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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 848-849

Field emission scanning electron microscopy study of orbital venous malformation


1 Department of Uvea, Ocular Pathology and Neuro-ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Oculoplasty, Cataract and Refractive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
3 Centre for Nanotechnology and Department of Chemical Engineering, Indian Institute of Technology, Guwahati, Assam, India
4 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
5 Department of Ocular Pathology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission16-Apr-2021
Date of Acceptance13-Jun-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Dipankar Das
Senior Consultant and HOD: Uveitis-Ocular Pathology Services, Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, 96 Basistha Road, Beltola, Guwahati - 781 028, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_880_21

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  Abstract 


Keywords: Malformation, orbitotomy, proptosis, venous


How to cite this article:
Das D, Bhattacharjee K, Maity S, Deshmukh S, Raichura R, Garg M, Deka A. Field emission scanning electron microscopy study of orbital venous malformation. Indian J Ophthalmol Case Rep 2021;1:848-9

How to cite this URL:
Das D, Bhattacharjee K, Maity S, Deshmukh S, Raichura R, Garg M, Deka A. Field emission scanning electron microscopy study of orbital venous malformation. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 28];1:848-9. Available from: https://www.ijoreports.in/text.asp?2021/1/4/848/327711



Venous malformations (VMs) can present in eye and adnexa.[1],[2],[3],[4],[5] Very recently, these anomalies have been classified based on a number of criteria.[1],[2],[3],[4],[5]

A 40-year-old Indian male presented with proptosis in the left eye (OS). It was gradual progressive in nature. There was no orbital or ocular pain. There was no complaint of diplopia or diminution of vision. On physical examination, there was no local heat, tenderness, or thrill felt on palpation over the proptosed area. Fundus examination was within normal limits. Magnetic resonance imaging in sagittal scan of the brain and orbit showed a well-defined, lobulated, moderately heterogeneous contrast-enhanced lesion with intraconal portion of the left orbit having adjoining mass effect, which was suggestive of benign intraconal VMs [Figure 1]. Blood investigations were normal. Left-sided lateral orbitotomy was carried out under general anesthesia with proper consent. The specimen measured 24.3 × 20.1 × 18.6 mm and was bluish-black in color [Figure 2]a. The cut section of the lesion showed large blood filled cavities [Figure 2]b. Microscopic appearance of the lesion showed capsule with numerous engorged blood vessels lined by endothelial cells with intervening fibrous septas [Figure 3]a. A portion of the lesion was subjected to field emission electron microscopy (FESEM) study which showed characteristic endothelial cells studded over the wall of the blood vessels [Figure 3]b.
Figure 1: Magnetic resonance imaging (MRI) of the brain and orbit in sagittal view in T1-weighted image showing a well-defined, lobulated, moderately heterogeneous contrast-enhanced lesion with numerous thin hypointense incomplete septae in intraconal portion of the left orbit having adjoining mass effect suggestive of benign intraconal VMs

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Figure 2: (a) Gross photograph of the bluish black colored specimen measuring 24.3 × 20.1 × 18.6 mm. Surface vascularity were noted over the capsule. (b) Cut section of the lesion showed large blood filled spaces. They were enhanced grossly by putting a drop of 95% alcohol over the raw area.

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Figure 3: (a) Microscopic appearance of the lesion with numerous engorged blood vessels lined by endothelial cells and intervening fibrous septas (H and E, ×40). (b) Field emission electron microscopy picture of characteristic endothelial cells studded over the wall of the blood vessels (×8000).

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  Discussion Top


VMs are composed of abnormal collection of veins that have variable luminal wall thickness, size, and can be superficial or deep.[1],[2],[3],[4],[5] VMs were previously called as cavernous hemangiomas.[1],[2],[3] These are classified under slow flow lesion category by International Society for the Study of Vascular Anomalies.[1] These anomalies are common in the orbit and seen in the third to sixth decade of life.[3],[4],[5] By FESEM observations, we could see that endothelial cells were normally spaced without any irregularity and sprouting.[4] Tumor endothelial cells did not show great variations unlike the observations made by author (s) in 2016 by compound microscopy study.[4]

This case is first of its kind in the literature to document the FESEM features of orbital VM.

Acknowledgement

The authors would like to thank:

  1. Prof. Panna Deka, MD;
  2. Prof. Dipankar Bandyopadhyay, PhD, Centre for Nanotechnology and Department of Chemical Engineering, Indian Institute of Technology Guwahati, Assam, India; and
  3. Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has/have given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
International Society for the Study of Vascular Anomalies. Classification. Available from: https://www.issva.org/classification. [Last accessed on 2021 Apr 15].  Back to cited text no. 1
    
2.
Mulliken JB. Diagnosis and natural history of haemangiomas. In: Mulliken JB, Young AE, editors. Vascular Birthmarks: Haemangiomas and Vascular Malformations. 2nd ed. Philadelphia: W. B. Saunders; 1988. p. 41-62.  Back to cited text no. 2
    
3.
Mulligan PR, Prajapati HJ, Martin LG, Patel TH. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 2014;87:20130392.  Back to cited text no. 3
    
4.
Das, D, Bhattacharjee K, Deka P, Bhattacharjee H, Misra DK, Koul A, et al. An interesting case of angiogenesis in cavernous hemangioma. Indian J Ophthalmol Case Rep2016;64:783-5.  Back to cited text no. 4
    
5.
George A, Mani V, Noufal A. Update on the classification of hemangioma. J Oral Maxillo fac Pathol 2014;18(Suppl 1):S117-20.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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