PART TWO
Diagnostic Cytology
Fig. 17.3 Anatomic landmarks of the eye.
The contents of the eye are the lens, supported and controlled
by the uvea, and two liquid-filled compartments separated by
the lens. The anterior chamber contains a thin fluid, the aque-
ous humor; the major portion of the eye contains a viscous gel,
the vitreous body. Both fluids must be free of cells and color
in order to optimally transmit light to the retina. The cornea,
lens, aqueous humor, and vitreous body compose the refracting
media of the eye.
Eyelids
As noted, lesions affecting the lids are similar to skin lesions
in general, with similar histologic and cytologic characteris-
tics. Only a few diseases are unique to this area or require extra
care to obtain the samples without unnecessarily damaging the
delicate tissues of the eye and surrounding structures.
Viral Diseases
Molluscum contagiosum, verruca vulgaris, herpes zoster, and
herpes types 1 and 2 can infect the lids and conjunctiva. These
diseases are frequently sexually transmitted and are present in
the genital tracts of the patient, sexual partner, or both. Diagno-
sis and treatment, therefore, should be directed toward all likely
sources so that reinoculation does not occur, because these
infections can be sight threatening. Morphologic characteristics
can be diagnostic if the eye specimen is well preserved and not
air-dried, which is difficult because of minimal moisture in the
area. (For detailed cytologic features, readers are referred to the
appropriate sections in this text and to the illustrated chapter in
another work.14) Advances in viral diagnosis (e.g. in situ hybridi-
zation, various blot methods, and improved culture techniques)
are welcome aids to confirming these lesions.
Key features of viral lesions
Molluscum contagiosum:
large intracytoplasmic inclu-
sion bodies (Henderson-Patterson bodies);
Verruca vulgaris:
papillomatous lesion marked by
acanthosis, parakeratosis, and hyperkeratosis with
vacuolated cells and basophilic viral inclusion bodies;
and
Variola, vaccinia, varicella, herpes zoster, herpes simplex:
intraepidermal vesicles with eosinophilic inclusion
bodies.
Xanthelasm a
These lesions are so clinically characteristic that the need for
cytologic diagnosis is remote.
However, if a xanthelasma
were to be aspirated, only lipid-filled macrophages would be
recovered.
Key features of xanthelasma
• Collections of histiocytes with microvesicular foamy
cytoplasm clustered around vessels; and
• Paucity of other inflammatory cells.
M elanocytic tumors
Little experience is reflected in the literature regarding cytology
of benign nevi in any location. However, if a melanoma is sus-
pected, then an aspirate or a scraping of the lesion would con-
tain cells in which the nuclear features and size would clearly
define the lesion as malignant.40,41 Pigmented lesions are usually
completely excised for cosmesis, diagnosis, and potential cure,
without using an intermediate cytologic diagnosis.
Chalazion
These painful swellings are caused by retained secretions of
the meibomian glands and are characterized by a mixture of
lipogranulomatous and suppurative inflammation. The proc-
ess is usually grossly diffuse and occasionally nodular and can
clinically mimic a sebaceous carcinoma. An aspirate contains
granulomas with lipid-laden macrophages and neutrophils.
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