1. 2013-2014 2 nd circulation Dr HS Mudhar and Dr l Irione.

2. Number of returns 26

3. Case 1 H13.11805 F 63 Left cornea; and anterior chamber infection.

8. Case 1 responses Amoebic/acanthamoebic keratitis: 23 Acute keratits (gram and PCR for viral infection): 1 Acute keratitis ?amoebic?fungal (fungal stains, giemsa,iron heamatoxylin) 1 Acute keratitis (gram, grocott) 1 ORIGINAL ANSWER:ACANTHAMOEBA KERATITIS

9. Case 2 H13.19069 Left canaliculitis

13. Case 2 responses Actinomyces +/-dacryolith 20 Mycetoma likely actionomyces 1 Fungal infection possibly actino (gram grocott pas) 1 Organism fungal? Actino? (grocott, pas gram). 1 Dacryolith organism? (DPAS, gram) 1 Splendore Hoeppli phenomenon (grocott gram) 1 Mycetoma-acute canaliculitis 1 ORIGINAL ANSWER: GRAM POSITIVE FILAMENTOUS BACTERIA CONSISTENT WITH ACTINOMYCES

14. Case 3 40257/13 M55 Vitreous opacities-cell block prep of vitreous

17. Case 3 responses Asteroid hyalosis 20 50:50 asteroid v amyloid (appropriate specials mentioned to distinguish) 1 Asteroid 70%: Amyloid 30% 1 No answer 1 Silicone oil from vitrectomy 1 Proteinaceous exudate (clinical correlation and PAS) 1 Morgagnian droplets from ruptured liquefied degeneration of lens cortex 1 ORIGINAL ANSWER: ASTEROID HYALOSIS

18. Case 4 30590/13 F10 Pigmented lesion bulbar conjunctiva getting larger

23. Case 4 Benign neavus (inflammation, juvenile, cyst 23 Spitz naevus1 benign conj adenoma/hyperplasia or benign conj myoepithelial adenoma/hyperplasia (immuno for keratins and S100)1 squamous cell papilloma1 ORIGINAL ANSWER:INFLAMED JUVENILE COMPOUND MELANOCYTIC NAEVUS (?BACKGROUND OF ALLERGY AS EOSINOPHILS PRESENT)

24. Case 5 24103/13 M45 ITU patient developed ‘hot’ eye. No previous ocular trauma or surgery. Vitreous biopsy. MST

26. Case 5 Fungal infection/vitritis/endophthalmitis ? Aspergillus12 Fungal vitritis /endophthalmitis (liaise with microbiology for species) 5 Mycosis1 Candida infection 2 Fungal infection? Mucor2 Aspergillosis1 Invasive fungal infection-aspergillosis 1 Aspergillus infection of choroid1 Fungal emboli1 ORIGINAL ANSWER:ACUTE FUNGAL ENDOPHTHALMITIS OF ENDOGENOUS TYPE

27. Case 6 D13/087761 F50 Firm lesion on right lower lid. Noticeably increasing in size over 2 months, PMH breast ca. On tamoxifen.

30. Case 6 responses Met breast ca (signet rings/lobular) 19 Met breast ca (90%) exclude skin primary1 Adeno ca presume met likely from breast1 Lipogranuloma-chalazion1 Met breast ca (70%) v primary adnexal tumour (30%)-immuno panel 1 Invasive ca likely breast primary or from other organ sites (immuno panel)2 Met signet ring ca (immuno-compare with original histology and immuno panel)1 ORIGINAL DIAGNOSIS:METASTATIC BREAST CARCINOMA

31. Case 7 D13/89250 Malignant lesion on eyelid. Clinical diagnosis BCC.

34. Case 7 responses Malignant melanoma (with naevus)22 Malignant neoplasm-malignant melanoma 1 Naevus 50%: melanoma 50% refer to skin patholgist 1 Malignant melanoma (need to exclude carcinoma-immuno panel)1 Epithelioid tumour (melanoma 80% met ca 20%-immuno panel)1 ORIGINAL ANSWER:NODULAR MALIGNANT MELANOMA

35. Case 8 2776/13 M69 Incidental finding on CT: mass over orbital floor. Profuse bleeding during surgery

38. Case 8 responses Vascular anomoly/malformation12 Angioma/Haemangioma (cavernous)12 Cirsoid aneurysm4/angiolipoma4/haemagioma1/cav haemagioma11 Angiolipoma 1 ORIGINAL ANSWER: VASCULAR MALFORMATION

39. Case 9 2415/13 F32 left limbal dermoid

41. Case 9 responses Limbal dermoid/choristoma21 Collagenous fibroma1 Fibrolipoma1 Dermolipoma1 Keloid1 Connective tissue naevus1 ORIGINAL ANSWER: LIMBAL CONJUNCTIVAL DERMOID

42. Case 10 M10893/13 M27 right lamellar keratoplasty for corneal dystrophy (bilateral).

45. Case 10 responses Macular corneal dystrophy17 Corneal mucopolysaccharide deposition (macular dystrophy favoured over systemic) 3 Macular 80%-:Schyder 10%:crystalline 10% (special stains) 1 Dystrophy 50%exogenous material (50) connective tissue stains, history, PAS 1 Looks like lipid deposition, given age most likely Schnyder corneal dystrophy (80); macular dystrophy (10); fleck dystrophy (10); oil red O, sudan black, alcian blue, colloidal iron, clinical correlation1 Odd manifestation of macular; something lipid like Schnyder; clinical information; AB; Oil red O 1 Schyner corneal dytrophy; clinical apperance, genetics, family history 1 Keratoconus (PAS, masson trichrome, congo red, EVG)1 ORIGINAL ANSWER: Mucopolysaccharidosis / macular corneal dystrophy