PART TWO
Diagnostic Cytology
Fig. 17.12 Retina in vitrectomy washing. Cytospin preparation
(Papanicolaou x HP).
Fig. 17.14 Macrophage with pigment in vitrectomy washing. Cytospin
preparation (Papanicolaou x HP).
Fig. 17.13 Retina in vitrectomy washing. Cytospin preparation
(May-Gr├╝nwald-Giemsa x HP).
cells that have been present in the vitreous for an extended
period lose their hemoglobin and become ghost erythrocytes. If
these ghost erythrocytes pass forward into the anterior chamber,
they can mechanically obstruct the trabecular meshwork, block-
ing aqueous outflow and thereby causing a secondary glaucoma.
This condition most commonly occurs after trauma in which
damage to anterior hyaloid (the most anterior portion of the vit-
reous) has occurred. Eyes with blood-induced glaucoma show a
spectrum of pathologic findings that suggest that obstruction of
aqueous outflow is caused by a combination of ghost erythro-
cytes (Fig. 17.15), hemolytic cells (Fig. 17.16), and hemosiderin.
These hemolytic cells have been characterized as histiocytes or
macrophages with engulfed red blood cells.27
It is now recognized that mechanical blockade of the anterior
chamber angle structures can be caused by proteinaceous debris
and/or characteristic large macrophages that have ingested lens
material. Phacolytic cells are swollen histiocytes with lightly
eosinophilic granular cytoplasm and lens material. These cells
can be seen in anterior chamber aspirate specimens.
Phacolytic glaucoma and "phacoanaphylaxis" may produce
lens fragments and inflammatory cells in both anterior chamber
Fig. 17.15 Ghost erythrocytes and hemoglobin fragments in vitrectomy
washing. Cytospin preparation (Papanicolaou x HP).
and vitreous fluids (Fig. 17.17).81 The characteristic appearance
of lens epithelium may have nuclei (Fig. 17.18). Lens capsule
may also be present in the vitreous washing specimen; this
capsule appears as a well-demarcated fragment of transparent
material (Fig. 17.19).
Neoplasms
Melanomas and retinoblastomas are the most common primary
neoplasms of the area (Table 17.3),71 but metastatic tumors are
also common. Malignancies most frequently metastasizing to
the eye are from the breast in women and the lung in men.61,82
Neuroblastomas in children often travel to the eye, making
distinction from a retinoblastoma impossible on cytologic
grounds;14 accurate history and anatomic location are necessary
for diagnosis.
Ocular melanomas
are usually located in the choroid, causing
visual deficits, or more rarely in the iris or ciliary body, where
they are obvious to a careful observer. Ocular melanomas are
amenable to fine-needle aspiration but are rarely needed for
diagnosis.40,70,71,83 However, the technique may be used to obtain
information that may be useful in prognostication.84 It has
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