Histopathology and Immunophenotyping of Congenital Lacrimal (Anlage) Fistulae.

PURPOSE: To report the histopathological and immuno histochemical features of congenital lacrimal fistulae. METHODS: Retrospective chart review of all patients who underwent a fistulectomy for congenital lacrimal fistulae, over a 3-year period from a single surgeon's (M.J.A.) database, were included in the study. A detailed lacrimal system evaluation was performed, and intraoperative findings were documented. The excised fistulae were studied using hematoxylin and eosin and periodic acid-Schiff staining. Immunophenotyping was performed using CD3, CD5, CD10, and CD20. RESULTS: Twelve excised fistulae of 12 patients were studied. The mean age at presentations was 5.3 years (range, 3-11 years). The deeper parts of the fistulae were lined with hypertrophied stratified squamous epithelium similar to canalicular tissue in 83.3% (10/12), reflecting its origin from the canalicular tissue, and 16.7% (2/12) originated from the lacrimal sac and were lined with columnar epithelium with areas of squamous metaplasia. The subepithelial areas showed presence of fibrosis and chronic inflammatory infiltrate. The infiltrates were lymphoplasmacytic and were positive for CD3, CD5, and CD20 and negative for CD10 immunostaining. CONCLUSION: Hypertrophied stratified squamous lining was the commonest finding. Immunophenotyping revealed features of chronic inflammatory infiltrate composed of a mixture of both T and B lymphocytes. Histopathological analysis of fistulae may be of adjunctive value in determining the origin of the anlage.

Paraparesis induced by inflammatory contents of a pneumonectomy cavity. Case report.

The authors report on a patient who developed acute-onset paraparesis after underoing a thoracotomy 40 years earlier for a carcinoid adenoma. No infectious or neoplastic origin could be found to explain the patient's current clinical course and radiographic findings. The postoperative events in this case are discussed, as well as the literature regarding postthoracotomy complications.

Macrophages during fibrosis following scleral fistulising surgery in a rat model.

PURPOSE: Glaucoma filtration surgery can fail in a minority of patients as a result of fibrosis in the subconjunctival bleb space and closure of the scleral fistula. In this study, the rat eye has been used as an experimental model for fistulising surgery in order to evaluate the clinical manifestation of bleb failure with the morphological events of the wound healing process. METHODS: A conjunctival bleb was successfully formed in 25 rats and was examined daily using slit lamp microscopy to evaluate postoperative inflammation and the presence of a bleb. At defined post-operative time points, serial frozen sections of eyes were stained immunohistochemically using a panel of monoclonal antibodies directed against known surface markers on rat immune/inflammatory cells. Positively stained cells were counted (a) in the bleb site, (b) at the sclerostomy and (c) at the suture site. RESULTS: Following an initial post-operative inflammation, a surgically formed sclerostomy and conjunctival bleb underwent a granulation and scarring response so that by 7-19 days the bleb had disappeared. Using the monoclonal antibodies applied in this study, it was possible to show that macrophages most likely play a major and pivotal role throughout the sequence of events that lead to repair of the fistula and closure of the bleb. It was also noted that the presence of an otherwise inert nylon suture used to close the incised conjunctiva can serve as a focus for macrophages. CONCLUSION: The rat has been successfully used as an experimental model of fistulising surgery and its subsequent failure. The use of a panel of monoclonal antibodies directed against specific surface markers on immune-inflammatory cells, highlighted macrophages to be prominent in all stages of this wound healing process.