Recent advances in pathology as applied to orbital biopsy. Practical considerations

Advances in pathology allow for more specific diagnoses of orbital disease. The authors discuss the value of awareness of advances in cytology, histochemistry, immunohistochemistry and electron microscopy as applied to orbital disease. Modern cytologic technique can aid in clearer visualization of cellular detail with improved diagnosis of thin needle aspiration biopsies. Histochemistry offers an increasing range of methods for identification of cellular and extracellular substances such as amyloid, fibrin, neuroglia, and collagen. Immunohistochemistry allows for identification of an ever-increasing number of component antigens including immunoglobulins, myoglobins, keratin, glial fibre protein, etc. Electronmicroscopic technique including plastic embedding allow for specific identification of lesions based on subcellular components and characteristic nuclear, cytoplasmic, membrane, basement membrane and stromal components. The value of these methods has been demonstrated with case presentations of "small round cell tumors" of the adult and child. In addition, the pathologic diagnosis of several rare lesions of the orbit including neuroendocrine carcinoma, histiocytosis X, simultaneously occurring poorly differentiated mucoepidermoid carcinoma of lacrimal gland and adenocarcinoma of the prostate are demonstrated to underline the advances in technology. Emphasis is placed on the management of biopsy material to maximize diagnostic potential.