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Ultrasound Images

Posted on May 9, 2016

3D ultrasound
3D ultrasound used to create topographic renderings of choroidal melanoma regression after palladium-103 plaque radiation therapy

3D ultrasound demonstrates the back of the plaque
3D ultrasound demonstrates the back of the plaque and the tumor in different planes of section.

3D ultrasound generated topographic map
3D ultrasound generated topographic map of a juxtapapillary melanocytoma

Brawny scleritis
Brawny scleritis - 10 MHz B-scan ultrasound reveals thickening of the sclera and vitreous cells (arrow).

Choroidal Hemangioma
Choroidal Hemangioma - Moderately high internal reflectivity and a "dome" shape are typically revealed by ultrasound imaging of choroidal hemangioma.

Choroidal hemangioma
Choroidal hemangioma - A-scan reveals high internal reflectivity within the tumor (arrow).

Choroidal hemangioma
Choroidal Hemangioma- A-scan image reveals characteristically high internal reflectivity (arrow) and an apical height of 5.2 mm.

Choroidal hemangioma
Choroidal Hemangioma- 10 MHz B-scan of a circumscribed choroidal hemangioma reveals the hyperechoic - highly reflective tumor

Choroidal Hemorrhage
Choroidal Hemorrhage- Interactive 3D ultrasound imaging is particularly helpful in evaluation of disorganized eyes.

Choroidal Melanoma
Choroidal Melanoma: Left, a slit lamp photograph demonstrates the anterior edge of the choroidal melanoma. Right, a corresponding 10 MHz B-scan reveals a large choroidal melanoma beneath a closed funnel retinal detachment.

Choroidal melanoma
Choroidal melanoma - 3D ultrasound demonstrates retrobulber extrascleral tumor extension (arrow) in both axial and coronal sections.

Choroidal melanoma
Choroidal Melanoma- 10 MHz B-scan reveals a collar button shpaed choroidal melanoma beneath an open funnel retinal detachment.

Choroidal melanoma
Choroidal Melanoma- 10 MHz B-scan ultrasound reveals choroidal excavation (arrow) at the base of this melanoma.

Choroidal melanoma
Choroidal melanoma- Collar button also called mushroom shaped

Choroidal melanoma
Choroidal melanoma- Dome shaped with secondary retinal detachment (3D ultrasound reconstruction)

Choroidal melanoma
Choroidal melanoma- Dome shaped with retinal detachment. Low internal reflectivity seen on interpolated A-scan (arrow).

Choroidal melanoma
Choroidal Melanoma- 10 MHz B-scan reveals a mushroom shaped choroidal melanoma beneath a total retinal detachment.

Choroidal melanoma
Choroidal melanoma- 10 MHz B-scan reveals a mushroom shaped tumor extension (arrow).

Choroidal metastasis 10 MHz B-scan
Choroidal metastasis 10 MHz B-scan image. Note the irregular surface, overlying retinal detachment, and variable internal reflectivity.

Choroidal osteoma
Choroidal osteoma and its associated orbital shadowing (arrow).

Ciliary body melanoma
Ciliary body melanoma - 20 MHz B-scan demonstrates the relatively hypoechoic tumor with no extension through the iris.

Ciliary body melanoma
Ciliary body melanoma - note the iris displacement and erosion of the iris pigment epithelium (arrow).

Ciliary Body Melanoma
Ciliary Body Melanoma- 20 MHz B-scan reveals a collar-button shaped ciliary body melanoma (this technique is used to measure tumor size).

Ciliary body melanoma
Ciliary body melanoma (T) with extrascleral extension (E) 20-MHz ultrasound- Note the thinning of the highly reflective sclera

Ciliary body melanomas
Ciliary body melanomas and how they can affect their anterior segment. Left: disinsertion of the iris root, Middle: Mass effect pushing the iris anteriorly, Right: erosion of the iris pigment epithelium.

Epibulbar Conjunctival Cyst
Epibulbar Conjunctival Cyst - 35 MHz High frrequency ultrasound (see conjunctival tumor images for correlation).

Epibulbar squamous carcinoma
Epibulbar squamous carcinoma 20 MHz B-scan- There is no evidence of intraocular invasion (blunting of the angle or thickening of the ciliary body and uvea).

Eyelid Hydrocystoma
Eyelid Hydrocystoma - Left, a slit lamp photograph demonstrates a pigmented hydrocystoma (simulating a melanoma). Right, a 20 MHz high frequency ultrasound demonstrates that it is cystic.

Hemorrhagic choroidal detachment
Hemorrhagic choroidal detachment - 3D ultrsound reveals a diagnostic blood - serum level (arrow)

Infiltrative choroidopathy
Infiltrative choroidopathy (10 MHz ultrasound) - Note the choroidal thickening (arrow), also widening of the optic nerve shadow and papilledema.

Iridociliary melanoma (20 MHz ultrasound)
Iridociliary melanoma (20 MHz ultrasound) - Note the low-reflective tumor extending into the supraciliary space.

Iridociliary melanoma
Iridociliary melanoma - 20 MHz B-scan reveals a hypoechoic tumor filling the angle and supraciliary space, with posterior displacement of the iris pigment epithelium.

Iris Melanocytoma
Iris Melanocytoma - 20 MHz B-scan reveals a relatively hyperechoic iris tumor. Note the tumor extends into the ciliary body and obscures the iris pigment epithelium.

Iris Melanoma
Iris Melanoma - 20 MHz B-scan reveals a hypoechoic tumor extending through the iris pigment epithelium (arrow).

Iris Melanoma
Iris Melanoma - High frequency (50 MHz) image- Note hypo-echoic tumor eroding through (arrow) the iris pigment epithelium.

Iris Melanoma
Iris Melanoma - 20 MHz B-scan demonstrates how the tumor (T) can break through and destroy the hyperechoic iris pigment epithelium (IPE).

Iris Melanoma
Iris melanoma (50 MHz ultrasound image)- Note the low reflective tumor has broken through the iris pigment epithelium (arrow).

Iris Pigment Epithelial Cyst
Iris Pigment Epithelial Cyst - This unusual pupillary cyst (left) is demonstrated to be acoustically hollow on a transverse 20 MHz B-scan examination (right).

Iris stromal cyst (50-MHz ultrasound)
Iris stromal cyst (50-MHz ultrasound) - Not that the iris stroma has been obliterated and the pigment epithelium is displaced posteriorly.

Metastatic choroidal tumor
Metastatic choroidal tumor - Wilm`s origin, note the variable internal tumor reflectivity and retrobulbar edema (arrow).

Neuroepithelial iris cyst
Neuroepithelial iris cyst - High frequency 50 MHz ultrasonography demonstrates the cyst (at the iris root) anteriorly displacing the iris stroma causing focal angle closure.

Orbital Hemangioma
Orbital Hemangioma - 10 MHz B-scan reveals a relatively low reflective ovoid intraconal tumor in contact with the optic nerve.

Orbital Lymphoma
Orbital Lymphoma - 3D ultrasound is used to display this retrobulbar lymphoma (arrow) in two planes of section.

Pearl cyst
Pearl cyst - High frequency 50 MHz B-scan ultrasound reveals 3 cyst layers.

Retinal Detachment
Retinal Detachment - 3D ultrasound can be used to create and scroll through successive coronal sections of a retinal detachment (in evaluation of subretinal traction:tumors).

Retinoblastoma
Retinoblastoma - high frequency ultrasound of anterior extension

Retinoblastoma
Retinoblastoma- Large tumor as seen in a 3D ultrasound block demonstrates calcium (arrows).

Squamous carcinoma with intraocular invasion
Squamous carcinoma with intraocular invasion - Note the blunted angle (arrow).

3D ultrasound of a retinoblastoma
Three-dimensional ultrasound of a retinoblastoma. Note the calcifications (arrows) within the tumor [T}. The optic nerve [ON] is not involved.

Retinoblastoma: Pathology Photographs of Whole Eye

Posted on May 9, 2016

Retinoblastoma associated iris neovascularization
Retinoblastoma associated iris neovascularization (low and high power). Courtesy of Tatyana Milman, MD

Retinoblastoma
Both gross and histopathologic images of retinoblastoma invading the optic nerve. Images courtesy of Tatyana Milman, MD

Retinoblastoma cells
Retinoblastoma cells. I high power photomicrograph courtesy of Tatyana Milman, MD

A clump of retinoblastoma cells
A clump of retinoblastoma cells located beneath the retinal pigment epithelium. Photomicrograph courtesy of Tatyana Milman, MD

Retinoblastoma with both endophytic and exophytic
Photograph reveals a retinoblastoma with both endophytic and exophytic growth patterns (Courtesy of Tatyana Milman, MD)

Retinoblastoma
Exophytic growth pattern, beneath total retinal detachment (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Massive Choroidal Invasion (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Stage T2b with clumps of vitreous cells courtesy of Tatyana Milman, MD

Retinoblastoma
Invasion of the optic nerve is noted. Photomicrograph courtesy of Tatyana Milman, MD

Retinal Tumors

Posted on May 9, 2016

Advanced retinoblastoma
This type of advanced retinoblastoma with orbital findings is unusual in the developed world and continues to be a therapeutic challenge.

Astrocytic hamartoma
Astrocytic hamartoma - Nodular and calcific.

Bear Tracks
Bear Tracks - Congenital hypertrophy of the retinal pigment epithelium (CHRPE) in a patient with colonic polyposis.

Cavernous Hemangioma
Note the multinodular retinal vascular tumor. Early phase fluorescein angiography reveals layered fluid levels within the macro aneurysmal dilated blood vessels. Courtesy of Dan Adelberg MD, Photographs taken by Robert Ramsay, COA.

Coat`s Disease
Coat`s Disease - Adult variant with intraretinal microangiopathy surrounded by lipid exudation

Combined hamartoma of the retinal pigment epithelium

Combined hamartoma of the retinal pigment epithelium
Combined hamartoma of the retinal pigment epithelium (RPE).

Hypertrophy of the retinal pigment epithelium
Hypertrophy of the retinal pigment epithelium - Flat, black with peripheral halo (arrow)

Myelinated Nerve Fibers
Myelinated Nerve Fibers at the optic nerve

Retinal adenoma
Retinal adenoma - Juxtapapillary tumor with dark coloration and pod-like extensions.

Retinal and Optic Nerve Leukemia
Retinal and Optic Nerve Leukemia (Infiltrates with Hemorrhage)

Retinoblastoma
Note this tumor extends both beneath the retina (exophytic) and into the vitreous (endophytic).

Retinoblastoma
Endophytic tumor extends from the retina into the vitreous.

Retinoblastoma
Tumor almost fills the anterior segment as to form a pseudo-hypopyon.

Retinoblastoma endophytic without seeds
Retinoblastoma endophytic without seeds - RetCam Image

Retinoblastoma invading the optic nerve
Retinoblastoma invading the optic nerve on histopathologic section.

Retinoblastoma Leukocoria
Retinoblastoma Leukocoria - Exophytic tumor causing a total retinal detachment.

Retinoblastoma leukocoria
Retinoblastoma leukocoria - "white pupil" - The tumor has filled the eye.

Retinoblastoma seeds
Retinoblastoma seeds - multiple fine seeds seen over the surface of a large endophytic tumor.

Retinoblastoma seeds on the iris
Retinoblastoma seeds on the iris (arrows) - Multiple white seeds have migrated onto the iris surface suggesting ciliary body involvement.

Retinoblastoma with orbital extension
Retinoblastoma with orbital extension - External photograph of a child prior to enucleation.

Retinoblastoma with vitreous seeds
Retinoblastoma with vitreous seeds - A medium sized endophytic retinoblastoma.

Retinoblastoma with vitreous seeds
Retinoblastoma with vitreous seeds - Ultrasound correlation.

Retinoblastoma
Extrascleral and optic nerve extension as seen on histopathologic section.

Von Hippel angioma
von Hippel angioma - Note the dilated feeder and draining retinal vessels.

Radiographic Images

Posted on May 9, 2016

Optic nerve sheath meningioma
Optic nerve sheath meningioma (arrow head)- Computed radiographic tomography (CT).

Sclerosing pseudotumor
Sclerosing pseudotumor - CT coronal image - nasal orbit- Note the irregular tumor margins.

Sarcoma
Sarcoma - Soft tissue sarcoma arising from the sclera- Magnetic resonance imaging T2 - dark (see arrow)

Rhabdomyosarcoma
Rhabdomyosarcoma as seen on Magnetic Resonance Imaging (MRI)

Rhabdomyosarcoma
Rhabdomyosarcoma as seen on computed radiographic tomography (CT).

Retinoblastoma
Retinoblastoma - Computed radiographic tomography demonstrates calcium (arrow) within a large intraocular retinoblastoma

Retinoblastoma
Retinoblastoma - Computed radiographic tomography (CT) demonstrates unilateral buphthalmos and bilateral intraocular calcifications.

Pinealoma associated with a bilateral retinoblastoma

PET:CT image
PET:CT image demonstrates an isolated liver metastasis (arrow)

Orbital hemangioma
Orbital hemangioma - A relatively large intraconal tumor seen on axial and coronal CT images.

Adenoid cystic carcinoma
Adenoid cystic carcinoma of the lacrimal gland (arrow).

Metastatic choroidal melanoma
Metastatic choroidal melanoma - Total body PET:CT puts the form of spiral CT and the function seen with positron emission tomography on the same diagnostic page.

Malignant Lymphoma
Malignant Lymphoma involving the orbit, sclera and choroid (arrow) prior to radiation therapy

Magnetic resonance imaging
Magnetic resonance imaging (T2), demonstrates an nasal orbital lymphoma with subcutaneous extension (arrows).

Liver metastasis
Liver metastasis - Computed axial tomography CT reveal multiple hypodense tumors (arrows).

Infantile hemangioma
Infantile hemangioma - MRI image of tumor in the supero-temporal orbit (H).

Ethmoidal mucocele
Ethmoidal mucocele - Magnetic resonance imaging (MRI) demonstrates an ethmoidal mucocele (M) displacing the optic nerve.

Enucleation Implant
Enucleation Implant - Computed radiographic tomography reveals the hyperdense (PMMA) spherical implant within the muscle cone of the left orbit.

Choroidal Melanoma
MRI SAGITTAL SECTION demonstrates massive extrascleral tumor extension (T).

Choroidal Melanoma
Choroidal Melanoma - MRI CORONAL section demonstrates massive extrascleral tumor extension (T).

Radiation Images

Posted on May 9, 2016

3D ultrasound
3D ultrasound demonstrates the relative position of an eye plaque utilizing a coronal section at the posterior plaque surface.

A graph of the relative dose distribution
A graph of the relative dose distribution from a single iodine-125 versus palladium-103 seed.

Choroidal Melanoma
Hemorrhage (arrows) and ghost vessels are seen on the retinal surface of a juxtapapillary melanoma (4 years after treatment with palladium-103 plaque therapy). Note there is no significant radiation maculopathy.

Choroidal Melanoma
Choroidal Melanoma - Radiation retinopathy findings including, retinal hemorrhages, exudates, and ghost vessels.

COMS gold eye plaque
COMS gold eye plaque with COMS-type silicone insert filled with iodine-125 seeds.

COMS plaque components
COMS plaque components - seeds, insert and gold plaque

COMS plaque
COMS plaque with palladium-103 seeds in acrylic

COMS style ophthalmic plaques
A set of COMS style ophthalmic plaques

COMS type eye plaque
COMS type eye plaque - Left shows back surface, middle reveals inner surface, right is a silicone seed holder (insert)

COMS type gold eye plaque
COMS type gold eye plaque with new Seed-Guide insert, currently holding 3 iodine-125 seeds.

Cystoid macular edema
Cystoid macular edema can tumor or radiation therapy induced.

4-lights around a choroidal melanoma
Diode lights attached to an eye plaque demonstrate 4-lights around a choroidal melanoma.

Early radiation retinopathy
Cotton wool spots and intraretinal hemorrhages are signs of early radiation retinopathy.

Plaque block radiation (black) on x-ray film
The gold backing and side walls of the plaque block radiation (black) on x-ray film

Shift in radiation fields
Graphic demonstrates the shift in radiation fields for proton treatment of anterior versus posterior choroidal melanoma

The relative radiation distribution of proton versus plaque radiation
Graphic of the relative radiation distribution of proton versus plaque radiation for an anterior T2:medium sized choroidal melanoma

How plaque radiation distribution shifts
Graphic demonstrates how plaque radiation distribution shifts along with tumor position (note an increased dose to the macula in treatment of a posterior choroidal melanoma).

The relative radiation distribution of proton versus plaque radiation
Graphic of the relative radiation distribution of proton versus plaque radiation for a posterior T2:medium sized choroidal melanoma

Iridociliary melanoma
Iridociliary melanoma before (left) and after (right) palladium-103 plaque radiation therapy

Iridociliary melanoma
Iridociliary melanoma 10-years after palladium-103 plaque radiation therapy

Iridociliary melanoma
Iridociliary melanoma 7.5 years after palladium-103 plaque radiation therapy

Iris Bombe
Iris Bombe- Neovascularization, posterior synechiae and secondary glaucoma can occur after irradiation for choroidal melanoma.

Notched COMS plaque
Notched COMS plaque with side wall (Posterior Aspect)

Palladium-103 seeds
Palladium-103 seeds - "Theraseed" - Promotional image

Palladium-103 seeds
Palladium-103 seeds - Note they are the same size as iodine-125 seeds but have flattened ends.

Plaque radiation therapy
Graphic of plaque radiation therapy in treatment of a T2:medium-sized posterior choroidal melanoma

Proton beam radiation therapy
Proton beam radiation therapy Eyelash loss, iris neovascularization, dry eye and cataract as can be seen after proton beam radiation therapy.

Proton radiation therapy
Graphic of proton radiation therapy in treatment of a T2:medium-sized posterior choroidal melanoma

Radiation associated posterior subcapsular (PSC) cataract
Radiation associated posterior subcapsular (PSC) cataract - This unilateral cataract was seeen after iodine-125 plaque radiation therapy.

Radiation blocking glasses
Radiation blocking glasses (lateral view) can be used instead of a lead patch during low energy plaque radiation therapy.

Radiation blocking glasses
Radiation blocking glasses containing lead glass can be worn during plaque therapy.

Radiation effects
Radiation effects on the posterior segment of the eye include: T= regressed tumor, CRA = choroiretinal atrophy, G= ghost vessels, S= sheathed vessels, IRMA=intraretinal microangiopathy, RON=radiation optic neuropathy

Radiation optic neuropathy
Radiation optic neuropathy - Fundus photograph demonstrates hemorrhagic variant.

Ruthenium-106 plaque in a lead pig

Scleral necrosis seen after ruthenium
Scleral necrosis seen after ruthenium -106 plaque radiation therapy for an anterior choroidal melanoma- An unusual complication.

USC-style gold plaque
A USC-style gold plaque with grooves to aid (standardize) seed placement.

Irregularly shaped uveal melanoma
Transillumination shadow from a irregularly shaped uveal melanoma

Pathology: Exenteration Specimens

Posted on May 9, 2016

Squamous Carcinoma
Note the epibulbar tumor nodule (top, right arrow) and choroidal tumor (arrows)

Pathology Slides

Posted on May 9, 2016

Adenocarcinoma of the retinal pigment epithelium
Adenocarcinoma of the retinal pigment epithelium wth focal invasion of the choroid.

Adenoid cystic carcinoma

Capillary hemangioma specimen from a child.

Choroidal melanoma
Choroidal melanoma - Histopathology reveals the sclerostomy (arrow) through which the retrobulbar melanoma was formed.

Choroidal Melanoma
Choroidal Melanoma - As many as 50% of choroidal melanomas are thought to invade the sclera (arrows).

Choroidal melanoma of the optic nerve
Choroidal melanoma of the optic nerve - This circumpapillary melanoma has grown as to cover and extend into the optic nerve.

Choroidal Nevus Histopathology
Choroidal Nevus Histopathology - Courtesy of Tatyana Milman, MD

Epibulbar Oncocytoma

Gross pathologic specimen
Gross pathologic specimen - Section of an eye with a choroidal melanoma.

Iris Melanocytoma
Iris Melanocytoma - bleached iridectomy specimen

Iris Melanoma
Iris Melanoma - HIstopathology reveals full thickness invasion of the iris stroma by melanoma cells.

Iris Melanoma
Iris Melanoma - Diffuse melanoma with invasion of the iris stroma and trabecular meshwork.

Kaposis sarcoma histology
Kaposis sarcoma histology - The tumor is almost entirely composed of blood vessels.

Lacrimal Gland Choristoma
Lacrimal Gland Choristoma - Histopathology images courtesy of Tatyana Milman, MD.

Pathology Slides
Pathology Slides - Retinoblastoma- Homer-Wright rosettes II (Courtesy of Tatyana Milman, MD)

Patient with known metastatic breast cancer presents with bilateral conjunctival metastases.

Retinoblastoma
Retinoblastoma - Tumor induced iris neovascularization stands as evidence of secondary neovascular glaucoma (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Homer Wright Rosettes (arrows). Pseudorosettes formed by the arrangement of tumor cells around an area of fibrillarity, evidence of neuroblastic differentiation in a retinoblastoma (Courtesy of Tayana Millman, MD).

Retinoblastoma
Retinoblastoma - High power histopathology reveals tumor invasion (arrows) into the optic nerve (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Retinoblastoma - low power histopathology reveals tumor invasion (arrows) into the optic nerve (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Retinoblastoma- This retinoblastoma seed is seated below the retinal pigment epithelium, but does not extend into the subjacent choroid (Courtesy of Tatyana Millman, MD)

Retinoblastoma
Retinoblastoma- This slide demonstrates an area of relatively undifferentiated clumps of retinoblastoma cells (Courtesy of Tatyana Millman, MD)

Retinoblastoma with intratumoral calcifications (arrows).

Ring Melanoma
Hematoxylin and eosin composite demonstrates malignant melanoma in the ciliary body and on the iris surface (Courtesy of Tatyana Millman, MD)

Sarcoidosis
Sarcoidosis - Iris tumor- iridectomy specimen

Squamous carcinoma of the conjunctiva
Squamous carcinoma of the conjunctiva - Note the tumor is invading the cornea and sclera.

Squamous carcinoma of the conjunctiva
Squamous carcinoma of the conjunctiva (T) with intraocular invasion (arrows)

Wilm`s Tumor

Orbitotomy Images

Posted on May 9, 2016

Two years after left lateral orbitotomy surgery

Orbital Tumors

Posted on May 9, 2016

Adenoid cystic carcinoma of the lacrimal gland
Adenoid cystic carcinoma of the lacrimal gland (arrow).

Capillary hemangioma of childhood

orbital extension of retinoblastoma
Clinical photograph of a child with orbital extension of retinoblastoma.

Ethmoidal mucocele (M) displacing the optic nerve
Magnetic resonance imaging (MRI) demonstrates an ethmoidal mucocele (M) displacing the optic nerve.

Intraconal orbital hemangioma
Intraconal orbital hemangioma - A relatively large tumor seen on axial and coronal CT images.

Nasal orbital lymphoma with subcutaneous extension
Magnetic resonance imaging (T2), demonstrates an nasal orbital lymphoma with subcutaneous extension (arrows).

Optociliary shunt vessels
Optociliary shunt vessels induced by an optic nerve sheath meningioma.

Orbital lymphangioma
Orbital lymphangioma that invades the upper lid and has subconjunctival lymphangiectasias

Orbital lymphoma
Orbital lymphoma 6 months after external beam radiation therapy (arrow)

Orbital lymphoma before radiation therapy (T)

Orbital Sarcoid
Orbital Sarcoid - primarily involving the lacrimal gland

Sclerosing pseudotumor
Sclerosing pseudotumor - Note the periorbital edema (arrow) and epibulbar infiltration.

Subcutaneous capillary hemangioma
Subcutaneous capillary hemangioma can cause bluish discoloration of the eyelid

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