17
Eye
Fig. 17.16 Hemolytic cells in vitrectomy washing. Cytospin preparation
(Papanicolaou x HP).
Fig. 17.18 Lens fragment with lens epithelium in vitrectomy washing.
Cytospin preparation (Papanicolaou x HP).
Fig. 17.17 Lens fragment in vitrectomy washing. Cytospin preparation
(May-Gr├╝nwald-Giemsa x HP).
Fig. 17.19 Lens fragment and fragment of glass capsule in vitrectomy
washing. Cytospin preparation (Papanicolaou x LP).
been noted that this technique should not be used unless the
information gained is important for clinical management, since
some complications may be vision threatening.
Histologically, intraocular melanomas may be divided into
epithelial and spindle cells (Fig. 17.20). Choroidal melanoma
remains a deadly cancer, with nearly 50% of all patients dying
from metastasis within 15 to 25 years.85-88 Treatment tends to be
more conservative than that for melanomas elsewhere, in order
to preserve sight whenever possible. Determining the progno-
sis of patients receiving treatment for choroidal melanoma has
traditionally relied upon the clinical and histopathologic char-
acteristics of the tumor. However, these features, which include
age at diagnosis, largest tumor diameter, ciliary body involve-
ment, presence of epithelioid cells, and identification of vas-
cular loops, are problematic because enucleated specimens are
required and because their ability to identify patients at high
risk for metastatic disease is limited. Because the biologic behav-
ior is not necessarily reflected in the cytomorphologic features,
some groups are exploring alternative methods of determining
prognosis of choroidal melanoma. A recent publication described
a fine-needle aspiration biopsy approach for the in vivo detection
of monosomy 3, the strongest known genetic marker for high
risk of metastatic disease in patients undergoing brachytherapy
for choroidal melanoma. Adequate biopsy material for cytologic
diagnosis was obtained in 78% of lesions, many of which were
very small, but only 50% of tumor samples yielded a determina-
tion of chromosome 3 status with FISH testing.84
Smears of aspirates of epithelial-type melanoma contain
clusters and single large, freely dispersed, variably shaped cells
with abundant cytoplasm. The cytoplasm may contain fine mel-
anin granules. Free melanin pigment can be seen in the back-
ground and ingested in benign macrophages. Nuclei are large
and pleomorphic, especially in the truly epithelioid cells where
they are frequently eccentric and sometimes multiple. Nucleoli
are prominent and large, and intranuclear cytoplasmic invagina-
tions can be found, as in melanomas elsewhere.
The spindle cell type is composed of slender cohesive cells,
connected by bipolar cytoplasmic processes. These cells may be
intermixed with epithelioid cells. Melanin pigment and intranu-
clear inclusions are not as common as in the epithelial variant.
465
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