Eye

General

Grossing & features to report



Topic Completed: 1 February 2014

Minor changes: 19 April 2021

Copyright: 2004-2021, PathologyOutlines.com, Inc.

PubMed Search: Grossing globe

Nat Pernick, M.D.
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Cite this page: Pernick N. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeglobegrossing.html. Accessed December 6th, 2021.
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
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