Tuberculosis of the choroid : perforation of the sclera ; extension posteriorly with involvement of the optic nerve ; histological and bacteriological examination of the specimen / by G. E. de Schweinitz and E. A. Shumway.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: Tuberculosis of the choroid : perforation of the sclera ; extension posteriorly with involvement of the optic nerve ; histological and bacteriological examination of the specimen / by G. E. de Schweinitz and E. A. Shumway. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    section which passed through the scleral perforation, the center of the cornea and the optic nerve. Microscopically the e.ye showed a tumor mass in the position of the choroid, which was 4 ram. thick at the posterior pole, and extended well forward both above and below. It was non-pigmented, and presented in many respects the appearance of a glioma of the retina. The optic nerve was thickened to a diameter of 10 mm. and was evidently destroyed by the growth. The opening in the sclera noted in the clinical history was 3 mm. wide and located 3 Txim. back of the attachment of the ciliary muscle; no trace of the retina could be found. The lens was pushed forward so that the iris was in contact with the cornea; the latter showed evidence of previous ulceration. (Fig. 1.) Microscopical examination of the celloidin sections show the character of the tumor to be that of a conglomerate tubercle, which has had its origin in the choroid coat. Considerable portions of the tissue have undergone necrosis and contain no formed elements; in other places there are fragments of cell nuclei and granular detritus which stain with the hematoxylin, and great numbers of typical tubercular giant cells, with their nuclei arranged about the periphery of the cell bodies. At the margin of the tumor there are masses of round cells, which stain well and with them the usual epithelioid cells. All traces of the choroid coat have disappeared, with the exception of the pigment cells; the mass extends forward as far as the ora serrata below and to a point 3 mm. back of the ora above. In the center of the growth the blood vessels have been completely destroyed, while in the less necrotic portions they show thickening and hyalin degeneration of their walls, with obliteration of their lumens by the grow^th of the lining endothelial cells. The sclera is invaded, and at vhe point of perforation its struc- ture has disappeared, the lips of the opening being filled with necrotic tissue. Posteriorly a similar perforation has just taken place, and an extra-scleral nodule may be seen alongside the nerve. The retina is detached and passes forward as a disorganized membrane from its attachment at the ora serrata to the postei-ior surface of the lens. The optic nerve is enormously thickened, and replaced by a necrotic mass in which no nervoug elements can be found.