LEUKEMIA
Leukemia may involve the eye in some form in as many as 80% to 90% of cases. [30,
31,
32] Usually, it takes the form of focal infiltration of the choroids. [
33]Iris involvement by leukemic cells can lead to a pseudohypopyon (Figure 9-7). [
34] This may occur with acute lymphocytic leukemia, chronic lymphocytic leukemia, or acute myelogenous leukemia. [
35,
36,
37,
38, 39] A simple aqueous aspirate with a small gauge needle is often sufficient for diagnosis (Figure 9-8).
CHOROIDAL MELANOMA
Choroidal melanoma accounts for about 80% to 87% of all ocular melanomas. [40] Patients most frequently present clinically with blurred vision and examination reveals a mass in the posterior globe (Figure 9-9). Malignant melanomas of the choroids differ from those of the skin. They have a more bland histologic appearance and they have a better prognosis (Figure 9-10). [41] Historically, choroidal melanomas are classified according to the presence of spindle or epithelioid cells. [42,
43, 44] However, it is apparent the other cytologic information may be important, including the standard deviation of the nucleolar area. [45,
46] Fine needle aspiration of uveal tumors has been an effective means of diagnosis. [
47,
48,
49,
50,
51,
52] Criteria for cytologic diagnosis of malignant include clusters or single pigmented cells with enlarged nuclei and prominent nucleoli. Spindle cells retain their elongated shaper and have nuclear grooves (Figure 9-11). [29] Cells with dendritic cytoplasm are frequently present (Figure 9-12). Epithelioid cells have more abundant cytoplasm, larger round nuclei, and more prominent nucleoli (Figure 9-13). Occasionally, enlarged cells with vacuolated cytoplasm (balloon cells) are sampled (Figure 9-14). Invariably present in fine needle aspirate smears are macrophages that are stuffed with pigment (Figure 9-15).
METASTATIC CARCINOMA
One source of difficulty in the differential diagnosis of ocular tumors is metatstatic disease. The incidence of metastatic ocular cancer in autopsy studies varies from 0.06% to 2.3%. [53,
54] The most common site for metastasis in the eye is the choroids. [55,
56] The site of the primary lesion is most often is the breast (46% to 90%) followed by the lung (10% to 29%). [
57] Because metastatic lesions may produce dome-shaped tumors in the choroids, fine needle aspiration may be necessary to differentiate a primary ocular amelanotic melanoma from a metastatic cancer (Figure 9-16). The cytologic findings of metastatic tumors correspond to those of the primary tumor and occasionally, the features may suggest a primary site (Figure 9-17).
References
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