17
Eye
Fig. 17.6 Coccidioidomycosis. Direct smear made from anterior chamber
aspirate (Papanicolaou x HP).
Orbital Infections
In one retrospective study of fine-needle aspirations of chronic
inflammations of the orbit and ocular adnexa over a 15-year
period, of 55 chronic inflammations, 42 were diagnosed as
granulomatous
inflammations
comprising
chalazion
(18),
tuberculosis (5),
Cysticercus cellulosae
(3), ruptured epidermal
cysts (2), actinomycosis (1), and leprosy (13), supporting the
use of fine-needle aspiration cytology as a useful diagnostic pro-
cedure in chronic inflammations of the ocular adnexa.57 Other
infections diagnosed cytologically in the orbit include coccidio-
mycosis (Fig. 17.6),13,58 and
Aspergillus
sp.59
Hematoma
Spontaneous orbital hemorrhage is quite amenable to fine-
needle aspiration. The presence of ghost cells, hemoglobin
fragments, and pigment laden macrophages indicate remote
hemorrhage. This is to be distinguished from the cavernous
hemangioma, which frequently reveals fresh blood.2
Key features of hematoma
• Ghost cells, hemoglobin fragments, and pigment
laden macrophages.
Mucocele
This simple cyst contains mucus, scattered inflammatory cells,
and occasional cuboidal epithelial cells. Rarely ciliated epithe-
lium may be recovered.
Key features of mucocele
• Mucoid material with occasional vacuolated macro-
phages (mucophages); and
• Pseudostratified, ciliated or columnar epithelium from
cyst wall may be present.
Meningioma
Although meningioma can involve the orbit by extension from
the intracranial space, the lesion may also arise from the menin-
ges covering the optic nerve and appear as a retrobulbar mass
Fig. 17.7 Orbital meningioma. Tight clusters of cells with round to oval
nuclei and salt and pepper chromatin show characteristic intranuclear
inclusions (H&E x MP).
within the orbit. Classically the orbital meningioma involves
the greater wing of the sphenoid bone. Aspirates are composed
of tightly coherent clusters of small ovoid nuclei with scant cyto-
plasm. Nuclear chromatin is fine, nucleoli are inconspicuous,
and nuclear pseudoinclusions may be found. The classic three-
dimensional concentric whorls of these cells (noncalcified psam-
moma bodies) provide the conclusive diagnosis (Fig. 17.7).53,60
Key features of meningioma
• Oval and round cells with scant cytoplasm organized
in occasional whorls (psammoma bodies);
• Scant cytoplasm;
• Clusters of small ovoid nuclei with inclusions; and
• Fine nuclear chromatin.
Metastatic Lesions
Although metastases to the orbit usually reflect disseminated dis-
ease, the occurrence of a metastatic deposit in this region may
rarely be the first presentation of a patient's illness.61,62 For example,
a report in the literature describes the use of FNA in diagnosis of
metastatic mucinous adenocarcinoma of the ovary.63 When metas-
tases do occur in the region of the eye, they are commonly from the
breast in women, from the lung in men, and from neuroblastomas
in children.62,64,65 Distinguishing retinoblastoma from neuroblast-
oma may be cytologically difficult, since the specific differentiating
features of retinoblastoma, fleurettes, are rarely observed in needle
aspirates.66 Squamous carcinoma usually invades the orbit from
adjacent structures, skin, or perinasal sinuses (Fig. 17.8).
W egener's granulom atosis
Sampling is a major problem in cases of Wegener's granuloma-
tosis. It is likely that necrotic material will be obtained (pather-
gic necrosis), but since there is accompanying fibrosis, very
scant material is usually obtained in aspirates. Since histologic
evidence of granulomatous inflammation is only evident in
slightly over 62% of cases, the retrieval on fine-needle aspirate is
even more difficult.2
Key features of Wegener's granulomatosis
• Necrosis;
• Perivascular or intravascular inflammation; and
• Granulomatous inflammation.
461
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