7. PATH Eye Flashcards
What is the MCC of uni or bilateral exopthalmos due to enlargement of the extraocular muscles with nongranulomatous inflammation, increased glycosaminoglycans and endomysial fibrosis?
Thyroid Dz: Graves orbitopathy
In Graves dz extraocular muscles are enlarged in size but the tendons of the muscles and adipose are NOT inflammed/ enlarged as compared to a pseudotumor (idopathic orbital inflammation) which the opposite occurs. Complications of proptosis/exopthalmos includes corneal complications due to excessive exposure as well as what?
Vision loss due to compression of the optic N
What inflammation morphology of the eye is characterized by chronic inflammation and fibrosis, where the orbital fat is replaced by fibrosis, with the inflammatory infiltrate consisting of lymphocytes, plasma cells, and occasionally eosinophils?
Idiopathic orbital inflammation
also necrosis+degenerating collagen w vasculitis = wegener granulomatosis
What is a systemic dz with granulomatous uveitis and sympathetic ophthalmia, may produce bilateral granulomatous inflammation secondary to penetrating injury, ‘Mutton fat’ is keratic ppt in the anterior segment and candle wax drippings see on opthalmic exam which is perivascular inflammation of the retina?
Sarcoidosis
What is the MC malignant tumor of periocular skin (eyelid), 15-40X greater than squamous cell carcinoma, seen in younger patients with lots of sun exposure, more common in the lower eyelid> inner canthus > upper lid > outer canthus, nests of basaloid cells that show peripheral palisading of nuclei*?
Basal Cell Carcinoma BCC
Basal Cell Carcinoma BCC is typically nodulo-ulcerative containing pearly nodules, telangiectatic vessels, central ulcer (rodent ulcer) and rolled edges, with morpheaform which is cords/tendrils of tumor cells embedded in densely fibrotic stroma, widely and deeply infiltrative..aka as Blue and Below- which means what?
large masses (blue colored on histo) below the epidermis
Note: SCC has keratin pearls and is more pink colored
What carcinoma is as common as SCC of the eyelid, seen in >40yo asian women, 2/3 are in the UPPER eyelid and meibomian gland and has a masquerade syndrome known as unilateral keratoconjunctivitis unresponsive to therapy, intraepithelial spread of tumor cells replaces conjunctival epithelium in a pagetoid or bowenoid fasion?
Sebaceous Carcinoma
(form a focal mass that mimics chalazion- result from a granulomtous response where lipid extravasates into surrounding tissue/ lipogranuloma)
Sebaceous Carcinoma has larger nuclei with increased pleomorphism, and more hyperchromatic and more atypical than BCC, comedocarcinoma = necrotic centrally, can met to LN, lung, liver brain and skull, tumor mortality is 15%, +EMA (epithelial membrane antigen), focally + BRST1, P16 highlights pagetoid cells, what is a stain that tests positively for fat on frozen section?
Oil Red O Fat Stain +
*NOTE: well differentiated with vacuolization of the cytoplasm (foamy)
What submucosal elevation of the conjuctiva which is benign, results from sun exposure (actinic damage) and appear at the interpalpebral fissure, formed by growths of fibrovascular connective tissue that migrates onto the cornea, dissecting into the plane normall occupied by the bowmen layer resulting in a corneal scar- does not pose a threat to vision?
Pterygium ***in cornea may cover eye
What is a small yellowish submucosal elevation of the conjuctiva which is benign, has thin epithelium (hyperplastic or dysplastic) with fragmented stromal collagen and basophilic degeneration (elastic degen), due to sun exposure and typically originate NEXT to cornea- not involving it?
Pinguecula **next to
A freckle is increased melanin within basal keratinocytes, melanocytes normal in # but may be slightly enlarged. What is a linear non-nested melanocytic hyperplasia restricted to the basal cell layer?
Lentigo
Nevus are melanocytes that become round and grow in aggregates of nests. Junctional nevi are epidermal nests ALONG THE dermoepidermal junction, compound nevi is when junctional grows INTO underlying dermis as nests/cords, what nevi is when the epidermal nests are completely lost?
Intradermal Nevi
Nevi are uniform, with round nucleui, inconspicuous nucleoli w no mitotic activity
What kind of nevi are of the eye and are common, rarely invade the cornea or appear in the fornix or over the palpebral conjunctiva, the pigmented zones most likely represent melanoma or melanoma precursors?
Conjuctival Nevi
What is the MC intraocular tumor in adults via metastasis to the eye, uvea is the MC PRIMARY intraocular tumor in adults accounting for 5% of US cases, GNAQ and GNA11 are the MC uveal type, morphologically see spindle/fusiform, if epithelioid type- is spherical, greater atypia and a WORSE prognosis?
Melanoma/ Uveal melanoma
uvea consists of iris, choroid and ciliary body
Uveal Melanoma usually has large nuclei and prominent nucleoli with infiltrating plasma cells and lymphs, it first spreads to the liver, 80% 5 yr / 40% at 10yr, there is no difference in survival between enucleation vs. eye sparing XRT, what melanoma cells are associated with an adverse outcome?
Epithelioid melanoma cells
The corneal tissue is stained by PAS to highlight basement membranes, has 3 layers including epithelium, bowmans layer and the stroma (inner most), a thin PAS+ basement membrane separates the epithelium from the bowman layer - which is acellular, on the inside of the cornea, stroma continues and transitions to what PAS + membrane, which is then next to the cornea endothelium?
PAS+ Descemet membrane
layers outside to in: epithelium, bowmans, stroma, descemet membrane, endothelium
Corneal stroma lacks blood vessels and lymphatics which contributes to its opacity and lack* of rejection, during transplant the risk of graft rejection increases with stromal vascularization and invasion, non-immunologic rejection (ie: loss endothelial cells/subsequent corneal edema) is more common than immunological, what may accompany chronic corneal edema, inflammation and scarring?
Corneal Vascularization - tx/prevent with VEGF antagonists
Myopia is when the eye is too long for its refractive power- image falls in front of the retina = short sightedness- can see near not far.. What occurs when the eye is too short for its refractive power and the image falls behind the retina causing far sightedness in which a person can see far but not near?
Hyperopia
MC infections of the eye are staphylococcus aureus, strep pneumo, pseudomonas, and enterobacteriaceae, PMNs and necrotic debris, gram stain but culture is MOST accurate, What keratitis is the MC with dendrite- linear arborizing pattern of opacification and swelling of epithelial cells, giemsa reveals intranuclear viral inclusions, infected cells may coalesce to form multinucleated giant cells, chronic stromal keratitis leads to ulceration and scarring,and it can cause a granulomatous reaction at descemets membrane (hallmark) when full thickness involved?
Herpes Simplex Virus Keratitis
histo: cornea is thin and scarred w increased # of fibroblast nuclei
What are lenticular opacities that may be congenital or acquired, with risk factors including DM*, wilsons, atopic dermatitis, drugs, radiation and trauma, can be age related typically resulting from opacification of the lens nucleus = nuclear sclerosis and can render the nucleus brown to distort the patients perception of blue?
Cataract (anterior segment)
Migration of the lens epithelium posterior to the lens equator may result in posterior subscapular cataract secondary to enlargement of abnormall positioned lens epithelium, if the lens cortex liquifues nearly entirely, it is a condition known as?
Morgagnin (hypermature) cataract
What type of glaucoma is a secondary open angle glaucoma where high molecular weight proteins can leak through the lens capsule (known as phacolysis), these proteins can clob the trabecular meshwork and contribute to elevation in IOP and optic nerve damage?
Phacolytic Glaucoma
Glaucoma is a collection of diseases with distinctive changes in the visual field and in the cup of the optic nerve, most are assoc with elevated intraocular pressure, the aqueous humor from posterior to anterior chamber drains thru trabecular network into canal of schlemm, what kind of glaucoma is when the peripheral zone of the iris adheres to the trabecular meshwork and physically impedes the egress of humor from the eye?
Angle-closure glaucoma (closed-angle)
Open angle glaucoma is where aqueous humor has complete open access to the trabecular meshwork but there is resistance to outflow causing IOP. Primary open angle is MC form, MYOC (myocilin) gene mutations for juveniles and adults, some adults with OPTN (optineurin) mutation instead, secondary open angle MC type is what, which is due to deposition of fibrillary material throughout anterior segment- *LOX1 gene?
Pseudoexfoliation
LOX= lysyl oxidase like 1 gene, also deposits seen in vessels, CT, liver kidney and GB
