Bernadette Kantelip

Primary lymphoma of the lacrimal sac: an EORTC ophthalmic oncology task force study

Aim: To define the clinical and histopathological characteristics of primary lacrimal sac lymphoma in a predominantly white population. Methods: Specimens of lacrimal sac lymphoma and follow up data were solicited from members of the Ophthalmic Oncology Task Force of the European Organization for Research and Treatment of Cancer (EORTC) and the European Ophthalmic Pathology Society (EOPS). Specimens were stained with haematoxylin and eosin and an immunohistochemical panel against leucocyte antigens was applied. Diagnosis was reached by consensus of five experienced pathologists according to the World Health Organization classification system. The histopathological findings were correlated with the clinical data. Results: Of 15 primary lacrimal sac lymphomas, five (33%) were diffuse large B cell lymphoma (DLBCL), five (33%) were extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma), three were classified as “transitional MALT lymphoma,” being in transition from MALT lymphoma to DLBCL, and two were unclassified B cell lymphomas. Nine of the patients were female, and the median age at the time of diagnosis was 71 years (range 45–95 years). The most frequent presenting symptoms were epiphora (85%), swelling in the region of the lacrimal sac (79%), and dacryocystitis (21%). All but one patient presented in stage I. Systemic spread occurred in three of nine patients (33%). The 5 year overall survival was 65%. Conclusions: DLBCL and MALT lymphoma are equally common in the lacrimal sac in contrast with the remaining periorbital and/or orbital region where MALT lymphoma predominates.

Morphology, Histology, and Ultrastructure of Human C31 Organ-Cultured Corneas

Our objective was to evaluate corneal structural modifications induced by corneal preservation in a C31 organ culture medium. Twenty-four postmortem human corneas preserved in C31 medium (CRTS, Besanc,on, France) for 2-21 days and 12 fresh postmortem human corneas were studied and evaluated by means of light microscopy, morphometry, and transmission electron microscopy (TEM). Endothelial cell loss during preservation averaged 9.2% (± 7.2%). Endothelial morphology displayed significantly more moderate alterations in the group of fresh corneas than in the group of preserved corneas. Endothelial morphometry resulted in a higher coefficient of variation (p=0.002) in the preserved group but showed no difference for the average figure coefficient and average cell area. The histological study showed corneal swelling and epithelial sloughing in the preserved group. TEM displayed moderate preservation injuries, such as numerous vacuoles, mitochondrial swelling, and increased cell thickness. These results are consistent with previous findings that indicated that C31 medium induces moderate preservation injuries.

Modulation of HLA-DR and CD1a expression on human cornea with low-dose UVB irradiation

PURPOSE To evaluate the effects of low-dose UVB irradiation of HLA and CD1a expression and the toxic effects of UVB on human corneas. METHODS 24 pairs of human corneas from 24 donors were studied. One cornea from each pair was randomly irradiated with UVB (100 mJ/cm2) after enucleation. All corneas were then organ-cultured for 2, 7, 14 or 21 days. Endothelium was studied after enucleation and organ culture. Following preservation, corneas were evaluated by means of light microscopy, morphometry and TEM. HLA and CD1a staining was performed using an immuno-alkaline-phosphatase technique. RESULTS Endothelial cell loss during organ culture averaged 9.1% in the UVB group and 9.2% in the control group (NS). The number of rosette and reformation figures (p = 0.004) and the coefficient of variation (p = 0.014) were higher in the control group. Epithelial sloughing was more accentuated in the UVB group. We observed the same moderate ultrastructural injuries in both groups. In the epithelium, the average number of HLA-DR+ cells per field was 0.12 in the UVB group and 0.42 in the control group (p = 0.035). In the stroma, these figures were respectively 1.04 and 1.34 (p = 0.026). In the epithelium, the average number of CD1a + cells was respectively 0. 025 and 0.078 (p = 0.019). In the preservation mediums, the average percentage of CD1a + cells was 0.07% in the UVB group and 0.27% in the control group (p = 0.014). CONCLUSIONS Low-dose UVB (100 mJ/cm2) decreases HLA-DR and CD1a expression of organ-cultured human corneas and induces moderate corneal injuries. Low-dose UVB might be useful for preventing allograft rejection.

Danger of systemic cyclosporine for corneal graft.

Purpose. To report a case of posttransplant lymphoproliferative disorder (PTLD) in a patient receiving oral cyclosporine (CS) for immunosuppression in a high-risk keratoplasty. Methods. A systemic CS therapy was given to prevent graft rejection of a keratoplasty. Risk rejection was high in regard to a previous graft rejection and persistence of a corneal vascularization. One year after the keratoplasty, the patient developed a gastric Epstein-Barr virus (EBV)-induced B cell lymphoma. The outcome was favorable after chemotherapy. Conclusions. This unique case of lymphoma (PTLD) in the course of corneal graft management questions the indications and the follow-up of patients with CS therapy and raises the issue of topical CS treatment.

Toxic Retinopathy induced by Sodium Iodate in Rabbits: Correlation between Electroretinography, Vitamin A levels in Blood, Electronmicroscopic Histology and Colour Fluorescein Angiography

Experimentally induced retinoses are useful in that they give the possibility of studying the pathogenesis of human tapeto-retinal degeneration. Intravenous injections of sodium iodate at 20 mg/kg were chosen to intoxicate rabbits of the “Fauve de Bourgogne” variety. At varying times after the injections, the following were carried out: 1. An electroretinography study: this shows the early disappearance of the e-waves, followed by a change in the b2-wave. 2. A biochemical study: this shows a drop of the vitamin A level in the blood, which happens long after the electroretinographic changes. 3. An electronmicroscopic study: this shows early changes in Bruch’s membrane and the pigment epithelium. 4. A colour fluorescein angiographic study: this shows an abnormal distribution of the fluorescein which probably indicates perturbations in the permeability of the pigment epithelium.