S. Ry Andersen

BENIGN MUCOUS MEMBRANE PEMPHIGOID

Conjunctival biopsy specimens were taken from the inferior fornix of 16 eyes affected with benign mucous membrane pemphigoid (BMMP). Biopsy revealed in all cases metaplasia changing the normal columnar epithelium into squamous epithelium, with parakeratinization in eight specimens and keratinization as well, in four. Correlation was noticed between keratinization and reduced secretions of both tears and mucus.

Late complications of biopsy in intraocular tumors.

The diagnosis of an intraocular malignant tumor may be very difficult or impossible by clinical methods and the question of performing an intraocular biopsy is naturally raised. Intraocular biopsy has been used since 1868 (Hirschberg) but only in a few cases of tumors of the choroid. As far as we know a follow-up of biopsied cases has never been done. As for the cases of intraocular biopsy published before, the reader is referred to a paper in 1954 by one of us (S. R. A.). In recent years only a few cases have been added. Sunders (1953) made an intraocular biopsy in 3 cases of malignant melanomas of the choroid followed by enucleation three days after the operation. The tumors were of the cell types spindle B., mixed and epithelioid respectively. 2 of the patients died from metastases 2 and 3 years after the enucleation, the 3rd was not followed. Sanders also made a biopsy in 2 cases of neurofibromas. His technique was a sclerotomy or trepanation. Sunders concluded that the value of biopsy in tumors of the ciliary body and choroid is limited, but may be indicated in one-eyed individuals or unusual clinical cases and in patients demanding a histological diagnosis before enucleation. Christensen & Rowen (1955) found a high incidence of free-floating tumor cells in the subretinal fluid in globes with retinal detachment secondary to malignant melanoma. They do not recommend this method because of danger of extraocular extension of unrecognized tumors through the puncture. Other

Spontaneous regression of a malignant melanoma of the choroid.

A 65‐year‐old man had for 12 years a lesion in the right eye, clinically atypical of a melanoma. The lesion and function of the eye was unchanged during the 12 years. Since a melanoma seemed clinically most probable the eyeball was enucleated. Histopathological examination revealed a choroidal lesion with incipient invasion of the sclera, abundant fibrosis, calcifications and scattered neoplastic melanocytes, confirmed by electron microscopy. There was no necrosis and no inflammatory reaction. The diagnosis and the cause of regression are discussed, and it is concluded that this case represents a true spontaneous regression of a primary malignant melanoma of the choroid.

RETINOBLASTOMA WITH NECROSIS OF CENTRAL RETINAL ARTERY AND VEIN AND PARTIAL SPONTANEOUS REGRESSION

A case of partial spontaneous regression of retinoblastoma in one eye and fatal retinoblastoma in the other eye is described. In the spontaneously regressed retinoblastoma, necrosis of the central retinal artery in the lamina cribrosa and necrosis of the central retinal artery and vein in the disc were demonstrated. No DNA deposits were established in the haematoxyphilic retinal vessels, some of which were thrombosed. The most likely explanation of the spontaneous regression is that the tumour had grown out of its vascular supply with secondary necrosis of the tumour and haemorrhage on the disc followed by necrosis of the central retinal vessels. An inflammatory reaction in the necrotic tumour tissue might be the cause of the simultaneous rhinitis and pleuritis. An immunological reaction in the tumour or a primary inflammation outside the eye causing the panophthalmitis have also been considered.

JUVENILE XANTHOGRANULOMA OF THE CORNEA AND CONJUNCTIVA

Juvenile xaiithogranuloma is a benign disease which has been known by the name of naevoxanthoendothelioma in dermatology since the beginning of this century. The lesions manifest themselves on the skin as single or multiple efflorescences ranging in size from 8-2 cm. As a rule they are elevated, but may be quite flat. Most often they affect the head, but may be seen also on the trunk and limbs. The signs may be present at birth or may appear during early childhood. They remit spontaneously in the course of months or years. As an accidental autopsy finding, Helwig & Hackney ( 1 ) observed involvement of the testes, dura. and lungs in a child who had died of another cause. Ocular manifestations were demonstrated for the first time in the American Ophthalmic Pathology Club in 1948 by Fry, and in 1949 his case was published by Blank, bglick & Beernzan ( 2 ) . The patient was a 4-month-old boy with a nodule in the iris and elevated tension. The eye was enucleated because of a suspicion of primary sarcoma, and the diagnosis was not made until 3 months later when skin manifestations appeared. Comparison of the microscopic appearances of a skin biopsy and of the eye showed complete identity. Xanthogranuloma has later been found in the eyelids, orbit, and conjunctiva, in a few cases encroaching on the cornea. In 1965 Zimmerman ( 3 ) published a review on the ocular pathology on the basis of all cases known to the Registry of Ophthalniic Pathology, Washington, D. C., a total of 53. Of these 32 had

TUMOURS OF THE EYE AND ITS ADNEXA

A survey from the Eye Pathology Institute and the Ophthalmological Tumour Centre, Copenhagen, of the present position of diagnosis and treatment of some of the more important tumours and tumour‐like lesions of the eye and its adnexa.

ACCESSORY OUTER SEGMENT, A RE-DISCOVERED CILIUM-LIKE STRUCTURE IN THE LAYER OF RODS AND CONES OF THE HUMAN RETINA

A separate cilium-like structure lying along the outer segment of the visual cells was found in the retina of various teleostean fishes by Engstrom (19611, who called it the accessory element. Electron microscopic studies of fishes have shown that this thread-shaped element which originates from the outer edge of the ellipsoid close beside the base of the connecting cilium is probably a modified cilium (Engstriini 1962 and private communication). In accordance with this finding Engstrom now calls this structure the accessory outer segment; the outer part of the accessory outer segment is inserted into a retinal pigment epithelium cell. According to Engstrom (1962) visual cells possessing an accessory outer segment may possibly have originated from embryonic cells with two cilia, one of which develops into the outer segment, the other into the accessory outer segment. The accessory outer segment has also been recognized in the pure-rod retinae of two deep-sea fishes (Munk) (fig. 1). This thread-shaped element has apparently also been recognized by the older anatomists. Furst (1904) briefly states that a thread originates from the

TUBERCULOUS DACRYOCYSTITIS AND LUPUS OF THE NOSE DIAGNOSED AS BOECK'S DISEASE*)

A girl, aged 15 (case rec. No. 397J46), who had so far been healthy apart from convergent strabismus with a resultant left-sided amblyopia, was treated at the out-patients’ department in 1943 for a phlyctenular conjunctivitis which yielded to Pagenstecher’s ointment. After that the patient was in good health until Oct. 1945 when she got a left-sided dacryocystitis with intermittent secretion of pus. Probing, irrigation with a solution of lucosil, and lucosil tablets were tried with no avail. A retention persisted although the irrigation met no resistance. Otherwise the patient was symptomless, and she had never before suffered from phlegmonous affection of the lacrimal passages. Admitted to the Department in September 1946.

HISTOPATHOLOGY IN BOTRYOMYCOSIS-LIKE PANOPHTHALMITIS DUE TO STAPHYLOCOCCUS AUREUS. A LIGHT MICROSCOPIC AND ELECTRON MICROSCOPIC STUDY:A Case Report

A Swedish farmers wife aged 46 developed a unilateral panophthalmitis 6 weeks after a visit to Gambia in Africa. Vitreous puncture revealed growth of Staphylococcus aureus, but in spite of adequate treatment the eye had to be enucleated 5 weeks after the onset of symptoms. Gram‐positive microorganisms in botryomycosis‐like granules in the vitreal abscesses were at first suspected to be Histoplasma capsulatum. Electron microscopic examination revealed microorganisms, consistent with staphylococci. There was extensive proliferation of mesosomes, most probably due to the intense treatment. The poor nutrition and slow resorbtion of the dead microorganisms from the avascular vitreous did possibly also play a part in the proliferation of the mesosomes.

MALIGNANT MELANOMA OF THE CONJUNCTIVA WITH A METASTASIS TO THE CHOROID

The patient was a female, aged 35, who for the last 5 years or so had been aware of a small reddish nodule at the edge of the cornea on her left eye. It had only embarrassed her slightly and its growth was extremely slow. An examination at the Eye Department of the Finsen Institute in July 1946 revealed nothing abnormal except a small, reddish, fairly vascularized tumour at the limbus on the temporal side, overlapping the cornea on a short space. No pigment was demonstrable in the tumour or in the conjunctiva on the whole. Biopsy from the tumour revealed na naevus tumour presumably in a state of beginning malignant proliferation(( (Fridt jof Bung, M. D.). There was melanotic pigment in places. I t did not react to Berlin blue, but turned black when stained with silver. Otherwise the examination of the eyes revealed normal conditions. Ophthalmoscopy natural. Two and a half months later the patient submitted to enucleation. At that time the tumour was unchanged and X-ray of the lungs showed no signs of metastases.