Prenatal Detection of Orbital Rhabdomyosarcoma

tures of keratic precipitates during intraocular inflammation. To our knowledge, the use of IVCM to describe conjunctival pathological characteristics has not previously been reported. The human conjunctiva is an excellent tissue to examine using the confocal microscope because it is semitranslucent and the underlying vessels and cellular structures are easily accessible. The histopathological features of conjunctival sarcoid granulomas are well described and often used to confirm the diagnosis of sarcoidosis. Conjunctival biopsy can be used as a diagnostic tool when the diagnosis of sarcoidosis is suspected. Nichols et al showed that in patients with biopsyproven sarcoidosis from other sites conjunctival biopsy results were positive in 55%. Karcioglu and Brear reportedpositiveconjunctivalbiopsy results in 71% of patients in this same group. Interestingly, they also found a 29% positive biopsy rate in patients with suspected sarcoidosis. There is some difficulty when comparing IVCM images and stained histopathological slides. We therefore used IVCM on unstained, sectioned tissue to delineate the confocal appearance of MGCs. This allowed us to directly compare the images captured on IVCM with the histopathological features seen on light microscopy. Our case illustrates that a noninvasive procedure, IVCM, can visualize the markers of granulomatous inflammation in a patient with a known diagnosis of sarcoidosis, allowing MGCs and granulomas to be imaged without harm to the patient. In this case, we performed a conjunctival biopsy to confirm and establish the validity of these initial and novel IVCM images. Further study is required, especially in patients with known sarcoidosis without grossly visible conjunctival nodules. We surmise that the confocal microscope, as with conjunctival biopsy, may be able to detect MGCs and granulomas in these patients before the nodules become clinically apparent. With further validation, we believe that IVCM someday may be used similarly to histopathological diagnosis as a useful clinical adjunct to confirm the diagnosis of sarcoidosis in individuals with a suspicious history and examination results, without the morbidity of an invasive procedure.