Cytokeratin expression in corneal dystrophies.

PURPOSE: To identify an immunohistochemical pattern of epithelial markers in granular, lattice and Avellino corneal dystrophies. METHODS: Twenty-two corneal buttons, diagnosed as lattice (17), Avellino (4) and granular (1) underwent immunohistochemical studies of cytokeratins (CKs) on paraffin-embedded sections (group I). Monoclonal antibodies for pan-CK (AE1/AE3) and CKs 3/12, 5/6, 8, 18 and 19 were used. Twenty-two normal corneas were used as the control (group II). RESULTS: Six lattice and 2 Avellino cases of group I stained positively with anti-CK 3/12 in corneal epithelium and areas of corneal stroma deposits. One of these cases of lattice was positive for anti-pan-CK (AE1/AE3) also in the epithelium and areas of corneal stroma deposits with a similar pattern. None of the controls (group II) revealed any staining in corneal stroma. All disease and control cases (groups I and II) revealed positive staining in corneal epithelium. CONCLUSION: AE1/AE3 and CK 3/12 anti-CK positive markers in the stromal deposits of lattice and Avellino dystrophies may suggest an epithelial genesis of the disease.

Cytokeratin expression in corneal dystrophies / Expressão de citoqueratinas em distrofias corneanas

PURPOSE: To identify an immunohistochemical pattern of epithelial markers in granular, lattice and Avellino corneal dystrophies. METHODS: Twenty-two corneal buttons, diagnosed as lattice (17), Avellino (4) and granular (1) underwent immunohistochemical studies of cytokeratins (CKs) on pa- raffin-embedded sections (group I). Monoclonal antibodies for pan-CK (AE1/AE3) and CKs 3/12, 5/6, 8, 18 and 19 were used. Twenty-two normal corneas were used as the control (group II). RESULTS: Six lattice and 2 Avellino cases of group I stained positively with anti-CK 3/12 in corneal epithelium and areas of corneal stroma deposits. One of these cases of lattice was positive for anti-pan-CK (AE1/AE3) also in the epithelium and areas of corneal stroma deposits with a similar pattern. None of the controls (group II) revealed any staining in corneal stroma. All disease and control cases (groups I and II) revealed positive staining in corneal epithelium. CONCLUSION: AE1/AE3 and CK 3/12 anti-CK positive markers in the stromal deposits of lattice and Avellino dystrophies may suggest an epithelial genesis of the disease.

OBJETIVO: Investigar a expressão de citoqueratinas (CKs) em córneas com distrofias corneanas tipo granular, lattice e Avellino. MÉTODOS: Vinte e dois botões corneanos com diagnóstico anatomopatológico de distrofia estromal tipo lattice (17), Avellino (4) e granular (1) foram submetidos à avaliação imunohistoquímica nos tecidos inclusos em parafina (grupo I). Anticorpos monoclonais para pan-CK (AE1/AE3) e CKs de números 3/12, 5/6, 8, 18 e 19 foram utilizados. Vinte e dois botões corneanos normais foram usados como controle (grupo II). RESULTADOS: Oito casos do grupo I (seis lattice e dois Avellino) apresentaram reações imuno-histoquímicas positivas com anti-CK 3/12, tanto no epitélio como nos depósitos estromais e um destes casos (lattice) também se mostrou positivo para anti-pan-CK (AE1/AE3) com o mesmo padrão de reação. Nenhum caso do grupo II mostrou reação imuno-histoquímica positiva no estroma corneano. Na avaliação imuno-histoquímica dos grupos I e II, o epitélio apresentou uma reação positiva com o anticorpo anti-pan-CK (AE1/AE3) e com o anti-CK 3/12. CONCLUSÃO: O fato da pan-CK e CK 3/12 apresentarem uma reação positiva nos depósitos das distrofias tipo lattice e Avellino sugere uma origem epitelial desses depósitos corneanos.

The expression of cyclooxygenase 2 in retinoblastoma: primary enucleated eyes and enucleation after conservative treatment.

PURPOSE: To provide insight into the relationship between cyclooxygenase-2 (COX-2) expression and histopathologic features of retinoblastoma specimens treated either by primary or secondary enucleation. DESIGN: Laboratory investigation. METHODS: Twenty-five retinoblastoma specimens received between 1994 and 2003 were retrieved for this study from the Ocular Pathology Registry, Federal University of São Paulo, Brazil and the Henry C. Witelson Ocular Pathology Laboratory and Registry, McGill University, Montreal, Canada. The specimens retrieved were divided into two groups: Group I, enucleation was performed as a form of primary treatment (n = 15) and Group II, enucleation after failure of conservative treatment (n = 10). Patient information and formalin-fixed, paraffin-embedded specimens were obtained. New sections of these blocks were used for hematoxylin and eosin stain and for immunoassay using a monoclonal mouse anti-COX-2 antibody. Two independent ophthalmic pathologists reviewed all of the microslides. RESULTS: Twenty-three specimens (92%) presented a high expression of COX-2 (15 in Group I; eight in Group II) and there was no statistical difference in COX-2 expression between the two groups (P = .07). However, all specimens expressed COX-2 to a different degree. The areas of tumor invasion were positive for COX-2 in 87.5% of the two groups. CONCLUSION: Most retinoblastoma specimens revealed a high COX-2 expression. Future studies will be necessary to correlate the high expression of COX-2 in retinoblastoma and a possible applicability of anti-COX-2 medications in the treatment of these tumors.

Histopathological features and P-glycoprotein expression in retinoblastoma.

PURPOSE: To investigate the expression of P-glycoprotein (P-gp) in retinoblastoma specimens enucleated as a primary treatment or after conservative treatment and to correlate this expression with histopathological tumor features. METHODS: Retrospective analysis was performed on retinoblastoma specimens obtained consecutively between 1993 and 2003 by enucleation either as primary treatment (group I) or after the failure of conservative treatment (group II). Sections from the formalin-fixed, paraffin-embedded specimens were stained with hematoxylin and eosin. Group I tumor differentiation was classified according to the percentage of Flexner-Wintersteiner rosettes. Group II tumors, categorized as viable-appearing, regressed with a well-differentiated component (WDC), and regressed. Other features, such as choroidal and optic nerve invasion, were evaluated. P-gp expression was graded semiquantitatively as negative, low, or high. Variables were statistically analyzed by chi(2) and Student's t-tests. RESULTS: Histopathological assessment of group I revealed 65% moderately differentiated tumors, 30% well differentiated, and 5% poorly differentiated. Fifteen percent had optic nerve tumor invasion only, 20% choroidal invasion only, and 55% both choroidal and optic nerve invasion. Group II had 62.5% well-differentiated, regressed tumors; 25% had regressed tumors replaced by glial scarring; and 12.5% had tumors containing viable, poorly differentiated cells. Approximately 18% had choroidal tumor invasion only, 6.3% optic nerve tumor invasion only, and 6.3% simultaneous optic nerve and choroidal invasion. P-gp expression was observed in 60% of group I and 66.6% of group II. All P-gp-positive cases in group II had a high expression. P-gp was also expressed by 81.2% of well-differentiated tumors. CONCLUSIONS: P-gp was expressed more frequently by well-differentiated retinoblastomas, especially those treated by chemotherapy before enucleation. This finding could be related to treatment failure.

Histopathological review of sebaceous carcinoma of the eyelid.

BACKGROUND: Sebaceous carcinoma of the eyelid can clinically mimic benign conditions, such as recurrent chalazion and inflammation and histopathologically squamous cell and basal cell carcinoma (BCC). This retrospective study was undertaken as an attempt to improve the characterization and consequently the diagnosis of these tumors. METHODS: Retrospective analysis was performed on eyelid specimens diagnosed as sebaceous carcinoma retrieved from Henry C. Witelson Ophthalmic Pathology Registry, Canada and Hospital Luis S. Bulnes Pathology Registry, Mexico. Two independent, masked pathologists reviewed the H&E microslides. RESULTS: Forty-four cases were retrieved, 31 from Canada and 13 from Mexico. Cytoplasmic vacuoles were observed in 48% of the cases. Eighty-four percent of the cases were classified as poorly differentiated lesions. Of these, 75% had features similar to squamous cell carcinoma (SqCC), some with dyskeratosis (30%) and 7% resembled BCC. Solid growth pattern was seen in 26.2% of the cases and lobular growth pattern in 26.2%. Superficial spread resembling Bowen-like disease was observed in 33% of the cases, pagetoid features in 33% and comedocarcinoma in 31.8%. CONCLUSION: Sebaceous carcinoma presented as a poorly differentiated lesion in most cases of this series, which suggests a possibility of misdiagnosis because of its similarities to SqCC.

Estudo retrospectivo dos transplantes penetrantes de córnea da Santa Casa de Porto Alegre / Retrospective study of penetrating keratoplasty at the Santa Casa of Porto Alegre

Objetivos: Traçar o perfil clínico e social dos pacientes submetidos a transplante de córnea e avaliar as principais indicaçöes desses transplantes, tempo de espera para doaçäo e os índices de sucesso, rejeiçäo e falência dos transplantes penetrantes de córnea. Métodos: Foram analisados retrospectivamente os prontuários de 87 pacientes submetidos a transplante penetrante de córnea no Serviço de Oftalmologia da Santa Casa de Porto Alegre entre janeiro de 1990 e dezembro de 1998, totalizando 91 olhos. Destes, 56 pacientes foram chamados para avaliaçäo clínica do enxerto durante o levantamento de dados para este estudo. Resultados: Considerando-se os 91 transplantes (87 pacientes), 53 (60,9 por cento) foram realizados em pacientes do sexo masculino e 34 (39 por cento), do sexo feminino. A idade variou de 3 a 89 anos, com média de 42,3 ñ 19,8 anos. As principais indicaçöes para transplante de córnea foram ceratocone em 32 (35 por cento) olhos, ceratopatia bolhosa (pós-facectomia, distrofia de Fuchs e outros) em 24 (26,4 por cento), trauma mecânico em 9 (9,9 por cento), causas infecciosas em 9 (9,9 por cento), queimadura química em 2 (2,2 por cento), queimadura térmica em 1(1,1 cento) e outras causas em 14 (15,4 cento) olhos. O tempo médio de espera por doaçäo de córnea foi de 17,3 ñ 9,9 meses. Do total de 91 olhos transplantados, 25 (27,5 por cento) apresentaram rejeiçäo e 12 (13,2 por cento) olhos apresentaram falência do transplante. Conclusöes: Este estudo mostrou a epidemiologia dos pacientes transplantados. A falta de dados seriados devido à alta precoce e perda de acompanhamento dos pacientes tornou impossível a análise e a comparaçäo dos resultados pós-operatórios com outros estudos.

Retinopexia com introflexão escleral em serviço de ensino de Oftalmologia / Scleral buckling procedure at an ophthalmic teaching facility

Objetivos: Avaliar: 1) o sucesso anatômico do tratamento cirúrgico do deslocamento de retina usando a técnica de retinopexia com introflexão escleral associada à crioterapia ou diatermia; 2) a acuidade visual pré e pós-operatória; 3) a relação entre a localização do defeito retiniano e o sucesso cirúrgico; 4) as complicações pós-operatória decorrentes do procedimento realizado. Pacientes e Métodos: foram analisados, retrospectivamente, 3 pacientes com deslocamento de retina diagnosticados via oftalmoscopia indireta no Serviço de Oftalmologia da Santa Casa de Porto Alegre durante o período de 1998 a 1999. Os critérios de exclusão foram: pontuário incompleto e vitrectomia via pars plana. Trina e sete pacientes foram submetidos à retinopexia com introflexão escleral associada à criopexia ou diatermia trans-escleral realizadas por médicos residentes (3o. ano) com supervisão. No pós-operatório foram avaliados os resultados considerando: sucesso anatômico, resultados da acuidade visual, relação entre pré-operatória do defeito retiniano e o sucesso operatório, e complicações cirúrgicas. Resultados: Sucesso anatômico foi obtido em 26 retinopexias (70,2 porcento). A acuidade visual no pós-operatório apresentou melhora. Em 11 pacientes foi realizada nova cirurgia com sucesso anatômico em 5 destes pacientes. O índice de sucesso total foi de 83,8 porcento (n=31). Conclusão: Os resultados anatômicos e acuidade visual obtidos foram comparáveis à publicações científicas internacionais. Não houve associação entre localização prévia de ruptura e sucesso anatômico nesta série. A complicação cirúrgica mais frequente foi o DR recorrente.