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History

 

  • A 30-year-old male presents with a phthisical left eye and undergoes enucleation. He has some lesions in his right eye that are under ophthalmic surveillance.
  • Figure 1 is a low power of the enucleation.
  • Figures 2, 3 and 4 are higher power shots of the arrowed lesion in 
Figure 1.

 

 

Figure 1.

 

Figure 2.

 

Figure 3.

 

Figure 4. 

 

 

Questions

 

  1. What do Figures 2 and 3 show?
  2. What does Figure 4 show (arrow)?
  3. What is the likeliest diagnosis?
  4. Which immuno-stain will highlight the cells in Figure 4?
  5. What other history may you ask for from the clinicians?

 



 

 

 


Answers

 

1. A vascular neoplasm.
2. Foamy stromal cells between the vascular element.
3. The combination of endothelial and foamy stromal cells makes this a retinal haemangioblastoma. The stromal cells are the neoplastic element.
4. Anti-VEGF.
5. This patient has Von Hippel Lindau disease (hence the lesions in the other eye). The systemic manifestations are:
• Retina: haemangioblastoma

• Peripheral nerves: haemangioblastoma
• Kidney: cysts and renal cell carcinoma
• Pancreas: cysts, microcystic adenoma and neuroendocrine tumours
• Adrenal gland / paraganglia: phaeochromocytoma / paraganglioma
• Endolymphatic sac / duct: endolymphatic sac tumour
• Epididymis: epididymal cystadenoma• Adnexae: cystadenoma
• Other organs: cysts.

 

Further reading

  • http://emedicine.medscape.com/article/1219430-overview
  • WHO classification of tumours of the central nervous system. Third edition. IARC Press; 2007:215-7.
  • Mettu P, Agron E, Samtani S, et al. Genotype-phenotype correlation in ocular von Hippel-Lindau (VHL) disease: The effect of missense mutation position on ocular VHL phenotype. Invest Ophthalmol Vis Sci 2010;51(9):4464-70.

 

 

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CONTRIBUTOR
Hardeep Singh Mudhar

HSOPS, Histopathology, Royal Hallamshire Hospital, Sheffield, UK

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