PMC3638067_01
Slit lamp photograph (6A) of an elevated gelatinous corneal-conjunctival lesion with tufts of blood vessels. Ultra high resolution optical coherence tomography (UHR-OCT) image (6B) in the area of the black dotted arrow disclosed an unremarkable epithelium (6B-a) and a lesion (6B-b) confined to the subepithelial layer (6B-c). The mass was composed of small dots; which may represent cellular infiltration (6B-b). Note oval hypo-reflective areas that represent blood vessels (6B-c). Histopathologic examination of the excised specimen (6C) confirmed UHR-OCT findings of cellular infiltration, in this case of CD68 positive histiocytes (6C-a) underneath an intact appearing epithelium (6C-b), suggesting a diagnosis of conjunctival histiocytosis. (stain, hematoxylin-eosin; original magnification, X200).
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A 56-year-old female patient presented with an elevated gelatinous corneal-conjunctival lesion that had tufts of blood vessels. (Fig 6A) Based on the clinical picture a diagnosis of CCIN was made and the patient had been treated with topical mitomycin-C. UHR-OCT images (Fig 6B) were not consistent with OSSN. UHR-OCT image disclosed that epithelial layer was uninvolved (Fig 6B-a) and that the lesion (Fig 6B-b) was confined to the substantia propria and was well circumscribed. (Fig 6B-c) The body of the lesion appeared to be stippled by small hyper-reflective dots that were suggestive of an infiltration of a homogenous cell population. (Fig 6B-b) Round and oval hypo-reflective areas were also noted and were suggestive of blood vessels within the lesion. (Fig 6B-d) Histopathological examination of the specimen confirmed that the lesion was conjunctival histiocytosis; not OSSN (Fig 6C) and demonstrated close correlations to UHR-OCT images.
Slit lamp photograph (7A) of a salmon pink conjunctival lesion. Ultra high resolution optical coherence tomography (7B) indicates a normal epithelium (7B-a) and a lesion in the substantia propria (7B-b) formed of stippled dots. The lesion was hyporeflective and homogeneous in nature. Histopathologic examination (7C) discloses a monomorphous population of small to moderate sized blue cells located within the substantia propria. Flow cytometry and gene rearrangement results confirmed the diagnosis of extranodal marginal zone lymphoma. (stain, hematoxylin-eosin; original magnification, X200).
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Six patients presented with pink conjunctival lesions that were clinically suspicious for lymphoma. (Fig 7A) UHR-OCT images (Fig 7B) showed a normal epithelium (Fig 7B-a) and a lesion in the substantia propria. (Fig 7B-b) The subepithelial lesions were overall quite homogenous, hypo-reflective and dark, but seemed to be formed of stippled hyper-reflective dots. Histopathological examination, along with flow cytometry and gene rearrangement of specimens obtained from the 6 lesions (Fig 7C), disclosed a monoclonal lymphoid infiltrate located within the substantia propria confirming the diagnosis of extranodal marginal zone lymphoma.
Slit lamp photograph (9A) of a yellow-pink conjunctival lesion that was thought to be conjunctival lymphoma. Ultra high resolution optical coherence tomography in area of black dotted arrow (9B) disclosed a normal epithelium (9B-a) and hypo-reflective lesion (9B-b) present diffusely in the substantia propria intermixed with hyper-reflective linear areas (9B-c). Histopathological examination (9C) revealed paucicellular material located diffusely within the substania propria that was PAS, congo-red positive and demonstrates an apple green-birefringence (9C) with polarized light. Flow cytometry and gene studies were negative. A diagnosis of conjunctival amyloidosis was made. (stain, hematoxylin-eosin; original magnification, X100).
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Two patients presented with yellowish pink conjunctival lesions that were clinically diagnosed as conjunctival lymphoma. (Fig 9A) UHR-OCT images (Fig 9B) showed normal epithelium (Fig 9B-a) and a lesion (Fig 9B-b) present in the substantia propria. Histopathological examination of specimens disclosed conjunctiva that contained a moderate amount of paucicellular material located within the substania propria that was PAS, congo-red positive and demonstrated apple-green birefringence with polarized light (Fig 9C).
Slit lamp photograph (10A) demonstrates a pterygium. Ultra high resolution optical coherence tomography (UHR-OCT) in the area of the black dotted arrow disclosed a moderately hyper-reflective epithelium (10B-a) and a highly hyper-reflective fibrillary subepithelial lesion (10B-b). Hypo-reflective areas may correspond to blood vessels (10B-c). Histopathological examination (10C) demonstrated an unremarkable epithelium with solar elastosis within the substantia propria confirming the diagnosis of pterygium (stain, hematoxylin-eosin; original magnification, X200).
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UHR-OCT images of those lesions revealed a normal thickness epithelium with moderate hyper-reflectivity. (Fig 10B-a) The lesions seen on UHR-OCT demonstrated a highly hyper-reflective fibrillary subepithelial demarcated layer (Fig 10B-b).