Cellular Histopathology
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Goblet Cells
Goblet cells in conjunctiva
- Mucin-secreting cell found mostly in conjunctival epithelium in the fornices and the plica semilunaris
- Resembles a goblet
- Cup: apical portion with many mucin granules that do not stain with H&E
- Stem: basal portion without mucin granules that stains with H&E
- An increased number of goblet cells in the conjunctival epithelium signifies that you are further away from the limbus.
Immune Cells
Pyogenic granuloma specimen with multiple inflammatory cells including PMNs
- Polymorphonuclear leukocyte (PMN)= neutrophil
- Multi-lobed nuclei and intracytoplasmic granules
- Key player in acute-phase bacterial infections
- Function through phagocytosis and degranulation of digestive enzymes
- Degranulation enzymes destroy pathogen as well as normal surrounding tissue
- Basophil
- Basophilic intracytoplasmic granules that often obscure visualization of the nucleus
- Phagocytic
- Granules contain histamine and serotonin
- Involved in anaphylaxis
- Mast cells: basophils that have entered the tissue and no longer have segmented nuclei
Eosinophils in a pseudotumor specimen
- Eosinophil
- Heart-shaped bilobed nuclei with eosinophilic intracytoplasmic granules
- Involved in parasitic infections and chronic allergies
- Steroids and stress decrease number of eosinophils
- Present in chronic inflammation, such as in sympathetic ophthalmia
Pyogenic granuloma specimen with multiple inflammatory cells including monocytes
Macrophages
- Monocyte
- Kidney-shaped or indented nucleus
- Function through phagocytosis, antigen presentation to T cells, and cytokine production
- Macrophages: monocytes that have migrated into tissue, AKA histiocytes
- Eccentric nuclei with abundant cytoplasm
- Epithelioid histiocytes: subset of histiocytes that resemble epithelial cells with distinct cell borders
- Can merge to form a multinucleated giant cell and granulomas with or without central necrosis
Pyogenic granuloma specimen with multiple inflammatory cells including lymphocytes
Plasma cells
Russell bodies
- Lymphocyte
- 90% nucleus with scant cytoplasm
- Found in viral infections and chronic inflammatory processes
- Cannot differentiate between B and T cells with routine histology
- T cells: cell-mediated immunity
- B cells: antibody-mediated immunity
- Plasma cells: differentiated antibody-producing B lymphocyte
- Eccentric nucleus with clock-face chromatin
- Now 2/3 of cell is cytoplasm
- Russell body: plasma cell that is filled with antibodies and the nucleus has been pushed out
- Sign of really chronic inflammation
- Plasma cells: differentiated antibody-producing B lymphocyte
Blood smear with immune cells
Giant Cells
- Syncytium of merged epithelioid histiocytes with multiple nuclei
Multinucleated Langhans giant cell
Multiple Langhans giant cells
- Langhans: horseshoe-shaped arrangement of nuclei
- Often present along with other inflammatory cells
- Example: inflammatory contents of a chalazion
Touton giant cell
- Touton: cell has a peripheral ring of nuclei as well as a clear lipid halo
- Associated with juvenile xanthogranulomas, a rare inflammatory condition in children of the skin or uvea with lipid-laden histiocytes, lymphocytes, Touton giant cells, and some eosinophils
Foreign body giant cell
Foreign body giant cell with a suture
- Foreign body: haphazard arrangement of nuclei
- Found around sutures and other foreign bodies
Granulomatous Reactions
- Inflammatory reaction mediated by epithelioid histiocytes
- Can have autoimmune, foreign body, drug-related, or neoplastic etiology
Diffuse granulomatous reaction in Sympathetic Ophthalmia
- Diffuse: distributed infiltration of epithelioid histiocytes along with lymphocytes and plasma cells
- Example: Sympathetic ophthalmia, an autoimmune reaction that occurs 10-14 days following a severe trauma to the fellow eye.
- Treat with steroids
- Example: Sympathetic ophthalmia, an autoimmune reaction that occurs 10-14 days following a severe trauma to the fellow eye.
Nodular granulomatous reaction in Sarcoidosis
Giant cell with Asteroid Body
- Nodular/Discrete (sarcoidalor tuberculoidal): multiple nodules of inflammation that contain bizarre-looking giant cells with asteroid bodies and are surrounded by lymphocytes
- Example: Sarcoidosis, which is characterized by non-caseating (lack central necrosis) granulomas.
- Most common manifestation of sarcoidosis in the eye is uveitis
- Example: Sarcoidosis, which is characterized by non-caseating (lack central necrosis) granulomas.
Focal granulomatous reaction around foreign body vegetation
Large area of central necrosis around lens capsule remnants
- Focal or Zonal: inflammation centered around a particular focal point
- Example: Traumatic rupture of the lens capsule causes inflammation around the lens capsule remnants
Bacteria
Gram-positive bacteria
- Cause of infection in various ocular tissues
- Categorized into gram-positive and gram-negative
- Gram-positive:bacteria with peptidoglycan cell wall stains purple with Gram stain
- Gram-negative: bacteria without thick peptidoglycan cell wall stains red with Gram stain
- Acid-fast, or Ziehl-Neelsen, stain used to identify certain bacteria in which Gram stain does not work well
- Specifically stains lipid cell walls in certain bacterial species, such as mycobacteria
- Also categorize by shape
- Cocci: round
- Bacilli: rod
- Coccobacilli: shape between round and rod
- Can also categorize by aerobic or anaerobic and by certain enzymes (catalase, oxidase, urease, etc.)
- Important prefixes
- Staphylo-: grape-like clusters
- Strepto-: chain-like
- Bacterial pathogens seen in ocular pathology
- Staphylococcus aureus: gram-positive round-shaped bacteria in clusters found in skin flora
- Streptococcus: gram-positive chain of round-shaped bacteria
- Streptococcus pneumoniae: diplococci commonly found in Meningitis, Otitis media, Pneumonia, and Sinusitis (MOPS)
- Haemophilus influenzae: gram-negative coccobacilli with some serotypes that have a polysaccharide capsule
- Pseudomonas aeruginosa: gram-negative bacilli
- Chlamydiae:gram-negativeobligate intracellularbacteria
- Chlamydiae trachomatis: cause of trachoma
- Mycobacteriumtuberculosis: acid-fast bacilli which creates necrotizing granulomatous inflammation
- Clostridium: gram-positive, obligate anaerobic, endospore-forming bacilli
- Bacteroides: gram-negative, obligate anaerobic, nonendospore-forming bacilli found in gastrointestinal flora
- Klebsiella: gram-negative bacilli found in mucosal flora
- Proteus: gram-negative, urease-positive bacilli common in nosocomial urinary tract infections
Fungal Elements
Fungal hyphae in corneal specimen
- Multicellular pathogen seen in infections of several ocular tissues
- Infections typically occur in immunocompromised patients
- Stains silver with GMS stain
- Better able to penetrate through Descemet membrane than bacterial infections
- Hyphae: long filaments that form the structure of fungi
- May be septate or aseptate
- Dimorphic fungi
- Part of life cycle spent in filament form with hyphae
- Part of life cycle as spherules of endospores which typically infect humans when inhaled
- Fungal pathogens seen in ocular pathology
- Candida: yeast that is found in the normal flora of mucous membranes
- Mucormycosis: hyphae grow in and around vasculature, particularly in patients with poorly-controlled diabetes mellitus
- Reaches orbit through contiguous spread from maxillofacial sinuses
- Aspergillus: septated hyphae with 45° branching pattern found in immunocompromisedpatients
- Spread from adjacent sinuses
- Cryptococcus neoformans: yeast with mucicarmine-positive mucopolysaccharide capsule that causes multifocal necrosis with little inflammation in immunocompromised patients
- India ink stain allows for easy visualization in cerebral spinal fluid
- Coccidiomycosis: dimorphic fungi that produces necrotizing granulomasin immunocompromised patients
References:
Harper RA. Basic Ophthalmology. Amer Academy of Ophthalmology; 2010.
Yanoff M, Fine BS. Ocular Pathology, A Text and Atlas. Lippincott Williams & Wilkins; 1989.