 7,500, or 15,000 cuts per minute). Cell viability and diagnostic yield in each subtype group were determined using hemocytometry, viable cell count using Cell Counting Kit-8, and pathologist-guided manual count. RESULTS No significant deviation in cell count was identified in any cut rate by ANOVA ( P = 0.61), and no trends in the number of viable cells were identified across cut rates (R 2 = 0.188, P = 0.47). Among histologic cell counts per cut-rate, neither linear regression (R = 0.531, P = 0.16) nor ANOVA ( P = 0.096) were statistically significant. CONCLUSION There was no significant degradation in the number of viable cells with increasing cut speed. These results suggest that in contrast to previous findings using 20g or 23g vitrectomy for diagnostic vitrectomy, modern vitrectomy systems may be used at up to 15,000 cpm without compromising the viability of lymphoma cells.
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Affiliation(s)
| | - David Xu
- MidAtlantic Retina, the Retina Service of Wills Eye Hospital
| | - Katherine Awh
- Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University; and
| | - Nancy Philp
- Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University; and
| | - Tatyana Milman
- Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University; and
- Wills Eye Hospital Department of Pathology, Philadelphia, Pennsylvania
| | - Sunir Garg
- MidAtlantic Retina, the Retina Service of Wills Eye Hospital
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Singla K, Sen M, Milman T, Shields CL. Conjunctival Amyloidosis: Apples and Oranges. Ophthalmic Plast Reconstr Surg 2023; 39:e98. [PMID: 36479876 DOI: 10.1097/iop.0000000000002275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Konica Singla
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Mrittika Sen
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Tatyana Milman
- Department of Eye Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Rozanski CA, DeSimone JD, Milman T, Ramesh S. Botfly Myiasis Masquerading as Dacryocystitis. Ophthalmic Plast Reconstr Surg 2023; 39:e72-e75. [PMID: 36852824 DOI: 10.1097/iop.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/01/2023]
Abstract
Cutaneous myiasis is an infection most commonly caused globally by Dermatobia hominus , the human botfly, which is endemic to Central and South America. In North America, the most common cause of cutaneous myiasis is infestation with the larvae of Cuterebra , the North American botfly. The authors describe a 44-year-old man who presented with a 1-month history of intermittent, severe, boring pain along the side of his nose that progressed to swelling and redness along his right inferior orbital rim and lacrimal sac. CT imaging showed a rim-enhancing collection at the right medial canthus with surrounding phlegmonous changes communicating with the skin. Pathologic evaluation revealed curvilinear pigmented material associated with a granulomatous and eosinophil-rich inflammatory infiltrate, consistent with botfly myiasis. This case describes the pathogenesis of the botfly infestation in humans, as well as the clinical, radiographic, and histopathologic features of this rare orbital infection, with an emphasis on its treatment.
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Affiliation(s)
- Collin A Rozanski
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Joseph D DeSimone
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Sathyadeepak Ramesh
- Oculoplastic & Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
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Daher ND, Saad AS, Jimenez HJ, Milman T, Gonzalez-Martinez OG, Deshmukh T, Pulido JS, Silver FH, Benedetto DA, Rapuano CJ, Syed ZA. Identification of the Vibrational Optical Coherence Tomography Corneal Cellular Peak. Transl Vis Sci Technol 2023; 12:11. [PMID: 37043335 PMCID: PMC10103735 DOI: 10.1167/tvst.12.4.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Purpose Our team previously identified the presence of five corneal resonant frequency (RF) peaks in healthy volunteers using vibrational optical coherence tomography (VOCT). Prior studies have suggested that the ≤100 Hz RF peak represents the cellular element of tissue. The aim of this study was to confirm that this peak reflects the human corneal cellular component using VOCT and histological analysis. Methods Two human research globes were obtained from the same donor, and VOCT measurements were collected from the full-thickness corneas. A microkeratome was then used to create serial-free corneal caps from each cornea, with VOCT performed on the residual stromal bed after each excision. All lamellar sections from both globes were sent for histological analysis to determine cellularity. Cell counts on the specimens were performed by two independent observers. Results The average of the normalized ≤100 Hz peak values before lamellar sectioning was significantly higher than the average of this peak values after the first, second, and third cuts (P = 0.023), which was 33.9% less than before any cuts. The cell count values in the first slice were significantly higher than the average cell count values of the three deeper slices (P < 0.001), and the cell count dropped 84.4% after the first slice was removed. Conclusions The findings of this study suggest that the ≤100 Hz corneal peak identified by VOCT corresponds to the cellular component of the cornea. Translational Relevance This work furthers our understanding of the origin of the corneal ≤100 Hz peak identified using VOCT.
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Affiliation(s)
- Nathalie D Daher
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ahmed Saeed Saad
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Hiram J Jimenez
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Tatyana Milman
- Pathology Department, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Orlando G Gonzalez-Martinez
- Pathology Department, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Jose S Pulido
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Frederick H Silver
- OptoVibronex, LLC., Bethlehem, PA, USA
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | | | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Shukla AG, Milman T, Fertala J, Steplewski A, Fertala A. Scar formation in the presence of mitomycin C and the anti-fibrotic antibody in a rabbit model of glaucoma microsurgery: A pilot study. Heliyon 2023; 9:e15368. [PMID: 37123929 PMCID: PMC10130883 DOI: 10.1016/j.heliyon.2023.e15368] [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: 10/12/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose This study aimed to evaluate the utility of a rationally engineered antibody that directly blocks collagen fibrillogenesis to reduce scar tissue formation associated with subconjunctival glaucoma surgery. Material and methods Fourteen eyes of 7 adult rabbits underwent glaucoma filtering surgery using XEN 45 Gel Stent. The rabbits' eyes were divided randomly into three treatment groups: (i) treated with the antibody, (ii) treated with mitomycin C, and (iii) treated with the antibody and mitomycin C. Following surgeries, the intraocular pressure and bleb appearance were evaluated in vivo. The rabbits were sacrificed 8 weeks after the surgery, and their eyes were harvested and processed for tissue analysis. Subsequently, tissue samples were analyzed microscopically for fibrotic tissue and cellular markers of inflammation. Moreover, the collagen-rich fibrotic tissue formed around the stents was analyzed using quantitative histology and infrared spectroscopy. The outcomes of this study were analyzed using the ANOVA test. Results This study demonstrated no significant differences in intraocular pressure, bleb appearance, or presence of complications such as bleb leak among the treatment groups. In contrast, we observed significant differences among the subpopulations of collagen fibrils formed within scar neo-tissue. Based on the spectroscopic analyses, we determined that the relative content of mature collagen cross-links in the antibody-treated group was significantly reduced compared to other groups. Conclusions Direct blocking of collagen fibrillogenesis with the anti-collagen antibody offers potentially beneficial effects that may reduce the negative impact of the subconjunctival scarring associated with glaucoma filtering surgery.
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Affiliation(s)
- Aakriti Garg Shukla
- Wills Eye Hospital, Philadelphia, PA, USA
- Glaucoma Division, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Jolanta Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrzej Steplewski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrzej Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Department of Orthopaedic Surgery; Sidney Kimmel Medical College, Thomas Jefferson University; Curtis Building, Room 501, 1015 Walnut Street, Philadelphia, 19107, PA, USA.
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Zhao Y, Cheng Z, Stefani C, Skillman T, Klimas A, Lee A, DiBernardo E, Mueller Brown K, Milman T, Gallagher B, Lagree K, Jena B, Pulido J, Filler S, Mitchell A, Hiller L, Lacy-Hulbert A. MicroMagnify: a multiplexed expansion microscopy method for pathogens and infected tissues. Res Sq 2023:rs.3.rs-2637060. [PMID: 36945526 PMCID: PMC10029075 DOI: 10.21203/rs.3.rs-2637060/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Super-resolution optical imaging tools are crucial in microbiology to understand the complex structures and behavior of microorganisms such as bacteria, fungi, and viruses. However, the capabilities of these tools, particularly when it comes to imaging pathogens and infected tissues, remain limited. We developed µMagnify, a nanoscale multiplexed imaging method for pathogens and infected tissues that are derived from an expansion microscopy technique with a universal biomolecular anchor. We formulated an enzyme cocktail specifically designed for robust cell wall digestion and expansion of microbial cells without distortion while efficiently retaining biomolecules suitable for high-plex fluorescence imaging with nanoscale precision. Additionally, we developed an associated virtual reality tool to facilitate the visualization and navigation of complex three-dimensional images generated by this method in an immersive environment allowing collaborative exploration among researchers around the world. µMagnify is a valuable imaging platform for studying how microbes interact with their host systems and enables development of new diagnosis strategies against infectious diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Bhanu Jena
- Wayne State University School of Medicine
| | - Jose Pulido
- Wills Eye Hospital and Jefferson University Hospital
| | - Scott Filler
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
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Vega Escobar K, Armijos PO, Milman T, Shields CL, Eagle RC. Intratumoral bacteria in uveal melanoma: A case report. Am J Ophthalmol Case Rep 2023; 30:101833. [PMID: 37139176 PMCID: PMC10149332 DOI: 10.1016/j.ajoc.2023.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/07/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose Intratumoral bacteria and their potential application to cancer immunotherapy have been a topic of interest in recent studies. To our knowledge, bacteria in uveal melanoma have not been previously reported. Observations We describe a patient with a large choroidal melanoma, measuring 18 × 16 mm in basal dimension and 15 mm in ultrasonographic thickness, managed by plaque brachytherapy. At the time of plaque removal, a prophylactic scleral patch graft was placed to protect from anticipated scleral necrosis. Progressive ocular ischemia led to a blind and painful eye. The enucleated eye demonstrated an extensively necrotic and heavily pigmented mushroom-shaped regressed cilichoroidal mass deep to the scleral patch graft. Numerous Gram-positive cocci were noted within the regressed uveal melanoma and the adjacent sclera. Conclusions and Importance This case highlights the fact that regressed uveal melanomas can contain intra-tumoral bacteria.
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Shoshany TN, Rapuano CJ, Milman T. Conjunctival and Lingual mucosal neuromas without multiple endocrine neoplasia type 2B. Am J Ophthalmol Case Rep 2023; 30:101828. [DOI: 10.1016/j.ajoc.2023.101828] [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] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
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Vega Escobar K, Shields CL, Milman T. Solitary Conjunctival Reticulohistiocytoma. Ophthalmology 2023; 130:323. [PMID: 35970670 DOI: 10.1016/j.ophtha.2022.06.027] [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: 06/13/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katherine Vega Escobar
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Ulloa-Padilla JP, Rubio RH, Zhou S, Carrasco J, Watson A, Jiang W, Cooper K, Morgenstern K, Milman T. Atypical Spindle Cell and Pleomorphic Lipomatous Tumor of the Ocular Adnexa: Two Cases of a Rare Entity. Ophthalmic Plast Reconstr Surg 2023; 39:e44-e49. [PMID: 36700863 DOI: 10.1097/iop.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/27/2023]
Abstract
Atypical spindle cell and pleomorphic lipomatous tumor (ASCPLT) is a rare lipomatous neoplasm that was recently introduced into the World Health Organization Classification of Soft Tissue and Bone tumors as a distinct entity. ASCPLT has potential for local recurrence but does not metastasize. This biologic behavior separates ASCPLT from its morphologic mimics. Ocular adnexal ASCPLT has not been previously reported. Described herein are two patients with ASCPLT. The subcutaneous orbital rim lesion featured markedly pleomorphic spindle and multinucleated cells. The eyelid lesion was dominated by atypical spindle cells in a background of mature adipocytes. Both neoplasms demonstrated infiltrative margins, rare mitotic figures, immunoreactivity for CD34 and loss of Rb1, and the absence of MDM2 amplification by fluorescence in situ hybridization. Recognition of ASCPLT in the differential of ocular adnexal neoplasms may lead to a re-evaluation of morphologically similar tumors, which may have varied biologic behavior and warrant a different management approach.
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Affiliation(s)
- Jan P Ulloa-Padilla
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | | | - Siwei Zhou
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Jacqueline Carrasco
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Alison Watson
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Wei Jiang
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Kumarasen Cooper
- Department of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
| | - Kenneth Morgenstern
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
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Mudhar HS, Milman T, Stevenson S, Watson M, Kim J, Magan T, Salvi SM, Harley U, Lally SE, Shields CL. PRAME expression by immunohistochemistry and reverse transcription quantitative PCR in conjunctival melanocytic lesions-a comprehensive clinicopathologic study of 202 cases and correlation of cytogenetics with PRAME expression in challenging conjunctival melanocytic lesions. Hum Pathol 2023; 134:1-18. [PMID: 36804828 DOI: 10.1016/j.humpath.2023.02.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
This study examined PRAME (preferentially expressed antigen in melanoma) expression by immunohistochemistry and reverse transcription quantitative PCR (RT-qPCR) in 202 histologically unequivocal conjunctival melanocytic lesions: 76 nevi, 29 benign melanoses, 25 low-grade conjunctival intraepithelial melanocytic lesions (LGCMIL), 26 high-grade conjunctival melanocytic intraepithelial lesions/in-situ melanoma (HGCMIL), and 46 invasive melanomas. PRAME score 0 was seen in 96% of nevi (73/76), 96% of benign melanoses (28/29), and 88% of LGCMIL (22/25). PRAME score 4 was seen in 50% HGCMIL (13/26) and 76% invasive melanomas (35/46). PRAME score 4 had a sensitivity of 50% and specificity of 100% in differentiating between HGCMIL and benign melanosis/LGCMIL. PRAME score 4 had a sensitivity of 76% and specificity of 100% in differentiating between melanoma and nevi. Relative quantification of PRAME mRNA expression by RT-qPCR was performed on 49 cases (24%): 17 nevi, 3 benign melanoses, 5 LGCMIL, 9 HGCMIL, and 15 invasive melanomas. The analysis generated two distinct groupings with 'high' relative PRAME expression for the HGCMIL and invasive melanoma and 'low/zero' expression for nevi, benign melanosis, and LGCMIL. Thirty-three challenging conjunctival melanocytic lesions that had previous fluorescence in situ hybridization (FISH) analysis were studied: 18 nevi, 12 melanomas in a nevus, 2 nevoid melanomas, and 1 in-situ melanoma. All nevi (100%) showed concordance between negative FISH and PRAME (scores 0-3). Four of 13 melanomas (31%; in-situ, invasive, isolated, and in association with nevus) showed concordance between positive FISH and PRAME score 4. In conclusion, PRAME score 4 has 100% specificity for the diagnosis of HGCMIL and melanoma. PRAME is limited in its sensitivity in the evaluation of challenging melanocytic lesions.
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Affiliation(s)
- Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Dept of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield S10 2JF, England, UK.
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Sarah Stevenson
- Sheffield Diagnostic Genetics Service, Sheffield Children's Hospital, Sheffield S10 2TH, England, UK; The University of Manchester, Manchester M13 9PL, England, UK.
| | - Mark Watson
- Sheffield Diagnostic Genetics Service, Sheffield Children's Hospital, Sheffield S10 2TH, England, UK.
| | - Julie Kim
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Tejal Magan
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Sachin M Salvi
- Sheffield Ocular Oncology Service, Dept of Ophthalmology, A Floor, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Umiya Harley
- Sheffield Ocular Oncology Service, Dept of Ophthalmology, A Floor, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Sarah E Lally
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Vempuluru VS, Singla K, Milman T, Shields CL. Pigmented Peripunctal Mass in a Teenager. J Pediatr Ophthalmol Strabismus 2023; 60:5. [PMID: 36695348 DOI: 10.3928/01913913-20221010-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
A 5-year-old girl presented with a 6-month history of strabismus and painless left proptosis. Magnetic resonance imaging revealed a homogenously enhancing, anterior, superomedial, left orbital mass. Excisional biopsy established the diagnosis of orbital glomangiopericytoma. Glomangiopericytoma of soft tissue is a perivascular myoid neoplasm with hemangiocytoma-like vascular channels that has overlapping features between glomus tumor and myopericytoma. To the authors' knowledge, glomangiopericytoma of the orbit has not previously been reported.
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Affiliation(s)
- Benjamin Zhou
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul D Langer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Solomon DA, Ramani B, Eiger-Moscovich M, Milman T, Uludag G, Crawford JB, Phan I, Char DH, Shields CL, Eagle RC, Bastian BC, Bloomer MM, Pekmezci M. Iris and Ciliary Body Melanocytomas Are Defined by Solitary GNAQ Mutation Without Additional Oncogenic Alterations. Ophthalmology 2022; 129:1429-1439. [PMID: 35835335 DOI: 10.1016/j.ophtha.2022.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To analyze the genetic features of melanocytomas and melanomas of the anterior uvea and assess the value of molecular testing for diagnosis and prognostication. DESIGN Retrospective case-control study. SUBJECTS Patients with melanocytoma (n = 16) and melanoma (n = 19) of the anterior uvea. METHODS Targeted next-generation sequencing was performed on formalin-fixed, paraffin-embedded tumor tissue from anterior uveal melanocytic tumors and correlated with clinicopathologic features. MAIN OUTCOME MEASURES Presence or absence of accompanying oncogenic alterations beyond GNAQ/GNA11 and their association with histologic features and local recurrence. RESULTS Hotspot missense mutations in GNAQ/GNA11 were identified in 91% (32/35) of all cases. None of the melanocytomas with or without atypia demonstrated chromosomal imbalances or additional oncogenic variants beyond GNAQ mutation, and none recurred over a median follow-up of 36 months. Additional alterations identified in a subset of melanomas include mutations in BAP1 (n = 3), EIF1AX (n = 4), SRSF2 (n = 1), PTEN (n = 1), and EP300 (n = 1); monosomy 3p (n = 6); trisomy 6p (n = 3); trisomy 8q (n = 2); and an ultraviolet mutational signature (n = 5). Local recurrences were limited to melanomas, all of which demonstrated oncogenic alterations in addition to GNAQ/GNA11 (n = 5). A single melanoma harboring GNAQ and BAP1 mutations and monosomy 3 was the only tumor that metastasized. CONCLUSIONS In this study, anterior segment uveal melanocytomas did not display oncogenic alterations beyond GNAQ/GNA11. Therefore, they are genetically similar to uveal nevi rather than uveal melanoma based on their molecular features known from the literature. Molecular testing can be performed on borderline cases to aid risk stratification and clinical management decisions.
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Affiliation(s)
- David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Biswarathan Ramani
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Maya Eiger-Moscovich
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gunay Uludag
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - J Brooks Crawford
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Isabella Phan
- Department of Ophthalmology, Kaiser Permanente San Francisco, San Francisco, California
| | - Devron H Char
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Boris C Bastian
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Michele M Bloomer
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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Safran JP, Nataneli N, Vazirani J, Eagle Jr RC, Milman T. Corneal edema associated with degenerating Soemmering ring cataract: Clinical-pathologic correlation. Am J Ophthalmol Case Rep 2022; 28:101738. [PMID: 36393913 PMCID: PMC9663856 DOI: 10.1016/j.ajoc.2022.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To report three patients with an uncommon delayed complication of cataract extraction: corneal edema following dispersion of calcific lens particles from a degenerating Soemmering ring cataract. Observations We report three patients, 75–92 years old, presenting with corneal edema and dispersed, degenerated calcific lens material in the anterior chamber and vitreous 20–30 years after cataract surgery. In all patients, calcific particles studded the posterior surface of the cornea in a gravity-dependent distribution without apparent inflammation and were associated with localized corneal edema. In one patient, calcific particles were also associated with secondary open angle glaucoma. Deposits originated from the calcified Soemmering ring cataract. Histopathological examination demonstrated extracellular calcific deposits compatible with cataractous lens material on the posterior surface of stripped Descemet membrane of two patients. The deposits were associated with prominent localized loss of corneal endothelium and were not associated with inflammation. Morphologically similar acellular material was identified in the biopsied aqueous and vitreous fluid of one patient. Management included endothelial keratoplasty, anterior chamber lavage, pars plana vitrectomy, aspiration/removal of a portion of Soemmering ring cataract without intraocular lens implant explantation, and the removal of the entire capsular bag/implant complex. Cornea cleared and visual acuity improved in both patients who underwent endothelial keratoplasty. Persistent elevated intraocular pressure led to visual deterioration in one patient with secondary glaucoma. Conclusions and Importance Dispersion of calcific Soemmering ring cataract can occur decades following cataract surgery leading to corneal edema, secondary glaucoma, and vitreous opacities. Timely recognition of this phenomenon may prevent ocular morbidity, including corneal edema and glaucoma.
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Liu CK, Williamson JE, Milman T, Lally SE, Shields CL. Intramuscular Eyelid Myxoma. Ophthalmic Plast Reconstr Surg 2022; 38:e180-e183. [PMID: 35793663 DOI: 10.1097/iop.0000000000002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/25/2022]
Abstract
Myxomas are a heterogeneous group of mesenchymal tumors. Soft tissue myxomas are divided into myocardial, intramuscular, juxta-articular, superficial, aggressive, and nerve sheath myxomas. Although benign, myxomas have site-specific biologic behavior and syndromic associations, which can influence prognosis and management. In addition, myxomas need to be distinguished from malignant neoplasms, such as myxofibrosarcomas, low-grade fibromyxoid sarcomas, myxoid liposarcomas, and peripheral nerve sheath tumors. While myxomas can occur throughout the body, these tumors arise more commonly in the thigh, shoulder, buttocks, and upper extremity, and less often in the head and neck. Rarely, myxomas can arise in a periocular location, typically in the conjunctiva and eyelid skin. In this case report, we present a patient with recurrent intramuscular myxoma of the eyelid and discuss the differential diagnosis and syndromic associations of this neoplasm. To our knowledge, there have been no prior reports of intramuscular myxoma of the eyelid and orbit.
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Affiliation(s)
- Catherine K Liu
- Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - John E Williamson
- Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Tatyana Milman
- Pathology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Sara E Lally
- Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Carol L Shields
- Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Henry RK, Bilyk JR, Evans JJ, Lao PA, Milman T. Double-hit and triple-hit high-grade B-cell lymphoma of the ocular adnexa. Orbit 2022; 41:624-628. [PMID: 33779481 DOI: 10.1080/01676830.2021.1904426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/30/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
High-grade B-cell lymphoma (HGBL) with c-MYC and BCL2 and/or BCL6 rearrangements, also known as a double-hit and triple-hit lymphoma, is an aggressive non-Hodgkin lymphoma affecting older adults. After formal recognition of this entity in the 2017 revision of the World Health Organization Classification of lymphoid neoplasms, only two well-documented cases of triple-hit lymphoma of the orbit appear in the literature. Herein, we describe a 70-year-old man with progressive diplopia, ophthalmoplegia, and rapidly enlarging temporal mass. Biopsy revealed a tumor morphologically consistent with HGBL, coexpressing CD20, CD10, BCL6, BCL2, and c-MYC on immunohistochemical analysis. Fluorescence in-situ hybridization showed rearrangements in c-MYC and BCL-2 genes, confirming double-hit HGBL. Systemic workup revealed Ann Arbor stage IV disease. This report reviews the existing literature on ocular adnexal double-hit and triple-hit lymphoma and provides an update on the diagnostic ancillary studies, prognostic implications, and latest management for this aggressive hematolymphoid malignancy.
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Affiliation(s)
- Roger K Henry
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jurij R Bilyk
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James J Evans
- Department of Neurological Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla A Lao
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pathology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Armijos PO, Uhlenhake E, Milman T. Secretory Carcinoma of the Eyelid Arising in an Adnexal Gland. Ophthalmology 2022; 129:1218. [PMID: 35753863 DOI: 10.1016/j.ophtha.2022.02.024] [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: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 10/17/2022] Open
Affiliation(s)
- Paola Ordoñez Armijos
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth Uhlenhake
- Department of Dermatopathology, DermPro Dermatopathology Laboratory, Mason, Ohio
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Tien T, Crespo MA, Milman T, Syed ZA. Retained lens fragment presenting 32 years after cataract extraction. Am J Ophthalmol Case Rep 2022; 26:101546. [PMID: 35496763 PMCID: PMC9046127 DOI: 10.1016/j.ajoc.2022.101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a patient with retained lens material presenting over three decades after initial cataract extraction with fluctuating corneal edema and intraocular inflammation. Observations A 66-year-old man presented with a first episode of decreased vision and photophobia 32 years after cataract extraction without intraocular lens implantation in the right eye. Slit lamp examination revealed a tan-colored oblong mass in the inferior angle, in addition to corneal edema and an anterior chamber reaction. The patient was aphakic with traumatic mydriasis, and accordingly it was noted that the mass shifted location between anterior and posterior chambers over subsequent evaluations. The anterior chamber inflammation resolved in the latter position. The patient was requested to remain prone prior to clinical evaluation, and an in-office anterior chamber aspiration was performed. Histopathologic evaluation confirmed the presence of lens material and a phacolytic response. Conclusions And importance Although unusual, retained lens material may manifest with ocular morbidity decades after cataract extraction. In patients with corneal edema and intraocular inflammation, retained lens material should be considered as a possible underlying cause even in patients with a remote history of cataract extraction. This case represents one of the longest reported time periods from cataract extraction to clinical presentation of retained lens material.
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Affiliation(s)
- Thomas Tien
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marcos A. Crespo
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Zeba A. Syed
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Sidney Kimmel Medical College at Thomas Jefferson University, Cornea Service, Wills Eye Hospital, 840 Walnut Street, Suite 920, Philadelphia, 19107, PA, USA.
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Milman T, Eiger-Moscovich M, Henry RK, Ida CM, Ruben M, Shields CL, Lally SE, Penne RB, Stefanyszyn MA, Bilyk JR, Rapuano CJ, Rabinowitz M, Eagle RC. Cyclin D1 expression and molecular genetic findings in periocular histiocytoses and neoplasms of macrophage-dendritic cell lineage. Am J Ophthalmol 2022; 242:36-51. [PMID: 35594918 DOI: 10.1016/j.ajo.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Frequent activating mutations in the mitogen-activated protein kinase (MAPK) pathway genes have been identified in histiocytoses. MAPK signaling consistently upregulates Cyclin D1. The goal of this study was to determine whether Cyclin D1 expression by immunohistochemistry is a useful diagnostic marker for periocular histiocytoses and to further characterize their genetic basis. DESIGN Retrospective observational case series. METHODS Pathology records were searched for all patients with histiocytoses diagnosed between 1995-2020. Eleven histiocyte-rich inflammatory lesions and 10 xanthelasma served as controls. Cyclin D1 immunohistochemistry was performed on all tissues. A subset of histiocytoses was evaluated by next-generation sequencing (NGS) and droplet digital PCR (ddPCR). RESULTS There were 36 patients, 15 (42%) males and 21 (58%) females, with histiocytoses: 9 (25%) juvenile xanthogranuloma, 8 (22%) adult-onset asthma and periocular xanthogranuloma, 7 (19%) Langerhans cell histiocytosis, 5 (14%) Rosai-Dorfman disease, 5 (14%) xanthogranuloma not otherwise specified, 1 (3%) Erdheim-Chester disease, and 1 (3%) histiocytic sarcoma. Moderate-to-strong nuclear Cyclin D1 expression was present in ≥50% of lesional cells in histiocytoses (23/36, 64%), significantly more when compared to histiocyte-rich inflammatory lesions (0/11, 0%, P<.001) and xanthelasma (0/10, 0%, P<.001). Cyclin D1 was expressed in <10% of lesional cells in all 11 histiocyte-rich inflammatory lesions (P<.001) and all 10 xanthelasma lesions (P<.001). MAPK pathway gene mutations were detected in 12 of 14 (86%) histiocytoses successfully assayed by NGS and/or ddPCR. CONCLUSIONS Our study confirms that the Cyclin D1 immunohistochemical stain is a useful diagnostic marker for periocular histiocytoses, correlating with underlying mutations in MAPK pathway genes.
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Affiliation(s)
- Tatyana Milman
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Maya Eiger-Moscovich
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Maya Eiger-Moscovich is currently practicing at Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel. Meghan Ruben is currently practicing at Department of Ophthalmology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Roger K Henry
- Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School at Rutgers University (R.K.H.), Newark, New Jersey
| | - Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science (C.M.I.), Rochester, Minnesota; USA
| | - Megan Ruben
- Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sara E Lally
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert B Penne
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mary A Stefanyszyn
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jurij R Bilyk
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher J Rapuano
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Cornea Service (C.J.R.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rabinowitz
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Pulido JS, Dunavoelgyi R, Milman T, Shields CL. Response to 'Comment on: 'Minimal residual disease-a novel concept in uveal melanoma". Eye (Lond) 2022; 36:901. [PMID: 33976402 PMCID: PMC8956722 DOI: 10.1038/s41433-021-01576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jose S. Pulido
- grid.265008.90000 0001 2166
5843Ocular Oncology Service, Wills Eye
Hospital, Sidney Kimmel Medical College of
Thomas Jefferson University,
Philadelphia, PA USA ,grid.417124.50000 0004 0383
8052Bower Laboratory for Translational
Medicine, Vickie and Jack Farber Vision Research Center at Wills Eye
Hospital, Wills Eye Hospital,
Philadelphia, PA USA
| | - Roman Dunavoelgyi
- grid.22937.3d0000 0000 9259
8492Department of Ophthalmology,
Medical University of Vienna,
Vienna, Austria
| | - Tatyana Milman
- grid.417124.50000 0004 0383
8052Department of Pathology,
Wills Eye Hospital, Sidney Kimmel Medical
College of Thomas Jefferson University,
Philadelphia, PA USA
| | - Carol L. Shields
- grid.265008.90000 0001 2166
5843Ocular Oncology Service, Wills Eye
Hospital, Sidney Kimmel Medical College of
Thomas Jefferson University,
Philadelphia, PA USA
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