PMC10390264_01
(a) The fundus image was taken at the patient's first presentation for evaluation of the tumor (Zeiss FF 450+; Carl Zeiss AG, Oberkochen, Germany). Fundus imaging revealed a tumor located in the superotemporal quadrant of his right eye. The upper part of the tumor appeared salmon-pink, and the lower part was calcified. Some asteroid hyalosis was seen. (b) This fundus image was taken following three laser treatments (Zeiss FF 450+; Carl Zeiss AG, Oberkochen, Germany). (c) The fundus image taken one month prior to brachytherapy demonstrated relapse of the tumor (salmon-pink colour) (Zeiss FF 450+; Carl Zeiss AG, Oberkochen, Germany). (d) Fundus image following brachytherapy and about 2 years prior to vitrectomy showed a denser asteroid hyalosis (Optos 200Tx; Optos PLC, Dunfermline, Scotland, United Kingdom). (e) Fundus imaging captured 8 months following pars plana vitrectomy (Optos 200Tx; Optos PLC, Dunfermline, Scotland, United Kingdom).
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fig1
Fundus examination of his right eye revealed an intraocular retinal mass located in the superotemporal quadrant (Figure 1(a)). Five years following brachytherapy, when his BCVA was reduced to 0.6 due to increasing asteroid hyalosis (Figure 1(d)), he underwent pars plana vitrectomy without melphalan due to the complete regression of type 1 of the retinal tumor and type 2 of the vitreous seeding-like lesions. Atrophy of the area treated with brachytherapy was seen (Figure 1(e)).
Vitreous samples (a-d): small groups of cells, marginally larger than lymphocytes, were seen microscopically (a; HE, 200X, and 400X in the upper corner). The cells had a high nuclear-cytoplasmic ratio, circular eccentric nuclei, and condensed chromatin. The cytoplasm was slightly eosinophilic, and mitotic activity was not present. In addition, there were several eosinophilic globules, consistent with asteroid hyalosis. The "tumor" cells expressed CD56 (b; 200X), synaptophysin (c; 200X), and neuron-specific enolase (NSE). They were negative for the lymphocytic marker CD45. The proliferation index assessed with Ki67 was less than 1% (d, 400X). Collectively, the findings were consistent with regressed vitreous seeds type 2.
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fig2
The cytology of the corpus vitreous sample revealed a nontumoral cellular component and asteroid hyalosis, a few macrophages (positive for CD68), and a few retinal cells without atypia (positive for CD56 and synaptophysin (Figures 2(b) and 2(c)) and negative for CD45).