title: New insights into the development of infantile intraocular medulloepithelioma.
abstract: OBJECTIVE
  To define the maturational sequence of 3 infantile intraocular medulloepitheliomas.
  
  
  METHODS
  Retrospective clinicohistopathologic and immunohistochemical study.
  
  
  METHODS
  Immunoreactivity of paraffin sections for CRX (cone-rod homebox transcription factor) and NeuN (biomarker for neuronal differentiation) were investigated together with other biomarkers, including S100, glial fibrillary acidic protein, epithelial membrane antigen, and various cytokeratins.
  
  
  RESULTS
  Three infants (aged 1, 6, and 8 months) had iris neovascularization, 2 had anterior ciliary body tumors, and 1 a posterior tumor associated with a retinochoroidal coloboma. Each tumor displayed a premedullary monolayer of cuboidal epithelium that was S100(+), NeuN(-), and CRX(-) and that transitioned into a multilaminar medullary epithelium forming neurotubules with adluminal cells that were CRX(+). NeuN first appeared in ablumenal neurotubular cells in 1 tumor and was also discovered among neuroblast-appearing cells in another. The third tumor associated with a coloboma was CRX(-) and NeuN(-).
  
  
  CONCLUSIONS
  A simple premedullary epithelial monolayer appears to be the fundamental source for the tumor and its multilaminar medullary epithelium. CRX(+) and NeuN(+) cells within the multilayered medullary layer approximate expression patterns similar to those found in retinal development and differentiation. Discovery of these biomarkers in the neoplastic ciliary epithelium in a small number of tumors indicates preliminarily that the most anterior layers of the optic cup have a retained retinal and neuroglial differentiation potentiality. The third case was CRX(-) and NeuN(-) and possibly arose from embryonic pigment epithelium at the edge of the retinochoroidal coloboma. These immunohistochemical findings offer histogenetic and potential diagnostic insights.
authors.affiliation: David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address: Fred_Jakobiec@meei.harvard.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Jakobiec
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Danielle
authors.initials: D
authors.lastname: Trief
authors.affiliation: David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alia
authors.initials: A
authors.lastname: Rashid
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Rose
authors.affiliation: Department of Ophthalmology, University of California Medical School, Irvine, California.
authors.forename: Don
authors.initials: D
authors.lastname: Minckler
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Children's Refractive Service, Children's Hospital, Boston, Massachusetts.
authors.forename: Deborah
authors.initials: D
authors.lastname: Vanderveen
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shizuo
authors.initials: S
authors.lastname: Mukai
mesh_terms: D034961:Antigens, Nuclear / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D002829:Choroid / Q000002:abnormalities; D002924:Ciliary Body / Q000378:metabolism / Q000473:pathology*; D003103:Coloboma / Q000473:pathology; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D007231:Infant, Newborn; D007633:Keratins / Q000378:metabolism; D008297:Male; D018396:Mucin-1 / Q000378:metabolism; D009419:Nerve Tissue Proteins / Q000378:metabolism; D018242:Neuroectodermal Tumors, Primitive / Q000378:metabolism / Q000473:pathology*; D012160:Retina / Q000002:abnormalities; D019572:Retinal Neoplasms / Q000378:metabolism / Q000473:pathology*; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D015534:Trans-Activators / Q000378:metabolism; D014604:Uveal Neoplasms / Q000378:metabolism / Q000473:pathology*
chemical_list: D034961:Antigens, Nuclear; D014408:Biomarkers, Tumor; D005904:Glial Fibrillary Acidic Protein; D018398:Homeodomain Proteins; D018396:Mucin-1; D009419:Nerve Tissue Proteins; D009418:S100 Proteins; D015534:Trans-Activators; C109288:cone rod homeobox protein; C506808:neuronal nuclear antigen NeuN, human; D007633:Keratins