Eye
General
Grossing & features to report
Author: Nat Pernick, M.D.
Last author update: 1 February 2014
Last staff update: 19 April 2021
Copyright: 2004-2023, PathologyOutlines.com, Inc.
PubMed Search: Grossing globe
Table of Contents
Conjunctiva | Cornea | Eyelid tumors | Globe - description | Globe - sectioning | Retina tumors (retinoblastoma) | Uvea tumorsCite this page: Pernick N. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeglobegrossing.html. Accessed September 21st, 2023.
Conjunctiva
Grossing
- Specimens are thin and tend to fold when placed in fixative
- Surgeon should spread lesion onto filter paper, allow to dry for a few seconds, then place in specimen container
- Relevant landmarks should be labeled
- For lesions that extend to limbus, cut so sections are perpendicular to limbus
- Don't use methylene blue or toluidine blue ink for margins as they bleed into sample
- Don't place specimens on sponges which expand in fixative and distort specimen
Conjunctiva tumors - features to report
- Histologic type
- Degree of differentiation
- Precise anatomic location: bulbar by quadrant, palpebral (superior or inferior), fornix (superior or inferior), caruncle, plica semilunaris, limbus, cornea
- Tumor size
- Involvement of corneal stroma, episclera, orbital fat
- Involvement (noninvolvement) of other tissues present
- Margins (deep and lateral, minimum clearance)
- Presence of angiolymphatic, perineural, intraocular or intraorbital invasion
- Presence of ulceration
- For melanomas, also indicate thickness (from top of epithelium to deepest tumor cell in substantia propria using ocular micrometer) and mitotic activity
- Reference: Am J Surg Pathol 2003;27:999
Cornea
Grossing
- Don't pick up with forceps
- Bisect at center with sharp razor to see papillary excrescences or other lesions of interest
- Embed "on edge"
- Routine stains are hematoxylin & eosin and PAS (highlights basal lamina)
Cornea tumors - features to report
- Precise anatomic location - limbus by clock hour
- Histologic type
- Tumor size
- Involvement (noninvolvement) of other tissues present
- Margins (minimum clearance)
- Angiolymphatic invasion
- Presence of ulceration
Eyelid tumors
Features to report
- Precise anatomic location - upper or lower eyelid, medial or lateral canthus
- Histologic type and differentiation
- Tumor size(s) and gland of origin (Meibomian vs. Zeis)
- Presence of infiltrative growth pattern
- Presence of pagetoid spread
- Involvement (noninvolvement) of other tissues present
- Margins (minimum clearance); includes conjunctival margins and resection margin of optic nerve if specimen includes the globe
- Angiolymphatic invasion
- Perineural invasion
- Presence of ulceration
- For melanomas, indicate thickness and mitotic activity
Globe - description
Grossing
- Measure dimensions of the eye (anterior-posterior, horizontal, vertical)
- Measure length and diameter of optic nerve
- Measure cornea in mm (horizontal and vertical and anterioposterior)
- Look for sites of trauma (accidental or surgical)
- Examine eye surface for gross evidence of extraocular extension of tumor
- Describe the following:
- Corneal clarity
- Shape and diameter of pupil
- Color of iris, lesions
- Presence of lens
- Anterior chamber depth, configuration of anterior chamber angle
- Condition of ciliary body, lens, choroid, retina, vitreous body, optic disc
- Presence of foreign bodies (in traumatic specimens)
- For tumors, describe location, dimensions, shape, ulceration, color, consistency, hemorrhage, necrosis, calcification, ocular structures involved, extension into optic nerve, tumor distance to optic nerve and limbus, rupture of Bruch membrane
- Transillumination findings
Globe - sectioning
Grossing
- Enucleation: globe and part of optic nerve are removed from orbit
- For retinoblastoma, may need fresh tissue for genetic studies:
- Identify tumor location by transillumination
- Submit optic nerve margin separately before cut into globe
- Cut small window in sclera overlying tumor and obtain small tumor sample
- Try to avoid seeding of tumor cells onto optic nerve or elsewhere
- Fix in formalin (300 ml of 10% neutral buffered formalin) for 24 - 48 hours before sectioning
- Do not open or puncture the eye
- Wash in running tap water for 5 - 15 minutes
- Optionally place in 60 - 70% ethyl alcohol for 1 - 2 hours (firms up eye and restores color of vessels)
- Review clinical history and results of ophthalmologic examination prior to sectioning
- "Temporal" is same as lateral; "nasal" is same as medial
- Orient globe based on:
- Cornea is wider than tall by 1 mm
- Optic nerve distance to limbus (junction of cornea and sclera) is less medially than laterally (i.e. optic nerve is medial (nasal) to posterior pole)
- Superior oblique muscle tendon inserts in upper outer quadrant of posterior globe behind superior rectus muscle insertion and insertion points towards anterior nasal eye
- Inferior oblique muscle has muscular insertion in lower outer (temporal) quadrant of sclera and fibers run posteriorly and medially
- Long posterior ciliary arteries are in horizontal plane
- Four vortex veins exit posterior sclera
- Transilluminate globe to find tumor and cut accordingly
- Can use a substage microscope lamp in a dark room
- Rotate globe over light, mark abnormal shadows on sclera with indelible pencil
- Take Xray before opening globe if foreign body or retinoblastoma is suspected
- If choroidal melanoma is suspected, sample at least one vortex vein from each of four quadrants and submit separately
- Central section is called "pupil-optic nerve" section; other fragments are called calottes
- Try to include optic nerve, pupil, cornea, lens and large cut surface of tumor in same section, about 8 mm thick
- Use sharp razor to cut, holding globe with nondominant hand, cornea down against cutting block using blade between thumb and middle finger of dominant hand
- Open eye with sawing motion from back (adjacent to optic nerve) to front (1 mm inside limbus through peripheral cornea)
- If no tumor, cut globe at superior and inferior edges of iris in horizontal plane from back to front (5 mm above and below the optic nerve, missing the lens)
- Quick freeze first in liquid nitrogen to minimize artifacts
- Obtain cross section of optic nerve
Retina tumors (retinoblastoma)
Features to report
- Tumor location
- Number, size and location of lesion(s)
- Differentiation (poorly differentiated, Flexner-Wintersteiner rosettes, Homer-Wright rosettes, fleurettes)
- Growth pattern (diffuse, unifocal, multifocal)
- Extraocular extension or choroidal invasion
- Presence or absence of vitreous seeding
- Presence of absence of retinal detachment
- Invasion into optic nerve (prelaminar, to lamina cribrosa, retrolaminar, posterior resection margin)
- Involvement or noninvolvement of other structures submitted
- Margins (minimum clearance)
- Angiolymphatic invasion
- Tumor necrosis, calcification, DNA deposition around blood vessels, anterior chamber seeding, retinal or iris neovascularization
Uvea tumors
Features to report
- Histologic type
- Cell types present (for melanomas)
- Precise anatomic location (iris, ciliary body, choroid), relative to clock hour
- Tumor size
- Extraocular extension
- Growth pattern (diffuse, ring, focal)
- Dimension of largest diameter in contact with sclera
- Color of surface lesion and cut surface of lesion
- Involvement or noninvolvement of other structures present
- Margins (minimum clearance)
- Mitotic figures per 40 high power fields
- Presence of absence of 100 tumor infiltrating lymphocytes per 40 high power fields
- Presence of matrix rich microcirculation associated loops, networks or parallel with cross linking structures
- Angiolymphatic invasion
- Presence of retinal detachment or hemorrhage
- Involvement of intrascleral emissary channels
- For melanomas, indicate thickness and mitotic activity, color of surface lesion
- Other features present: drusen, neovascularization, nevi, etc.
- Reference: Arch Pathol Lab Med 2001;125:1177
